Indian Income Tax Return

INDIAN INCOME TAX RETURN
[For Individuals and HUFs not having income from profits and gains of business or Assessment
ITR2 profession] Year
(Please see Rule 12 of the Income-tax Rules, 1962) 2021 - 22
(Please refer instructions)
First Name Middle Name Last Name PAN

SURESH SAKHARAM GORIVALE ACEPG8688C
Flat/Door/Block No. Name of Premises/Building/Village
✔ Individual
B/3 ROOM NO 501 5TH FLR LAXMIWADI DR BABASAHEB AMBEDKAR ROAD
HUF
LAXMIMATA CO OP KALACHOWKI
Road/Street/Post Office
Mumbai
Date of Birth/ Formation (DD/MM/YYYY) 28/08/1955
Area/locality Aadhaar Number (12 digit) / Aadhaar Enrolment Id (28 digit) (if eligible for Aadhaar)
MUMBAI MUMBAI 3xxx xxxx 9951 /
State
Town/City/District 19-Maharashtra Pin code/Zip code
Kalachowki S.O Kalachowki S.O Country 400033
91-India
Residential/Office Phone Number with STD/ISD code/ Mobile No. 1 Mobile No. 2
9869145916 9326445419
Email Address-1 (self) Email Address-2
[email protected] [email protected]
✔ 139(1)-On or before due date, 139(4)-After due date, 139(5)-Revised Return,
Filed u/s (Tick)[Please see instruction ]
(a) 92CD-Modified return, 119(2)(b)-after condonation of delay.
Or Filed in response to notice u/s 139(9), 142(1), 148, 153A, 153C
Are you opting for new tax regime u/s 115BAC ? Yes ✔ No
Are you filing return of income under Seventh proviso to Section 139(1) – (Tick) Yes ✔ No
(b)
If yes, please furnish following information
Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more current
(bi) account during the previous year? (Yes/No) 0
Yes No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for
(bii) travel to a foreign country for yourself or for any other person? (Yes/No) 0
Yes No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on
(biii) consumption of electricity during the previous year? (Yes/No) 0
Yes No
If revised/defective/modified, then enter Receipt No.

(c)
and Date of filing original return (DD/MM/YYYY)
If filed, in response to a notice u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b) enter unique number/
(Unique
(d) Document Identification Number (DIN) and date of such notice/order, or if filed u/s 92CD, enter date of advance
Number)
pricing agreement
You were in India for 182 days or more during the previous year
[section 6(1)(a)]
A. Resident You were in India for 60 days or more during the previous year, and
have been in India for 365 days or more within the 4 preceding years
[section (6)(1)(c)] [where Explanation 1 is not applicable]
You have been a non-resident in India in 9 out of 10 preceding years

[section 6(6)(a)]
B. Resident but not Ordinarily
Resident You have been in India for 729 days or less during the 7 preceding
years [section 6(6)(a)]
Residential Status in India (for You were a non-resident during the previous year.
individuals) (Tick applicable Whether you were a resident of any jurisdiction (Yes/No)
(e) option) If yes,
(i)Please specify the jurisdiction(s) of residence during the previous
year -
S. Jurisdiction(s) of Taxpayer Identification Number

C. Non-resident No residence (s)
(ii) In case you are a Citizen of India or a Person of Indian Origin (POI),
please specify -
Total period of stay in India

Total period of stay in India during
during the previous year (in
the 4 preceding years (in days)
days)
Residential Status in India (for ✔

D. Resident Resident but not Ordinarily Resident Non-resident
HUF) (Tick applicable option)
(f) Do you want to claim the benefit under section 115H? (applicable in case of resident) Yes ✔ No
(g) Are you governed by Portuguese Civil Code as per section 5A? Tick) Yes ✔ No (If “YES” please fill Schedule 5A)
Whether this return is being filed by a Representative Assesse? Yes ✔ No

If yes, please furnish following information -
(1) Name of the representative

(h)
(2) Capacity of the Representative (drop down to be provided)
(3) Address of the representative
(4) Permanent Account Number (PAN)/ Aadhaar of the representative /
Whether you were Director in a company at any time during the previous year? (Tick) Yes ✔ No
(i)
If yes, please furnish following information -
Name of Company Type of company PAN Whether its shares are listed or unlisted Director Identification Number (DIN)
Whether you have held unlisted equity shares at any time during the previous year? Yes ✔ No
(j)
If yes, please furnish following information in respect of equity shares
Name of Type of PAN Opening balance Shares acquired during the year Shares transferred during the year Closing balance
Company company
No. of Cost of No. of Date of subscription Face value Issue price per Purchase price per share (in No. of Sale consideration No. of Cost of
shares acquisition shares / purchase per share share (in case of case of purchase from shares shares acquisition
fresh issue) existing shareholder)
1a 1b 2 3 4 5 6 7 8 9 10 11 12 13
SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE)
Details of Income from Salary
Name of Employer Nature of employer (Tick) TAN of Employer (mandatory if tax is

Bharat Petroleum CO.LTD Central Government deducted)
Pin code/ Zip
Address of employer Town/City State
code
Room no 120, mahul road Mumbai 19-Maharashtra
400074
1 Gross Salary (1a + 1b + 1c) 1 2,40,756
Salary as per section 17(1) (drop down to be
a 1a 2,40,756
provided)
Value of perquisites as per section 17(2) (drop down
b 1b 0
to be provided)
Profit in lieu of salary as per section 17(3) (drop down
c 1c 0
to be provided)
2 Total Gross Salary (from all employers) 2 2,40,756
Less allowances to the extent exempt u/s 10 (drop down to be provided in e-
3 filing utility) (please refer instructions) 3 100
(Note: Ensure that it is included in Total Gross salary in (2) above )
Sl.No. Nature of Exempt Allowance Amount

1 Any Other 100
4 Net Salary (2 - 3) 4 2,40,656
5 Deduction u/s 16 (5a + 5b + 5c) 5 50,000
A Standard deduction u/s 16(ia) 5a 50,000
B Entertainment allowance u/s 16(ii) 5b 0
C Professional tax u/s 16(iii) 5c 0
6 Income chargeable under the Head 'Salaries' (4 - 5) 6 1,90,656
Details Of Income From House Property (Please Refer Instructions)
Address of property 1
Town/ City State PIN Code/ Zip Code
1 Ajantha CHS LTD, Plot no 18, D
Navi Mumbai 19-Maharashtra 400709
16, Sector 22
Is the property co-owned?

Yes ✔ No (if “YES” please enter following details)
Your percentage of share in the property (%) 100
Sl. Name of other Co-owner(s) PAN/Aadhaar of other Co-owner(s) Percentage Share of other Co-owner(s) in
No. Property
[Tick the
applicable option] Sl. Name(s) of PAN/ Aadhaar No. of Tenant(s) PAN/TAN of Tenant(s) (if TDS credit is claimed)
✔ Let out
No. Tenant (if let (Please see note)
Self-occupied out)
Deemed let
out
a Gross rent received or receivable or letable value 1a 1,62,000
b The amount of rent which cannot be realized 1b 0
c Tax paid to local authorities 1c 0
d Total ( 1 b + 1 c) 1d 0
e Annual value ( 1 a – 1 d) (nil, if self -occupied etc. as per section 23(2)of the Act) 1e 1,62,000
f Annual value of the property owned (own percentage share x 1 e) 1f 1,62,000
g 30% of 1 f 1g 48,600
h Interest payable on borrowed capital 1h 0
i Total ( 1 g + 1 h) 1i 48,600
j Arrears/Unrealised rent received during the year less 30% 1j 0
1
k Income from house property 1 ( 1 f – 1 i + 1 j) 1,13,400
k
2 Sh,ree Shagun CHS Ltd, Plot
Navi Mumbai 19-Maharashtra 410210
no 253/254, sector 10,

No. Property
[Tick the
✔ Let out No. Tenant (if let (Please see note)
Self-occupied out)
Deemed let
out
a Gross rent received or receivable or letable value 2a 1,80,000
d Total ( 2 b + 2 c) 2d 0
e Annual value ( 2 a – 2 d) (nil, if self -occupied etc. as per section 23(2)of the Act) 2e 1,80,000
f Annual value of the property owned (own percentage share x 2 e) 2f 1,80,000
g 30% of 2 f 2g 54,000
i Total ( 2 g + 2 h) 2i 54,000
2
k Income from house property 2 ( 2 f – 2 i + 2 j) 1,26,000
k
3 Room No 1204, Badani Bohri
Mumbai 19-Maharashtra 400012
Chawl, Lalbaug

