Acknowledgement Number : 710115910211021

INDIAN INCOME TAX RETURN

[For individuals being a resident (other than not ordinarily resident) having total
income upto Rs.50 lakh, having Income from Salaries, one house property, other
FORM

Assessment
ITR 1 sources (Interest etc.), and agricultural income upto Rs.5 thousand]
Year
SAHAJ [Not for an individual who is either Director in a company or has invested in unlisted 2021-22
equity shares or in cases where TDS has been deducted u/s 194N or if income-tax is
deferred on ESOP]
(Refer instructions for eligibility)

PART A GENERAL INFORMATION

PAN Name Date of Birth Aadhaar Number (12 digits)/Aadhaar Enrolment Id (28 digits) (If
AYMPA6732H ANKUR 15-Oct-1992 eligible for Aadhaar No.)
7xxx xxxx 0750
Mobile No Email Address Address:
+ 917060965883 [email protected] 101GHASOULI-2, Ghasauli B.O, Ganaur, SONIPAT, 12 - Haryana,
91 - India 131101

Filed u/s (Tick) 139(1)-On or before due date, Nature of Employment -

[Please see Central Govt. State Govt.
139(4)-Belated, 139(5)-Revised,
instruction] Public Sector Undertaking
119(2)(b)- After Condonation of delay,
139(8A) Pensioners Others

Or Filed in Not Applicable (e.g. Family Pension etc.)

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

If revised/defective, then enter Receipt No. and Date of filing original return (DD/
MM/YYYY)
If filed in response to notice u/s 139(9)/142(1)/148 or order u/s 119(2)(b)- enter
Unique Number/Document Identification Number (DIN) And Date of such Notice or
Order

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) but otherwise not required to furnish return of income? - (Tick)
Yes No
If yes, please furnish following information
[Note: To be filled only if a person is not required to furnish a return of income under section 139(1) but filing return of income due to fulfilling
one or more conditions mentioned in the seventh proviso to section 139(1)]
Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more 0
current account during the previous year?
Yes No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for 0
travel to a foreign country for yourself or for any other person?
Yes No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on 0
consumption of electricity during the previous year?
Yes No

PART B GROSS TOTAL INCOME Whole - Rupee only

B1 i Gross Salary (ia+ib+ic) i 1,80,000

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 a Salary as per section 17(1) ia 1,80,000
b Value of perquisites as per section ib 0
SALARY / PENSION
17(2)
c Profit in lieu of salary as per ic 0
section 17(3)
ii Less allowances to the extent exempt u/s 10 (Ensure that it is included in salary income u/s ii 0
17(1)/17(2)/17(3) )
iii Net Salary (i – ii) iii 1,80,000

iv Deductions u/s 16 (iva + ivb + ivc) iv 50,000

a Standard deduction u/s 16(ia) iva 50,000

b Entertainment allowance u/s 16(ii) ivb 0

c Professional tax u/s 16(iii) ivc 0

v Income chargeable under the head ‘Salaries’ (iii – iv) B1 1,30,000

B2 Tick applicable option Self-Occupied Let Out Deemed Let Out
i Gross rent received/ receivable/ lettable value during the year i 0
HOUSE PROPERTY

ii Tax paid to local authorities ii 0

iii Annual Value (i – ii) iii 0
iv 30% of Annual Value iv 0
v Interest payable on borrowed capital v 0
vi Arrears/Unrealised rent received during the year vi 0
less 30%
vii Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put the figure in B2 0
negative)
Maximum loss from House Property that can be set-off is INR 2,00,000. To avail the benefit
of carry forward and set off of loss, please use ITR-2
B3 Income from Other Sources B3 2,20,000
S.No. Nature of Income Description ( If Any Other selected) Total Amount
1. Any Other OTHER JOB WORK 220000
Less: Deduction u/s 57(iia) (in case of family pension only) 0
Less: Income claimed for relief from taxation u/s 89A 0
B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4 3,50,000
Note: To avail the benefit of carry forward and set of loss, please use ITR-2

Part C - Deductions and Taxable Total Income (Refer instructions for Deduction limit as per Income-tax Act. Please note that the
deduction in respect of the investment/ deposit/ payments for the period 01-04- 2020 to 31-07-2020 cannot be claimed again, if
already claimed in the AY 2020-21)

S.No. Section Amount System Calculated

a 80C - Life insurance premia, deferred annuity, 5a 0 0

contributions to provident fund, subscription to certain
equity shares or debentures, etc.
b 80CCC - Payment in respect Pension Fund,etc. 5b 0 0
c 80CCD(1) - Contribution to pension scheme of Central 5c 0 0
Government
d 80CCD(1B) - Contribution to pension scheme of Central 5d 0 0
Government
e 80CCD(2) - Contribution to pension scheme of Central 5e 0 0
Government by employer
f 80D Deduction in respect of Health Insurance premia 5f 0 0
(Please fill 80D Schedule. This field is auto-populated
from schedule 80D.)