No. Property
[Tick the
Let out No. Tenant (if let (Please see note)
✔ Self-occupied
out)
Deemed let
out
a Gross rent received or receivable or letable value 3a 0
d Total ( 3 b + 3 c) 3d 0
e Annual value ( 3 a – 3 d) (nil, if self -occupied etc. as per section 23(2)of the Act) 3e 0
f Annual value of the property owned (own percentage share x 3 e) 3f 0
g 30% of 3 f 3g 0
i Total ( 3 g + 3 h) 3i 0
3
k Income from house property 3 ( 3 f – 3 i + 3 j) 0
k
4 501/B-3, Lakshmimata CHS, Dr Mumbai 19-Maharashtra 400033
B.A.Road, Kalachowki

No. Property
[Tick the
Let out No. Tenant (if let (Please see note)
✔ Self-occupied
out)
Deemed let
out
a Gross rent received or receivable or letable value 4a 0
d Total ( 4 b + 4 c) 4d 0
e Annual value ( 4 a – 4 d) (nil, if self -occupied etc. as per section 23(2)of the Act) 4e 0
f Annual value of the property owned (own percentage share x 4 e) 4f 0
g 30% of 4 f 4g 0
i Total ( 4 g + 4 h) 4i 0
4
k Income from house property 4 ( 4 f – 4 i + 4 j) 0
k
3 Pass through income/loss if any * 3 0
Income under the head “Income from house property” (1k + 2k + 3)

4 4 2,39,400
(if negative take the figure to 2i of schedule CYLA)
Please include the income of the specified persons referred to in Schedule SPI and Pass through income referred to in schedule PTI while
computing the income under this head.
Furnishing of PAN/ Aadhaar No. of tenant is mandatory, if tax is deducted under section 194-IB.
Furnishing of TAN of tenant is mandatory, if tax is deducted under section 194-I.
A Short-term Capital Gains (STCG) (Sub-items 3 and 4 are not applicable for residents)
1 From sale of land or building or both (fill up details separately for each property)
a i Full value of consideration received/receivable Ai 0
ii Value of property as per stamp valuation authority Aii 0
Full value of consideration adopted as per section 50C for the purpose of Capital Gains [in case (aii) does not
iii Aiii 0
exceed 1.10 times (ai), take this figure as (ai), or else take (aii)]
b Deductions under section 48
i Cost of acquisition without indexation Bi 0
ii Cost of Improvement without indexation Bii 0
iii Expenditure wholly and exclusively in connection with transfer Biii 0
iv Total (bi + bii + biii) Biv 0
c Balance (aiii – biv) 1c 0
d Deduction under section 54B (Specify details in item D below) 1d 0
e Short-term Capital Gains on Immovable property (1c - 1d) A1e 0
f In case of transfer of immovable property, please furnish the following details (see note)
Sl.No. Name of buyer(s) PAN/ Aadhaar of buyer(s) Percentage share Amount Address of property Pin code
Furnishing of PAN/ Aadhaar is mandatory, if the tax is deducted under section 194-IA or is quoted by buyer in the documents.
NOTE
In case of more than one buyer, please indicate the respective percentage share and amount.
From sale of equity share or unit of equity oriented Mutual Fund (MF) or unit of a business trust on which STT is paid under section 111A or 115AD(1)
2
(ii) proviso (for FII)
a Full value of consideration 2a 0
i Cost of acquisition without indexation bi 0
ii Cost of Improvement without indexation bii 0
iii Expenditure wholly and exclusively in connection with transfer biii 0
iv Total (i + ii + iii) biv 0
c Balance (2a – biv) 2c 0
Loss to be disallowed u/s 94(7) or 94(8)- for example if asset bought/acquired within 3 months prior to record date and
d dividend/income/bonus units are received, then loss arising out of sale of such asset to be ignored (Enter positive value 2d 0
only)
e Short-term capital gain on equity share or equity oriented MF (STT paid) (2c +2d) A2e 0
For NON-RESIDENT, not being an FII- from sale of shares or debentures of an Indian company (to be computed with foreign exchange adjustment
3
under first proviso to section 48)
a STCG on transactions on which securities transaction tax (STT) is paid A3a 0
b STCG on transactions on which securities transaction tax (STT) is not paid A3b 0
4 For NON-RESIDENT- from sale of securities (other than those at A2) by an FII as per section 115AD
a i In case securities sold include shares of a company other than quoted shares, enter the following details
a Full value of consideration received/receivable in respect of unquoted shares ia 0
b Fair market value of unquoted shares determined in the prescribed manner ib 0
Full value of consideration in respect of unquoted shares adopted as per section 50CA for the
c ic 0
purpose of Capital Gains (higher of a or b)
ii Full value of consideration in respect of securities other than unquoted shares aii 0
iii Total (ic + ii) aiii 0
ii Cost of improvement without indexation bii 0

c Balance (4aiii – biv) 4c 0
Loss to be disallowed u/s 94(7) or 94(8)- for example if security bought/acquired within 3 months prior to record date and
d dividend/income/bonus units are received, then loss arising out of sale of such security to be ignored (Enter positive value 4d 0
only)
e Short-term capital gain on sale of securities by an FII (other than those at A2) (4c +4d) A4e 0
5 From sale of assets other than at A1 or A2 or A3 or A4 above
a i In case assets sold include shares of a company other than quoted shares, enter the following details
c ic 0
In case of asset (security/unit) loss to be disallowed u/s 94(7) or 94(8)- for example if asset bought/acquired within 3
d months prior to record date and dividend/income/bonus units are received, then loss arising out of sale of such asset to 5d 0
be ignored (Enter positive value only)
e STCG on assets other than at A1 or A2 or A3 or A4 above (5c + 5d) A5e 0
6 Amount deemed to be short term capital gains
Whether any amount of unutilized capital gain on asset transferred during the previous years shown below was deposited in the Capital Gains
a Accounts Scheme within due date for that year?
yes No Not applicable. If yes, then provide the details below
Sl. Previous year Section under Whether new New asset acquired/constructed Amount not used for new asset
No. in which asset which deduction asset or remained unutilized in Capital
transferred claimed in that year acquired (Yes Year in which Amount utilised gains account (X)
/no) asset acquired out of Capital
/constructed Gains account
b Amount deemed to be short term capital gains, other than at 'a' 0
Total amount deemed to be short term capital gains (aXi + b) A6 0
7 Pass Through Income/ Loss in the nature of Short Term Capital Gain, (Fill up schedule PTI) (A7a + A7b + A7c) A7 0
a Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 15% A7a 0
b Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 30% A7b 0
c Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable at applicable rates A7c 0
8 Amount of STCG included in A1 – A7 but not chargeable to tax in India as per DTAA
Sl. Amount Item No. A1 to A7 Country Article Rate as per Whether Section Rate as Applicable rate
No. of above in which name & of Treaty TRC of I.T. per I.T. [lower of (6) or
income included Code DTAA (enter NIL, if obtained Act Act (9)]
not (Y/N)
chargeable
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
a Total amount of STCG not chargeable to tax in India as per DTAA A8a 0
b Total amount of STCG chargeable to tax at special rates in India as per DTAA A8b 0
9 Total Short-term Capital Gain (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6 + A7) A9 0
B Long-term capital gain (LTCG) (Sub-items, 5 , 6, 7 & 8 are not applicable for residents)
1 From sale of land or building or both (fill up details separately for each property)
a i Full value of consideration received/receivable ai 0
ii Value of property as per stamp valuation authority aii 0
Full value of consideration adopted as per section 50C for the purpose of Capital Gains [in case (aii) does not
iii aiii 0
exceed 1.10 times (ai), take this figure as (ai), or else take (aii)]
i Cost of acquisition with indexation bi 0
ii Cost of Improvement with indexation bii 0
Sl. Cost of Date of Cost of improvement with

No. improvement improvement indexation
iv Total (bi + bii + biii) biv 0
c Balance (aiii – biv) 1c 0
d Deduction under section 54/54B/54EC/54F/54GB (Specify details in item D below) 1d 0
e Long-term Capital Gains on Immovable property (1c - 1d) B1e 0
f In case of transfer of immovable property, please furnish the following details (see note)
Sl.No. Name of buyer(s) PAN/ Aadhaar Percentage share Amount Address of property Pin code
PAN/ Aadhaar
Furnishing of PAN/ Aadhaar is mandatory, if the tax is deducted under section 194-IA or is quoted by buyer in the documents.
NOTE
In case of more than one buyer, please indicate the respective percentage share and amount.
2 From sale of bonds or debenture (other than capital indexed bonds issued by Government)
iv Total (bi + bii +biii) biv 0
d Deduction under sections 54F (Specify details in item D below) 2d 0
e LTCG on bonds or debenture (2c – 2d) B2e 0
From sale of, (i) listed securities (other than a unit) or zero coupon bonds where proviso under section 112(1) is applicable (ii) GDR of an Indian
3
company referred in sec. 115ACA
e Long-term Capital Gains on assets at B3 above (3c – 3d) B3e 0
4 From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which STT is paid under section 112A
a LTCG u/s 112A (column 14 of Schedule 112A) 4a 0
b Deduction under sections 54F (Specify details in item D below) 4b 0
c Long-term Capital Gains on sale of capital assets at B4 above (4a – 4b) B4c 0
For NON-RESIDENTS- from sale of shares or debenture of Indian company (to be computed with foreign exchange adjustment under first proviso to
5
section 48)
a LTCG computed without indexation benefit 5a 0
b Deduction under sections 54F (Specify details in item D below) 5b 0
c LTCG on share or debenture (5a-5b) B5c 0
For NON-RESIDENTS- from sale of, (i) unlisted securities as per sec. 112(1)(c), (ii) bonds or GDR as referred in sec. 115AC, (iii) securities by FII as
6
referred to in sec. 115AD (other than securities referred to in section 112A for which column B7 is to be filled up)
a i In case securities sold include shares of a company other than quoted shares, enter the following details
c ic 0

d Deduction under sections /54F (Specify details in item D below) 6d 0
e Long-term Capital Gains on assets at 6 above in case of NON-REESIDENT (6c - 6d) B6e 0
For NON-RESIDENTS - From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which STT is paid under
7
section 112A
a LTCG u/s 112A (column 14 of Schedule 115AD(1)(iii)) 7a 0
b Deduction under section 54F (Specify details in item D below) 7b 0
c Long-term Capital Gains on sale of capital assets at B7 above (7a – 7b) B7c 0
8 From sale of foreign exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A)
a LTCG on sale of specified asset (computed without indexation) 8a 0
b Less deduction under section 115F (Specify details in item D below) 8b 0
c Balance LTCG on sale of specified asset (8a – 8b) B8c 0
d LTCG on sale of asset, other than specified asset (computed without indexation) 8d 0
e Less deduction under section 115F (Specify details in item D below) 8e 0
f Balance LTCG on sale of asset, other than specified asset (8d- 8e) B8f 0
9 From sale of assets where B1 to B8 above are not applicable
A i In case securities sold include shares of a company other than quoted shares, enter the following details
c ic 0
i Cost of acquisition with indexation bi 0
ii Cost of improvement with indexation bii 0
E Long-term Capital Gains on assets at B9 above ( (9c – 9d) 0
10 Amount deemed to be long-term capital gains
Whether any amount of unutilized capital gain on asset transferred during the previous year shown below was deposited in the Capital Gains
a Accounts Scheme within due date for that year?
Yes No Not applicable. If yes, then provide the details below
Sl. Previous year Section under Whether new New asset acquired/constructed Amount not used for new asset
No. in which asset which deduction asset or remained unutilized in Capital
transferred claimed in that year acquired (Yes Year in which Amount utilised gains account (X)
/no) asset acquired out of Capital
/constructed Gains account
b Amount deemed to be short term capital gains, other than at 'a'
Total amount deemed to be long-term capital gains (aXi + aXii + b) 0
11 Pass Through Income/ Loss in the nature of Long Term Capital Gain,(Fill up schedule PTI) (B11a1+ B11a2 + B11b) B11 0
a1 Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 10% u/s 112A B11a1 0
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 10% under sections other than u/s
a2 B11a2 0
112A
b Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 20% B11b 0
12 Amount of LTCG included in B1 - B11 but not chargeable to tax or chargeable at special rates in India as per DTAA
Sl. Amount Item No. B1 to B11 Country Article Rate as per Whether Section Rate as Applicable rate
No. of above in which name & of Treaty TRC of I.T. per I.T. [lower of (6) or
income included Code DTAA (enter NIL, if obtained Act Act (9)]
not (Y/N)
chargeable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
a Total amount of LTCG not chargeable to tax as per DTAA B12a 0
b Total amount of LTCG chargeable to tax at special rates as per DTAA B12b 0
13 Total long term capital gain chargeable under I.T. Act (B1e+B2e+B3e+B4c+B5c+B6e+B7c+B8c+B8f+B9e+B10 + B11 - B12a) B13 0
C Income chargeable under the head "CAPITAL GAINS" (A9 + B13) (take B13 as nil, if loss) C 0
D Information about deduction claimed against Capital Gains
1 In case of deduction u/s 54/54B/54EC/54F/54GB/115F give following details
a Deduction claimed u/s 54
Date of purchase/ Amount deposited in

Date of Transfer of Amount of deduction
construction of new Cost of new asset Capital Gains Accounts
Original Asset claimed
asset Scheme before due date
b Deduction claimed u/s 54B
Amount
Amount deposited in
Date of Transfer of Date of purchase of new Cost of new agricultural of
Capital Gains Accounts
Original Asset agricultural land land deduction
Scheme before due date
claimed
c Deduction claimed u/s 54EC
Amount
invested in
specified
Date of Transfer of /notified
Date of investment Amount of deduction claimed
Original Asset bonds (not
exceeding
fifty lakh
rupees)
d Deduction claimed u/s 54F
Date of
Amount
Transfer Amount deposited in Capital
Date of purchase/construction of
of Cost of new residential house Gains Accounts Scheme before
of new residential house deduction
Original due date
claimed
Asset
e Deduction claimed u/s 54GB
Cost of new Amount

Date of Date of
PAN of Amount utilised plant and deposited in Amount
transfer of Date of purchase
the for subscription of machinery Capital Gains of
original subscription of plant
eligible equity shares of purchased by Accounts deduction
residential of shares and
company eligible company the eligible Scheme before claimed
property machinery
company due date
f Deduction claimed u/s 115F (for Non-Resident Indians)
Amount invested in new

Date of Transfer of Amount of deduction
specified asset or savings Date of investment
foreign exchange asset claimed
certificate
g Total deduction claimed (1a + 1b + 1c + 1d + 1e + 1f) 1g 0
E Set-off of current year capital losses with current year capital gains (excluding amounts included in A8a & B12a which is not chargeable under DTAA)
Sl. Type of Capital Gain Capital Gain of current year (Fill this column only Short term capital loss Long term capital loss Current year’s capital
No. if computed figure is positive) gains remaining after set

15% 30% applicable rate DTAA 10% 20% DTAA
off
rates rates
(9=1-2-3-4-5-6-7-8)
1 2 3 4 5 6 7 8 9
i Capital Loss to be set off (Fill this row only if (A2e* + A4e* (A1e*+A3b*+A5e*+A6*+A7c*) A8b (B3e*+ B4c* + B6e* + B7c* + (B1e*+B2e*+B5c*+ B12b
computed figure is negative) A3a* + +A7b* B8c* + B11a1* + B11a2*) B8f*+B9e*+B10*+B11b*)
A7a*)
ii Short term capital gain 15% (A2e*+A3a*+A7a*) 0 0 0 0
iii 30% A4e*+A7b* 0 0 0 0
iv applicable rate (A1e*+A3b*+A5e*+A6* + A7c*) 0 0 0
v DTAA rates A8b 0 0 0
vi Long term capital gain 10% (B3e*+B4c*+B6e*+ B7c* + B8c*+B11a1*+B11a2*) 0 0 0 0 0 0 0
vii 20% (B1e*+B2e*+B5c*+B8f*+B9e*+B10*+B11b*) 0 0 0 0 0 0 0
viii Covered by DTAA B12b 0 0 0 0 0 0 0
ix Total loss set off (ii + iii + iv + v + vi+vii+viii) 0 0 0 0 0
x Loss remaining after set off (i – ix) 0 0 0 0 0
The figures of STCG in this table (A1e* etc.) are the amounts of STCG computed in respective column (A1-A6) as reduced by theamount of STCG not chargeable to tax or chargeable at special rates as
per DTAA, which is included therein, if any.
The figures of LTCG in this table (B1e* etc.) are the amounts of LTCG computed in respective column (B1-B10) as reduced by theamount of LTCG not chargeable to tax or chargeable at special rates as
per DTAA, which is included therein, if any.
F Information about accrual/receipt of capital gain
Type of Capital gain / Date Upto 15/6 16/6 to 15/9 16/9 to 15/12 16/12 to 15/3 16/3 to 31/3
(i) (ii) (iii) (iv) (v)
1 Short-term capital gains taxable at 0 0 0 0 0

the rate of 15%
Enter value from item 3iii of
schedule BFLA, if any.