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g 80DD - Maintenance including medical treatment of a 5g 0 0
dependent who is a person with disability -
h 80DDB - Medical treatment of specified disease - 5h 0 0
i 80E - Interest on loan taken for higher education 5i 0 0
j 80EE - Interest on loan taken for residential house 5j 0 0
property
k 80EEA - Deduction in respect of interest on loan taken 5k 0 0
for certain house property
l 80EEB - Deduction in respect of purchase of electric 5l 0 0
vehicle
m 80G - Donations to certain funds, charitable institutions, 5m 0 0
etc. (Please fill 80G Schedule. This field is auto-
populated from schedule.)
n 80GG - Rent paid 5n 0 0
o 80GGA - Certain donations for scientific research or 5o 0 0
rural development (Please fill 80GGA Schedule. This
field is auto-populated from schedule.)
p 80GGC - Donation to Political party 5p 0 0
q 80TTA - Interest on deposits in savings Accounts 5q 0 0
r 80TTB- Interest on deposits in case of senior citizens 5r 0 0
s 80U-In case of a person with disability 5s 0 0
Total Deductions (Add items 5a to 5s) 0 0
Note: Total deductions under chapter VI A cannot exceed GTI.
Total Income 3,50,000

Exempt income (For reporting Purposes)

S.No. Nature of Income Description ( If Any Other Total Amount

selected)
Total Exempt Income 0

PART D – COMPUTATION OF TAX PAYABLE

D1 Tax payable 5,000 D2 Rebate u/s 5,000 D3 Tax after 0

on total 87A Rebate
income
D4 Health and 0 D5 Total Tax 0 D6 Relief u/s 0
education and Cess 89 (Please
Cess @ 4% ensure to
on D3 submit Form
10E to claim
this relief)
D7 Interest u/s 0 D8 Interest u/s 0 D9 Interest u/s 0
234A 234B 234C
D7 Interest u/s 0 D8 Interest u/s 0 D9 Interest u/s 0
234A 234B 234C
D12 Total Taxes 0 D13 Amount 0 D14 Refund 0
Paid payable(D11- (D12-D11) (if
D12) (if D12>D11)
D11>D12)

PART E – OTHER INFORMATION

Details of all Bank Accounts held in India at any time during the previous year (excluding dormant accounts)

SI. IFS Code of the Bank Name of the Bank Account Number Select Account for
Refund Credit
1 UTIB0001844 AXIS BANK 915010003202564

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.

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Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior citizen? Not claiming for Self/ Family
(a) Self & Family 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(b) Self & Family including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(iii) Medical Expenditure (This deduction to be claimed on which health insurance is 0
not claimed at (i) above)
2 Whether any one of your parents is a senior citizen Not claiming for Parents
(a) Parents 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(b) Parents including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(iii) Medical Expenditure (This deduction can be claimed on which health insurance is 0
not claimed at (i) above)
3 Eligible Amount of Deduction 0
Schedule 80G: Details of donations entitled for deduction under section 80G
A. Donations entitled for 100% deduction without qualifying limit, (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total A 0 0 0 0

B. Donations entitled for 50% deduction without qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total B 0 0 0 0

C. Donations entitled for 100% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should
become mandatory)
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total C 0 0 0 0

D. Donations entitled for 50% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Donee Address City or Town or State Code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total D 0 0 0 0

E. Total Amount of Donations (A + B + C + D) 0 0 0 0

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Schedule 80GGA: Details of donations for scientific research or rural development
S No. Relevant Clause under Name of the Address City or State Code Pincode PAN of the Amount of donation Eligible
which deduction is Donee Town or Donee Amount
claimed District Donation Donation Total of
in cash in other Donation Donation
mode

- 0 0 0 0

Total Donations 0 0 0 0

Schedule-IT Details of Advance Tax and Self-Assessment Tax payments

BSR Code Date of Deposit(DD/MM/YYYY) Serial Number of Challan Tax paid

Col (1) Col (2) Col (3) Col (4)

Total 0

Schedule TDS1 - Details of Tax Deducted at Source from Salary [As per form 16 issued by Employer(s)]

Sl.No. TAN of the Deductor Name of Deductor Income chargeable under Total Tax Deducted
Salaries

1 2 3 4

Total 0

Schedule TDS2 - Details of Tax Deducted at Source from Income Other than Salary [As per form 16A issued by Deductor(s)]

Sl.No. Tax Name of the Deductor Gross receipt which Year of tax deduction Tax Deducted TDS Credit out of (5)
Deduction is subject to tax claimed for this Year
Account deduction
Number
(TAN) of the
Deductor

1 2 3 4 5 6

Total 0

Schedule TDS3 - Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]

Sl.No PAN of the Aadhaar Name of the Gross receipt which Year of Tax Deduction Tax Deducted TDS Credit out of (6)
Tenant Number of the Tenant is subject to tax claimed this Year
Tenant Deduction

1 2 3 4 5 6 7

Total 0

Schedule TCS - Details of Tax Collected at Source [As per form 27D issued by the Collector(s)]

Sl.No. Tax Collection Name of the Collector Gross payment Year of taxcollection Tax Collected TCS Credit out of (5)
Account Number which is subject to claimed this year
ofthe Collector tax collection

1 2 3 4 5 6

Total 0

VERIFICATION

I, ANKUR son/ daughter of SIYA NAND solemnly declare that to the best of my knowledge and belief, the information given in the
return is correct and complete and is in accordance with the provisions of the Income-tax Act, 1961. I further declare that I am making
this return in my capacity as Self and I am also competent to make this return and verify it. I am holding permanent account number AY
MPA6732H
Place : 122.177.105.99
Date : 21-Oct-2021

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No. of TRP Name of TRP Counter Signature of TRP

If TRP is entitled for any reimbursement from the Government, amount thereof

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