the rate of 30%
Enter value from item 3iv of
schedule BFLA, if any

applicable rates
Enter value from item 3v of

DTAA rates
Enter value from item 3vi of
5 Long- term capital gains taxable at 0 0 0 0 0

the rate of 10%
Enter value from item 3vi of

the rate of 20%
Enter value from item 3vii of

the rate DTAA rates
Enter value from item 3ix of
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while computing the income under this head
Income from other sources
1 Gross income chargeable to tax at normal applicable rates (1a+ 1b+ 1c+ 1d + 1e) 1 0
a Dividends Gross (ai +aii) 1a 0
ai Dividend income [other than (ii)] 1ai 0
aii Dividend income u/s 2(22)(e) 1aii 0
b Interest, Gross (bi + bii + biii + biv+ bv) 1b 0
i From Savings Bank bi 0
ii From Deposits (Bank/ Post Office/ Co- bii 0
iii From Income-tax Refund biii 0
iv In the nature of Pass through income/ loss biv 0
v Others bv 0
c Rental income from machinery, plants, buildings, etc., Gross 1c 0
Income of the nature referred to in section 56(2)(x) which is chargeable to tax (di + dii + diii +
d 1d 0
div + dv)
Aggregate value of sum of money received

i di 0
without consideration
In case immovable property is received without

ii dii 0
consideration, stamp duty value of property
In case immovable property is received for

inadequate consideration, stamp duty value of
iii diii 0
property in excess of such consideration as
adjusted as per section 56(2)(x)
In case any other property is received without

iv div 0
consideration, fair market value of property
In case any other property is received for

v inadequate consideration, fair market value of dv 0
property in excess of such consideration
e Any other income (please specify nature) 1e 0
Sl. No. Nature Amount
1 Family Pension 0
2 Income chargeable at special rates (2a+ 2b+ 2c+ 2d + 2e +2f elements related to Sl. No.1) 2 0
a Winnings from lotteries, crossword puzzles etc. chargeable u/s 115BB 2a 0
b Income chargeable u/s 115BBE (bi + bii + biii + biv+ bv + bvi) 2b 0
i Cash credits u/s 68 bi 0
ii Unexplained investments u/s 69 bii 0
iii Unexplained money etc. u/s 69A biii 0

iv Undisclosed investments etc. u/s 69B biv 0
v Unexplained expenditure etc. u/s 69C bv 0
vi Amount borrowed or repaid on hundi u/s 69D bvi 0
c Accumulated balance of recognised provident fund taxable u/s 111 2c 0
S.No. Assessment Year Income benefit Tax benefit
(i) (ii) (iii) (iv)
d Any other income chargeable at special rate (total of di to dxviii) 2d 0
115A(1)(a)(i)- Dividends interest and income from

i di 0
units purchase in foreign currency
115A(1)(a)(ii)- Interest received from govt/Indian

ii dii 0
Concerns received in Foreign Currency
115A(1) (a)(iia) -Interest from Infrastructure Debt

iii diii 0
Fund
iv 115A(1) (a)(iiaa) -Interest as per Sec. 194LC(1) div 0
v 115A(1) (a)(iiab) -Interest as per Sec. 194LD dv 0
vi 115A(1) (a)(iiac) -Interest as per Sec. 194LBA dvi 0
115A(1) (a)(iii) -Income received in respect of

vii dvii 0
units of UTI purchased in foreign currency
115A(1)(b)(A) & 115A(1)(b)(B)- Income from

viii dviii 0
royalty & technical services
115AC(1)(a & b) - Income from bonds or GDR

ix dix 0
purchased in foreign currency - non-resident
115ACA(1)(a) - Income from GDR purchased in

x dx 0
foreign currency -resident
115AD(1)(i) -Income (other than dividend)

xi received by an FII in respect of securities (other dxi 0
than units as per Sec 115AB)
115AD(1)(i) -Income received by an FII in respect

xii of bonds or government securities as per Sec dxii 0
194LD
115BBA - Tax on non-residents sportsmen or

xiii dxiii 0
sports associations
xiv 115BBC - Anonymous donations dxiv 0
115A(1)(a)(iiac) - Distributed income being

xv dxv 0
Dividend referred to in section 194LBA
xvi 115BBF - Tax on income from patent dxvi 0
115BBG - Tax on income from transfer of carbon

xvii dxvii 0
credits
xviii 115E(a) - Investment income dxviii 0
115A(1) (a)(iiaa) - Interest as referred in proviso

xix dxix 0
to section 194LC(1)
xx 115E(a) - Investment income dxviii 0
115AD(1)(i) - Income (being dividend) received

xxi by an FII in respect of securities (other than units dxx 0
referred to in section 115AB)
e Pass through income in the nature of income from other sources chargeable at special rates (drop down to be provided) 2e 0
Amount included in 1 and 2 above, which is chargeable at special rates in India as per DTAA (total of column (2) of table
2f 0
below)
Sl. Amount Item No.1 Country Article Rate as per Whether Section Rate Applicable
No. of & 2 in name & of Treaty (enter TRC of I.T. as rate [lower of
f
income which Code DTAA NIL, if not obtained Act per I. (6) or (10)]
included chargeable) (Y/N) T. Applicable
Act rate
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
3 Deductions under section 57 (other than those relating to income chargeable at special rates under 2a, 2b & 2d)
Expenses / Deductions (in case other than family pension)

ai 3ai 0
Expenses / Deductions
Interest expenditure u/s 57(1) (available only if income

aii 3aii
offered in 1a)
Interest expenditure claimed 0
Eligible amount of interest expenditure 0
aiii Deduction u/s. 57(iia) (in case of family pension only) 3aiii 0
Depreciation (available only if income offered in 1c of

b 3b 0
schedule OS)
c Total 3c 0
4 Amounts not deductible u/s 58 4 0
5 Profits chargeable to tax u/s 59 5 0
Net Income from other sources chargeable at normal applicable rates (1(after reducing income related to DTAA portion) – 3
6 6 0
+ 4 + 5) (If negative take the figure to 3i of schedule CYLA )
7 Income from other sources (other than from owning race horses) (2 + 6) (enter 6 as nil, if negative) 7 0
8 Income from the activity of owning and maintaining race horses
a Receipts 8a 0
Deductions under section 57 in relation to receipts at

b 8b 0
8a only
c Amounts not deductible u/s 58 8c 0
d Profits chargeable to tax u/s 59 8d 0
e Balance (8a - 8b + 8c + 8d) (if negative take the figure to 6xi of Schedule CFL) 8e 0
9 Income under the head "Income from other sources " (7 + 8e) (take 8e as nil if negative) 9 0
10 Information about accrual/receipt of income from Other Sources
S.No. Other Source Upto 15/6 From 16/6 to 15/9 From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3
Income
(i) (ii) (iii) (iv) (v)
1 Dividend Income u/s 0 0 0 0 0

115BBDA
2 Income by way of 0 0 0 0 0
winnings from
lotteries, crossword
puzzles, races,
games, gambling,
betting etc. referred
to in section 2(24)(ix)
3 Dividend Income 0 0 0 0 0
chargeable under
DTAArates
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while computing the income under this head.
Details of Income after Set off of current year losses
Sl. Head/ Source of Income Income of current year (Fill House property Net loss from Other sources chargeable at normal Current year’s
No. this column only if income is loss of the applicable rates (other than loss from race horses) Income
zero or positive) current year set of the current year set off remaining after
off set off
1 2 3 4=1-2-3
i Loss to be set off (Fill this 0 0

row only if computed figure
is negative)
ii Salaries 1,90,656 0 0 1,90,656
iii House property 2,39,400 0 2,39,400
iv Short-term capital gain 0 0 0 0

taxable @ 15%
v Short-term capital gain 0 0 0 0

taxable @ 30%
vi Short-term capital gain 0 0 0 0

taxable at applicable rates
vii Short-term capital gain 0 0 0 0

taxable at special rates in
India as per DTAA
viii Long term capital gain 0 0 0 0

taxable @ 10%
ix Long term capital gain 0 0 0 0

taxable @ 20%
x Long term capital gains 0 0 0 0

taxable at special rates in
India as per DTAA
xi Net income from other 1,76,192 0 1,76,192

sources chargeable at
normal applicable rates
xii Profit from the activity of 0 0 0 0

owning and maintaining
race horses
xiii Total loss set off (ii + iii + iv + v + vi + vii + viii + ix + x + xi + 0 0

xii)
xiv Loss remaining after set-off (i – xiii) 0 0

Details of Income after Set off of Brought Forward Losses of earlier years
Sl. Head/ Source of Income Income after set off, if any, of current year’s losses Brought forward Current year’s income
No. as per 4 of Schedule CYLA) loss set off remaining after set off
1 2 3
i Salaries 1,90,656 1,90,656
ii House property 2,39,400 0 2,39,400
iii Short-term capital gain taxable @ 15% 0 0 0
iv Short-term capital gain taxable @ 30% 0 0 0
v Short-term capital gain taxable at applicable 0 0 0

rates
vi Short-term capital gain taxable at special rates 0 0 0

in India as per DTAA
vii Long term capital gain taxable @ 10% 0 0 0
viii Long term capital gain taxable @ 20% 0 0 0
ix Long term capital gains taxable at special 0 0 0

rates in India as per DTAA
x Net income from other sources chargeable at 1,76,192 0 1,76,192

normal applicable rates
xi Profit from owning and maintaining race 0 0 0

horses
xii Total of brought forward loss set off (2ii + 2iii + 2iv + 2v+ 2vi + 2vii + 2ix + 2xi) 0
xiii Current year's income remaining after set off Total of (3i + 3ii + 3iii + 3iv + 3v+ 3vi + 3vii + 3viii+ 3ix + 3x + 3xi) 6,06,248
Details of Losses to be carried forward to future years
Assessment Date of House property loss Short-term capital loss Long-term Capital loss Loss from owning and
Year Filing (DD maintaining race horses
/MM
/YYYY)
1 2 3 4 5 6
i 2013-14 0 0 0
ii 2014-15 0 0 0
iii 2015-16 0 0 0
iv 2016-17 0 0 0
v 2017-18 0 0 0 0
vi 2018-19 0 0 0 0
vii 2019-20 0 0 0 0
viii 2020-21 0 0 0 0
ix Total of 0 0 0 0
earlier year
losses
x Adjustment 0 0 0 0
of above
losses in
Schedule
BFLA
xi 2020-21 0 0 0 0
(Current year
losses)
xii Total loss 0 0 0 0

carried
forward to
future years
Deductions under Chapter VI-A
1 Part B- Deduction in respect of certain payments
a 80C 1,50,000 b 80CCC 0
c 80CCD(1) 0 d 80CCD(1B) 0
e 80CCD(2) 0 f 80D 0
g 80DD 0 h 80DDB 0
i 80E 0 j 80EE 0
k 80EEA 0 l 80EEB 0
m 80G 0 n 80GG 0
o 80GGA 0 p 80GGC 0
2 Part C, CA and D- Deduction in respect of certain incomes/other deduction
q 80QQB 0 r 80RRB 0
s 80TTA 0 t 80TTB 1,76,192
u 80U 0
v Total deductions under Chapter VI-A (Total of a to u) v 2,00,000

Details of donations entitled for deduction under section 80G
A Donations entitled for 100% deduction without qualifying limit
Eligible
Amount
Name and address of Donee PAN of Donee Amount of donation
of
donation
Donation in other
Donation in cash Total Donation
mode
Total 0 0 0 0
B Donations entitled for 50% deduction without qualifying limit
Eligible Amount of
donation
Donation in other
mode
Total 0 0 0 0
C Donations entitled for 100% deduction subject to qualifying limit
Eligible Amount of
donation
Donation in other
mode
Total 0 0 0 0
D Donations entitled for 50% deduction subject to qualifying limit
Eligible Amount of
donation
Donation in other
mode
iii Total 0 0 0 0
E Total donations (A + B + C + D) 0
Details of donations for scientific research or rural development
Sl. Relevant clause under which deduction is claimed Name and address PAN of Amount of donation Eligible Amount of
No. (drop down to be provided) of Donee Donee donation
Donation Donation in Total

in cash other mode Donation
Total donation 0 0 0 0
Computation of Alternate Minimum Tax payable under section 115JC
1 Total Income as per item 12 of PART-B-TI 1 4,06,250
2 Adjustment as per section 115JC(2)
Deduction claimed under any section included in Chapter VI-A under the heading "C.—
a 2a 0
Deductions in respect of certain incomes"
3 Adjusted Total Income under section 115JC(1) (1+2a) 3 4,06,250
4 Tax payable under section 115JC [18.5% of (3)] (if 3 is greater than Rs. 20 lakhs) 4 0
Computation of tax credit under section 115JD
1 Tax under section 115JC in assessment year 2020-21 (1d of Part-B-TTI) 1 0
2 Tax under other provisions of the Act in assessment year 2020-21 (7 of Part-B-TTI) 2 0
3 Amount of tax against which credit is available [enter (2 – 1) if 2 is greater than 1, otherwise enter 0] 3 0
Utilisation of AMT credit Available (Sum of AMT credit utilized during the current year is subject to maximum of amount mentioned in 3 above and cannot exceed
4
the sum of AMT Credit Brought Forward)
S. Assessment Year AMT Credit AMT Credit Utilised during the Balance AMT Credit
No. (A) Current Assessment Year Carried Forward
Gross Set-off in earlier Balance brought forward to the
(C) (D)= (B3) –(C)
(B1) assessment years current assessment year
(B2) (B3) = (B1) – (B2)
1 2013-14 0 0 0 0 0
2 2014-15 0 0 0 0 0
3 2015-16 0 0 0 0 0
4 2016-17 0 0 0 0 0
5 2017-18 0 0 0 0 0
6 2018-19 0 0 0 0 0
7 2019-20 0 0 0 0 0
8 2020-21 0 0 0 0 0
viii Current AY (enter 1-2, if 0 0

1>2 else enter 0)
ix Total 0 0 0 0 0
5 Amount of tax credit under section 115JD utilised during the year [total of item No. 4 (C)] 5 0
6 Amount of AMT liability available for credit in subsequent assessment years [total of 4 (D)] 6 0
Income of specified persons (spouse, minor child etc.) includable in income of the assessee as per section 64
Sl No Name of person PAN/ Aadhaar of person (optional) Relationship Amount (Rs) Head of Income in which included
Income chargeable to tax at special rates (please see instructions No. 9 for rate of tax) Income chargeable to tax at special rates
Sl. No. Section Special rate Income Taxable Tax thereon

Income
after
adjusting
for min
chargeable
to tax
1 1 111 - Tax on accumulated balance of 1% 0 0 0

recognised PF
2 1A 111A (STCG on shares where STT 15 % 0 0 0

paid)
3 21 112 (LTCG on others) 20 % 0 0 0
4 22 112 proviso (LTCG on listed securities/ 10 % 0 0 0

units without indexation)
5 2A 112A LTCG on equity shares/units of 10 % 0 0 0

equity oriented fund/units of business
trust on which STT is paid,
6 21ciii 112(1)( c )(iii) LTCG on unlisted 10 % 0 0 0

securities incase of non-residents
7 5BB 115BB (Winnings from lotteries, 30 % 0 0 0

puzzles, races, games etc.)
8 5ADii 115AD(1)(ii) -STCG (other than on 30 % 0 0 0

equity share or equity oriented mutual
fund referred to in section 111A) by an
FII,
9 5AD1biip 115AD(i)(b)(ii)-Short term capital gains 15 % 0 0 0

referred to section 111A
10 5A1ai 115A(1)(a)(i)- Dividends interest and 20 % 0 0 0

income from units purchase in foreign
currency
11 5A1aii 115A(1)(a)(ii)- Interest received from 20 % 0 0 0

govt/Indian Concerns recived in
Foreign Currency
12 5A1aiia 115A(1) (a)(iia) -Interest from 5% 0 0 0

Infrastructure Debt Fund
13 5A1aiiaa 115A(1) (a)(iiaa) -Interest as per Sec. 5% 0 0 0

194LC
14 5A1aiiaaP 115A(1) (a)(iiaa) -Interest referred to in 4% 0 0 0

section 194LC(1P) - chargeable u/s
115A(1)(a)(iiaa) @4 %
15 5A1aiiab 115A(1) (a)(iiab) -Interest as per Sec. 5% 0 0 0

194LD
16 5A1aiiac 115A(1)(a)(iiac)-Interest as per Sec. 5% 0 0 0
194LBA
17 5A1aiiaci 115A(1)(a)(iiac) - Distributed income 10 % 0 0 0

being Dividend referred to in section
194LBA
18 5A1aiii 115A(1) (a)(iii) - Income received in 20 % 0 0 0

respect of units of UTI purchased in
Foreign Currency
19 5A1bA 115A(1)(b)- Income from royalty or fees 10 % 0 0 0

for technical services received from
Government or Indian concern -
chargeable u/s 115A(1)(b),
20 5AC1ab 115AC(1)(a and b) - Income from 10 % 0 0 0

bonds or GDR purchased in foreign
currency - non-resident
21 5AC1c 115AC(1)( c )-LTCG arising from the 10 % 0 0 0

transfer of bonds or GDR purchased in
foreign currency - Non Resident.
22 5ACA1a 115ACA(1)(a) - Income from GDR 10 % 0 0 0

purchased in foreign currency -resident
23 5ACA1b 115ACA(1)(b) - LTCG arising from the 10 % 0 0 0

transfer of GDR purchased in foreign
currency -resident
24 5AD1i 115AD(1)(i) -Income received by an FII 20 % 0 0 0

in respect of securities (other than units
as per Sec 115AB)
25 5AD1iP 115AD(1)(i) -Income received by an FII 5% 0 0 0

in respect of bonds or government
securities as per Sec 194LD
26 5ADiii 115AD(i)(iii)-LTCG by an FII 10 % 0 0 0
27 5ADiiiP Securities referred in section 112A read 10 % 0 0 0

with section 115AD
28 5BBA 115BBA - Tax on non-residents 20 % 0 0 0

sportsmen or sports associations
29 5BBC 115BBC - Anonymous donations 30 % 0 0 0
30 5BBE 115BBE - Tax on income referred to in 60 % 0 0 0

sections 68 or 69 or 69A or 69B or 69C
or 69D
31 5BBF 15BBF-Tax on income from patent 10 % 0 0 0
32 5BBG 115BBG-Tax on income from transfer 10 % 0 0 0

of carbon credits
33 5Ea 115E(a)-Investment income 20 % 0 0 0
34 5Eacg 115E(a)-LTCG on any asset other than 20 % 0 0 0

a specified asset-non resident Indian
35 5Eb 115E(b) - Income by way of long term 10 % 0 0 0

capital gains
36 DTAASTCG STCGDTAARate - STCG Chargeable 1% 0 0 0

at special rates in India as per DTAA
37 DTAALTCG LTCGDTAARate - LTCG Chargeable at 1% 0 0 0

special rates in India as per DTAA
38 DTAAOS OSDTAARate - Other source income 1% 0 0 0

chargeable under DTAA rates
39 PTI_STCG15P Pass Through Income in the nature of 15 % 0 0 0

Short Term Capital Gain chargeable @
15%
40 PTI_STCG30P Pass Through Income in the nature of 30 % 0 0 0

Short Term Capital Gain chargeable @
30%
41 PTI_LTCG10P Pass Through Income in the nature of 10 % 0 0 0

Long Term Capital Gain chargeable @
10%
42 PTI_LTCG10P112A Pass Through Income in the nature of 10 % 0 0 0

10% u/s 112A
43 PTI_LTCG20P Pass Through Income in the nature of 20 % 0 0 0

20%
44 PTI_5A1ai PTI-115A(1)(a)(i)- Dividends interest 20 % 0 0 0

and income from units purchase in
foreign currency
45 PTI_5A1aii PTI - Interest received in the case of 20 % 0 0 0

non-residents
46 PTI_5A1aiia PTI - Interest received by non-resident 5% 0 0 0

from infrastructure debt fund
47 PTI_5A1aiiaa PTI - Income received by non-resident 5% 0 0 0

as referred in section 194LC
48 PTI_5A1aiiaaP PTI-115A(1) (a)(iiaa) -Interest referred 4% 0 0 0

to in section 194LC(1P) - chargeable u
/s 115A(1)(a)(iiaa) @4 %
49 PTI_5A1aiiab PTI - Income received by non-resident 5% 0 0 0

as referred in section 194LD
50 PTI_5A1aiiac PTI - Income received by non-resident 5% 0 0 0

as referred in section 194LBA
51 PTI_5A1aiiaci PTI-115A(1)(a)(iiac) - Distributed 10 % 0 0 0

income being Dividend referred to in
section 194LBA
52 PTI_5A1aiii PTI - Income from units purchased in 20 % 0 0 0

foreign currency in the case of non-
residents
53 PTI_5A1bA PTI-115A(1)(b)Income from royalty or 10 % 0 0 0

fees for technical services received
from Government or Indian concern -
chargeable u/s 115A(1)(b)
54 PTI_5AC1ab PTI-115AC(1)(a and b) - Income from 10 % 0 0 0

bonds or GDR purchased in foreign
currency - non-resident
55 PTI_5ACA1a PTI_115ACA(1)(a )- Income from GDR 10 % 0 0 0

purchased in foreign currency or long
term capital gains arising from their
transfer in case of a resident employee
of an Indian company, engaged in
knowledge based industry or service
56 PTI_5AD1iDiv PTI-115AD(1)(i) - Income (being 20 % 0 0 0

dividend) received by an FII in respect
of securities (other than units referred
to in section 115AB)
57 5AD1iDiv 115AD(1)(i) - Income (being dividend) 20 % 0 0 0

received by an FII in respect of
securities (other than units referred to
in section 115AB)
58 PTI_5AD1i PTI-115AD(1)(i) -Income received by 20 % 0 0 0

an FII in respect of securities (other
than units as per Sec 115AB)
59 PTI_5AD1iP PTI-115AD(1)(i) -Income received by 5% 0 0 0

an FII in respect of bonds or
government securities as per Sec
194LD
60 PTI_5BBA PTI-115BBA - Tax on non-residents 20 % 0 0 0

sportsmen or sports associations
61 PTI_5BBC PTI_115BBC- Anonymous donations 30 % 0 0 0
62 PTI_5BBF PTI_115BBF- Tax on income from 10 % 0 0 0

patent
63 PTI_5BBG PTI_115BBG- Tax on income from 10 % 0 0 0

transfer of carbon credits
64 PTI_5Ea PTI_115E(a)- Investment income of a 20 % 0 0 0

non-resident Indian
Total 0 0 0
Details of Exempt Income (Income not to be included in Total Income or not chargeable to tax)
1 Interest income 1 0
Gross Agricultural receipts (other than income to be excluded under rule 7A, 7B or 8 of I.T.
i i 0
Rules)
ii Expenditure incurred on agriculture ii 0
2 iii Unabsorbed agricultural loss of previous eight assessment years iii 0
iv Net Agricultural income for the year (i – ii – iii) (enter nil if loss) 2 0
In case the net agricultural income for the year exceeds Rs.5 lakh, please furnish the following details (Fill up details separately
v
for each agricultural land)
3 Other exempt income (including exempt income of minor child) 3 0
4 Income not chargeable to tax as per DTAA
Sl. Amount of Nature of Country name & Article of Head of Whether TRC obtained (Y
No. income income Code DTAA Income /N)
III Total Income from DTAA not chargeable to tax 4 0
5 Pass through income not chargeable to tax (Schedule PTI) 5 0
6 Total (1+2+3+4+5+6) 6 0
Pass Through Income details from business trust or investment fund as per section 115UA, 115UB
Note: Please refer to the instructions for filling out this schedule.
Details of Income from outside India and tax relief (Available in case of resident)
Summary of tax relief claimed for taxes paid outside India (Available in case of resident)
1 Summary of Tax relief claimed
Country Tax Total proportionate taxes paid outside Total tax relief available (total of Tax Relief Claimed
Code Identification India (total of (c) of Schedule FSI in (f) of Schedule FSI in respect of under section (specify
Number respect of each country) each country) 90, 90A or 91)
(a) (b) (c) (d) (e)
Total 0 0
Total Tax relief available in respect of country where DTAA is applicable (section 90/90A) (Part of
2 2 0
total of 1(d))
Total Tax relief available in respect of country where DTAA is not applicable (section 91) (Part of
3 3 0
total of 1(d))
Whether any tax paid outside India, on which tax relief was allowed in India, has been refunded
4 4
/credited by the foreign tax authority during the year? If yes, provide the details below
Assessment year in which tax relief

a Amount of tax refunded 0 b
allowed in India
Details of Foreign Assets and Income from any source outside India
A1 Details of Foreign Depository Accounts held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Country Name of financial Address of financial ZIP Account Status Account Peak balance during Closing Gross interest paid/credited to the account
No name code institution institution code number opening date the period balance during the period
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A2 Details of Foreign Custodial Accounts held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Country Name of Address of ZIP Account Status Account Peak balance Closing Gross interest paid/credited to the account during the period
No name code financial financial code number opening during the balance (drop down to be provided specifying nature of amount viz. interest/dividend
institution institution date period /proceeds from sale or redemption of financial assets/ other income)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A3 Details of Foreign Equity and Debt Interest held (including any beneficial interest) in any entity at any time during the relevant accounting period
Sl Country Country Name Address ZIP Nature Date of Initial value of Peak value of Closing Total gross amount paid/credited with Total gross proceeds from sale or
No name code of of entity code of acquiring the the investment during balance respect to the holding during the period redemption of investment during the
entity entity interest investment the period period
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
A4 Details of Foreign Cash Value Insurance Contract or Annuity Contract held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Country Name of financial institution in which Address of financial ZIP Date of The cash value or surrender value Total gross amount paid/credited with respect to the
No name code insurance contract held institution code contract of the contract contract during the period
(1) (2) (3) (4) (5) (6) (7) (8) (9)
B Details of Financial Interest in any Entity held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Name ZIP Nature of Name and Address of Nature of Date Total Investment (at cost) Income accrued from Nature of Income taxable and offered in this return
No and code Code entity the Entity Interest-Direct since held (in rupees) such Interest Income
Amount Schedule Item number of
/Beneficialowner
where offered schedule
/Beneficiary
(1) (2) 2a (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
C Details of Immovable Property held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Name ZIP Address of the Ownership-Direct/ Beneficial Date of Total Investment (at cost) Income derived from Nature of Income taxable and offered in this return
No and code Code Property owner/ Beneficiary acquisition (in rupees) the property Income
(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
D Details of any other Capital Asset held (including any beneficial interest) at any time during the relevant accounting period
Sl Country Name ZIP Nature of Ownership-Direct/ Beneficial Date of Total Investment (at cost) Income derived from Nature of Income taxable and offered in this return
No and code Code Asset owner/ Beneficiary acquisition (in rupees) the asset Income

(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
E Details of account(s) in which you have signing authority held (including any beneficial interest) at any time during the relevant accounting period and which has not been included in A to D above.
Sl Name of the Institution Address of Country Zip Name of Account Peak Balance/ Investment during the year Whether income If (7) is yes, If (7) is yes, Income offered in
No in which the account is the Name and Code the account Number (in rupees) Peak Balance/ Investment accrued is taxable in Income accrued in this return
held Institution Code holder during the year your hands? the account
Amount Schedule Item
where number
offered of
schedule
(1) (2) (3) (3a) (3b) (4) (5) (6) (7) (8) (9) (10) (11)
F Details of trusts, created under the laws of a country outside India, in which you are a trustee, beneficiary or settlor
Sl Country ZIP Name and Name and Name and Name and address Date since Whether income derived is If (8) is yes, Income If (8) is yes, Income offered in this
No Name and CODE address of the address of address of of Beneficiaries position taxable in your hands? derived from the trust return
code trust trustees Settlor held

Amount Schedule Item
where number of
offered schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
G Details of any other income derived from any source outside India which is not included in,- (i) items A to F above and, (ii) income under the head business or profession
Sl Country Name and ZIP Name and address of the person from whom Income Nature of Whether taxable in your If (6) is yes, Income offered in this return
No code CODE derived derived income hands?

Amount Schedule where Item number of
offered schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9)
Note: Please refer to instructions for filling out this schedule. In case of an individual, not being an Indian citizen, who is in India on a business, employment or student visa, an asset acquired during any previous year in which he was non-resident
is not mandatory to be reported in this schedule if no income is derived from that asset during the current previous year.
Information regarding apportionment of income between spouses governed by Portuguese Civil Code
Name of the spouse
PAN/ Aadhaar of the

/
spouse
Receipts received under Amount apportioned in the hands of Amount of TDS deducted on TDS apportioned in the hands
Heads of Income
the head the spouse income at (ii) of spouse
(i) (ii) (iii) (iv) (v)
1 House Property 0 0 0 0
2 Capital gains 0 0 0 0
3 Other sources 0 0 0 0
4 Total 0 0 0 0
Assets and Liabilities at the end of the year (applicable in a case where total income exceeds Rs.50 lakh)
A Details of immovable assets
Sl. No. Description Address Pin code Amount (cost) in Rs.
(1) (2) (3) (4) (5)
B Details of movable assets

Sl. Amount (cost) in
Description
No. Rs.
(1) (2) (3)
(i) Jewellery, bullion etc. 0
(ii) Archaeological collections, drawings, painting, sculpture or any work of art 0
(iii) Vehicles, yachts, boats and aircrafts 0
Amount (cost) in
(iv) Financial assets
Rs.
(a) Bank (including all deposits) 0
(b) Shares and securities 0
(c) Insurance policies 0
(d) Loans and advances given 0
(e) Cash in hand 0
C Liabilities in relation to Assets at (A + B) 0
Note: Please refer to instructions for filling out this schedule.
Computation of total income
1 Salaries (6 of Schedule S) 1 1,90,656
2 Income from house property ( 4 of Schedule HP) (enter nil if loss) 2 2,39,400
3 Capital gains
Short term
i Short-term chargeable @ 15% (9ii of item E of schedule CG) ai 0
ii Short-term chargeable @ 30% (9iii of item E of schedule CG) aii 0

a iii Short-term chargeable at applicable rate (9iv of item E of schedule CG) aiii 0
Short-term chargeable at special rates in India as per DTAA (9v of item E of

iv aiv 0
Schedule CG)
v Total Short-term (ai + aii + aiii + aiv) (enter nil if loss) 3av 0
Long-term
i Long-term chargeable @ 10% (9vi of item E of schedule CG) bi 0
ii Long-term chargeable @ 20% (9vii of item E of schedule CG) bii 0

b
Long-term chargeable at special rates in India as per DTAA (9viii of item E of
iii biii 0
schedule CG)
iv Total Long-term (bi + bii + biii) (enter nil if loss) 3biv 0
c Total capital gains (3av + 3biv) (enter nil if loss) 3c 0
4 Income from other sources
Net income from other sources chargeable to tax at normal applicable rates (6 of
a 4a 1,76,192
Schedule OS) (enter nil if loss)
b Income chargeable to tax at special rates ( 2 of Schedule OS) 4b 0
Income from the activity of owning and maintaining race horses ( 8e of Schedule OS)
c 4c 0
(enter nil if loss)
d Total (4a + 4b + 4c) (enter nil if loss) 4d 1,76,192
5 Total of head wise income (1+2+3c+4d) 5 6,06,248
6 Losses of current year set off against 5 (total of 2xiii and 3xiii of Schedule CYLA) 6 0
Balance after set off current year losses (5-6) (total of column 4 of Schedule CYLA + 2 of
7 7 6,06,248
Schedule OS)
8 Brought forward losses set off against 7 ( 2xii of Schedule BFLA) 8 0
9 Gross Total income (7-8) (3xiii of Schedule BFLA + 2 of Schedule OS) 9 6,06,248
10 Income chargeable to tax at special rate under section 111A, 112, 112A etc. included in 9 10 0
11 Deductions under Chapter VI-A [v of Schedule VIA and limited to (9-10)] 11 2,00,000
12 Total income (9 - 11) 12 4,06,250

13 Income which is included in 12 and chargeable to tax at special rates (total of column (i) of 13 0
schedule SI)
14 Net agricultural income/ any other income for rate purpose ( 3 of Schedule EI) 14 0
Aggregate income (12-13+14) [applicable if (12-13) exceeds maximum amount not

15 15 4,06,250
chargeable to tax]
16 Losses of current year to be carried forward (total of row xi of Schedule CFL) 16 0
17 Deemed income under section 115JC (3 of Schedule AMT) 17 4,06,250

Computation of tax liability on total income
Tax payable on deemed total income u/s 115JC (4 of

a 1a 0
Schedule AMT)
1 b Surcharge on (a) (if applicable) 1b 0
c Health and Education Cess @ 4% on (1a + 1b) above 1c 0
d Total tax payable on deemed total income (1a + 1b + 1c) 1d 0
Tax payable on total income 5,313
a Tax at normal rates on 15 of Part B-TI 2a 5,313
b Tax at special rates (total of col. (ii) of Schedule SI) 2b 0

2
Rebate on agricultural income [applicable if (12-13) of
c Part B-TI exceeds maximum amount not chargeable to 2c 0
tax]
d Tax Payable on Total Income (2a + 2b - 2c) 2d 5,313
3 Rebate under section 87A 3 5,313
4 Tax payable after rebate (2d - 3) 4 0
5 Surcharge 0
Surcharge computed before marginal relief
i @ 25% of 16(ii) of Schedule SI 5i 0
@10% or 15%, as applicable of 2(ii), 3(ii), 8(ii), 11(ii), 21

ii 5ii 0
(ii), 23(ii) of Schedule SI
On [(4) – ( 16(ii), 2(ii), 3(ii), 8(ii), 11(ii), 21(ii), 23(ii) of

iii 5iii 0
Schedule SI)]
Surcharge after marginal relief
i @ 25% of 14(ii) of Schedule SI 5i 0
ia @ 25% of 16(ii) of Schedule SI 5ia 0
@10% or 15%, as applicable of 2(ii), 3(ii), 8(ii), 11(ii), 21

iia (ii), 23(ii) of Schedule SI On [(4) – ( 16(ii), 2(ii), 3(ii), 8(ii), 5iia 0
11(ii), 21(ii), 23(ii) of Schedule SI)]
iii Total (ia + iia) 5iii 0
6 Health and Education Cess @ 4% on (4 + 5iv) 6 0
7 Gross tax liability (4 + 5iv + 6) 7 0
8 Gross tax payable (higher of 1d and 7) 8 0
Tax on income without including income on perquisites

referred in section 17(2)(vi) received from employer,
a 8a 0
being an eligible start-up referred to in section 80-IAC (
Schedule Salary)
Tax deferred - relatable to income on perquisites

b referred in section 17(2)(vi) received from employer, 8b 0
being an eligible start-up referred to in section 80-IAC
Credit u/s 115JD of tax paid in earlier years (applicable only if 7 is higher than 1d) (row 5 of
9 9 0
Schedule AMTC)
10 Tax payable after credit u/s 115JD (8 - 9) 10 0
11 Tax relief
a Section 89(Please ensure to submit Form 10E) 11a 0
b Section 90/ 90A (2 of Schedule TR) 11b 0
c Section 91 (3 of Schedule TR) 11c 0
d Total (11a + 11b + 11c) 11d 0
12 Net tax liability (10 - 11d) (enter zero if negative) 12 0
13 Interest and fee payable
Interest for default in furnishing the return (section

a 13a 0
234A)
Interest for default in payment of advance tax (section

b 13b 0
234B)
c Interest for deferment of advance tax (section 234C) 13c 0
Fee for default in furnishing return of income (section

d 13d 0
234F)
e Total Interest and Fee Payable (13a+13b+13c+13d) 13e 0
14 Aggregate liability (12 + 13e) 14 0
15 Taxes Paid 9,822
a Advance Tax (from column 5 of 20A) 15a 0
b TDS (total of column 5 of 20B and column 9 of 20C) 15b 9,822
c TCS (total of column 5 of 20D) 15c 0
d Self-Assessment Tax (from column 5 of 20A) 15d 0
e Total Taxes Paid (15a + 15b + 15c + 15d) 15e 9,822
16 Amount payable (Enter if 14is greater than 15e, else enter 0) 16 0
17 Refund (If 15e is greater than 14) (Refund, if any, will be directly credited into the bank account) 17 9,820
Do you have a bank account in India (Non- Residents claiming refund with no bank account in India may
18 Select Yes or No
select No)
Sl. IFS Code of the Bank in case of Name of the Account Indicate the account in which you prefer to get your
No Bank Accounts held in India Bank Number refund credited, if any (tick accounts
STATE
1 SBIN0017594 BANK OF 10293473535
INDIA
Note:
1. Minimum one account should be selected for refund credit.
2. In case of Refund, multiple accounts are selected for refund credit, then refund will be credited to one of the account decided by CPC
after processing the return
Rows can be added as required
b) Non- residents, who are claiming income-tax refund and not having bank account in India may, at their option, furnish the details of
ii
one foreign bank account:
Sl. No. SWIFT Code Name of the Bank Country of Location IBAN
Do you at any time during the previous year,

(i) hold, as beneficial owner, beneficiary or otherwise, any asset (including financial interest in any entity) located
outside India; or Yes
19 ✔
(ii) have signing authority in any account located outside India; or No
(iii) have income from any source outside India?
[applicable only in case of a resident] [Ensure Schedule FA is filled up if the answer is Yes ]
20 TAX PAYMENTS
A Details of payments of Advance Tax and Self-Assessment Tax

Sl No BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Amount (Rs)
(1) (2) (3) (4) (5)
Advance Tax and Self Assessment Tax (total of column 5)

0
Note: Enter the totals of Advance tax and Self-Assessment tax in Sl No. 15a & 15d of Part B-TTI
B Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Sl Tax Deduction Account Number (TAN) of the Name of the Income chargeable under Total tax
No Employer Employer Salaries deducted
(1) (2) (3) (4) (5)
Note: Please enter total of column 5 in 11b of Part B-TTI
C Details of Tax Deducted at Source (TDS) on Income [As per Form 16 A issued or Form 16B/16C furnished by Deductor(s)]
Sl TDS credit relating to self PAN/ Aadhaar of TAN of the Unclaimed TDS TDS of the current Financial Year (TDS TDS credit being claimed this Year (only Corresponding TDS
No /other person [spouse as Other Person (if Deductor/ brought forward deducted during FY 2019-20) if corresponding income is being offered Receipt offered credit
per section 5A/other TDS credit related PAN/ Aadhaar (b/f) for tax this year) being
person as per rule 37BA to other person) of Tenant/ carried

Fin. Year TDS Deducted Deducted in the hands of Claimed Claimed in the hands of Gross Head
(2)] Buyer forward
in which b/f in own spouse as per section 5A in own spouse as per section 5A or Amount of
deducted hands or any other person as per hands any other person as per rule Income
rule 37BA(2) (if applicable) 37BA(2) (if applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Income TDS Income TDS PAN/
Aadhaar
1 Self MUMS86187D 0 9,822 0 0 9,822 0 0 / OS 0
1,30,510
TDS claimed in own hands (total of column 9)
9,822
Note: Please enter total of column 9 in11b of Part B- TTI
D Details of Tax Deducted at Source (TDS) on Income [As per Form 16A issued or Form 16B/16C/16D furnished by Deductor(s)]
Sl TDS credit relating to self PAN/ Aadhaar of PAN Unclaimed TDS TDS of the current Financial Year (TDS TDS credit being claimed this Year (only Corresponding TDS
No /other person [spouse as Other Person (if /Aadhaar brought forward deducted during FY 2019-20) if corresponding income is being offered Receipt offered credit
per section 5A/other TDS credit related No. of the (b/f) for tax this year) being
person as per rule 37BA(2)] to other person) Buyer / carried

Fin. Year TDS Deducted Deducted in the hands of Claimed Claimed in the hands of Gross Head
Tenant forward
in which b/f in own spouse as per section 5A or in own spouse as per section 5A or Amount of
deducted hands any other person as per rule hands any other person as per rule Income
37BA(2) (if applicable) 37BA(2) (if applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Income TDS Income TDS PAN/
Aadhaar
TDS claimed in own hands (total of column 9)
Note: Please enter total of column 9 in11b of Part B- TTI
E Details of Tax Collected at Source (TCS) [As per Form 27D issued by the Collector(s)]
Sl Tax Deduction and Collection Account Number of the Name of the Tax Amount out of (4) being Amount out of (4) being claimed in the hands of spouse, if section 5A is
No Collector Collector Collected claimed applicable
(1) (2) (3) (4) (5) (6)
TCS being claimed this year (total of column 5)
Note: Please enter total of column (5) in 11c of Part B-TTI

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INDIAN INCOME TAX RETURN

First Name Middle Name Last Name PAN

Or Filed in response to notice u/s 139(9), 142(1), 148, 153A, 153C

If revised/defective/modified, then enter Receipt No.

You have been a non-resident in India in 9 out of 10 preceding years

S. Jurisdiction(s) of Taxpayer Identification Number

Total period of stay in India

Residential Status in India (for ✔

Whether this return is being filed by a Representative Assesse? Yes ✔ No

(1) Name of the representative

(3) Address of the representative

(4) Permanent Account Number (PAN)/ Aadhaar of the representative /

fresh issue) existing shareholder)

SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE)

Details of Income from Salary

Name of Employer Nature of employer (Tick) TAN of Employer (mandatory if tax is

Sl.No. Nature of Exempt Allowance Amount

Details Of Income From House Property (Please Refer Instructions)

Is the property co-owned?

Your percentage of share in the property (%) 100

a Gross rent received or receivable or letable value 1a 1,62,000

b The amount of rent which cannot be realized 1b 0

c Tax paid to local authorities 1c 0

f Annual value of the property owned (own percentage share x 1 e) 1f 1,62,000

h Interest payable on borrowed capital 1h 0

j Arrears/Unrealised rent received during the year less 30% 1j 0

Is the property co-owned?

Your percentage of share in the property (%) 100

a Gross rent received or receivable or letable value 2a 1,80,000

b The amount of rent which cannot be realized 2b 0

c Tax paid to local authorities 2c 0

f Annual value of the property owned (own percentage share x 2 e) 2f 1,80,000

h Interest payable on borrowed capital 2h 0

j Arrears/Unrealised rent received during the year less 30% 2j 0

Is the property co-owned?

Your percentage of share in the property (%) 100

a Gross rent received or receivable or letable value 3a 0

b The amount of rent which cannot be realized 3b 0

c Tax paid to local authorities 3c 0

f Annual value of the property owned (own percentage share x 3 e) 3f 0

h Interest payable on borrowed capital 3h 0

j Arrears/Unrealised rent received during the year less 30% 3j 0

Is the property co-owned?

Your percentage of share in the property (%) 100

a Gross rent received or receivable or letable value 4a 0

b The amount of rent which cannot be realized 4b 0

c Tax paid to local authorities 4c 0

f Annual value of the property owned (own percentage share x 4 e) 4f 0

h Interest payable on borrowed capital 4h 0

j Arrears/Unrealised rent received during the year less 30% 4j 0

3 Pass through income/loss if any * 3 0

Income under the head “Income from house property” (1k + 2k + 3)

a i Full value of consideration received/receivable Ai 0

ii Value of property as per stamp valuation authority Aii 0

b Deductions under section 48

i Cost of acquisition without indexation Bi 0

ii Cost of Improvement without indexation Bii 0

iii Expenditure wholly and exclusively in connection with transfer Biii 0

iv Total (bi + bii + biii) Biv 0