Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

INDIAN INCOME TAX RETURN

FORM [For Individuals, HUFs and Firms (other than LLP) being a resident having total income upto Rs.50 lakh and
Assessment
having income from business and profession which is computed under sections 44AD, 44ADA or 44AE] [Not
ITR4 Year
for an individual who is either Director in a company or has invested in unlisted equity shares or if income-
SUGAM 2023-24
tax is deferred on ESOP or has agricultural income more than Rs.5000] (Please refer instructions for
eligibility)

PART A GENERAL INFORMATION

(A3) Last Name (A4) Permanent Account Number

(A1) First Name (A2) Middle Name
SHUBHAM JIIPS5042B
(A5) Date of Birth/Formation (DD/MM/YYYY) (A6) Flat/Door/Block No.
20/01/1999 S/O SH. SHIV KUMAR
(A8) Road/Street/Post Office (A9) Area/Locality
(A7) Name of Premises/Building/Village
ANAJ MANDI H.NO.10 WARD NO.8,
(A10) Town/City/District (A11) State (A12) Country/Region (A13) PIN Code/ZIP Code
CHARKHI DADRI 12-Haryana 91- INDIA 127306
(A14) Aadhaar Number(12 digits)/Aadhaar Enrolment Id(28 digits) (if eligible for Aadhaar No.) (A15) Status
5xxx xxxx 9432 Individual
(A16) Residential/Office Phone Number with STD Code /Mobile No.1
(A17) Mobile No.2
/ 91 8221973592
(A18) Email Address-1(Self)
Email Address-2 (A19) Nature of employment Not Applicable
[email protected]
(A20)(a) Filed u/s (Tick)[Please see instruction] (b) Or Filed in response to
139(1)-On or before due date
notice u/s"
(A21) If revised/defective then enter Receipt No. and Date of filing of
original return (DD/MM/YYYY)
(A22) If filed in response to notice u/s 139(9)/142(1)/148/153C or order u/s
119(2)(b)- enter Unique Number/ Document Identification Number (DIN) &
Date of such Notice or Order
(A23) (a) Have you ever opted for new tax regime u/s 115BAC in earlier years ?
Yes No
If Yes is Selected, please furnish the AY in which said option
is excercised along with the date of filing and
acknowledgement number of Form 10IE
(A23) (b) Have you ever opted out of section 115BAC in earlier years ?
Yes No
If Yes is Selected, please furnish the AY in which said option
is opted out along with the date of filing and
acknowledgement number of Form 10IE
(A23) (c) Option for current assessment year (Select Opting in now only if you are opting
Not opting
for first time)
For 'Opting in now' or 'Opt out', please furnish the date of filing and acknowledgement
number of Form 10IE
(A24) Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? (Not applicable
in case of firm) - (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)]
(i) Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more current account
during the previous year? 0
Yes No
(ii) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for travel to a
foreign country for yourself or for any other person? 0
Yes No
(iii) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 1 lakh on consumption
of electricity during the previous year? 0
Yes No
(iv) Are you required to file a return as per other conditions prescribed under clause (iv) of seventh proviso to section 139(1) (If yes, please select the
relevant condition from the drop down menu)
Yes No
(A25) Whether this return is being filed by a representative assessee?
Yes No
If yes, please furnish following information -

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

(1) Name of the representative

(2) Capacity of the representative

(3) Address of the representative

Permanent Account Number (PAN)/ Aadhaar

(4)
No. of the representative

PART B GROSS TOTAL INCOME

B1 Income from Business & Profession B1 6,11,596

B2 i Gross Salary (ia + ib + ic + id + ie) i 0

a Salary as per section 17(1) ia 0

b Value of perquisites as per section 17(2) ib 0

c Profit in lieu of salary as per section 17(3) ic 0

Income from retirement benefit account maintained in a notified country u/s

d id 0
89A

Income from retirement benefit account maintained in a country other than

e ie 0
notified country u/s 89A

Less allowances to the extent exempt u/s 10 [Ensure that it is included in salary income u/s
ii ii 0
17(1)/17(2)/17(3)]
Sl.
Nature of Exempt Allowance Description ( If Any Other selected) Amount
No.

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

iia Less : Income claimed for relief from taxation u/s 89A iia 0

iii Net Salary (i - ii - iia) iii 0

iv Deductions u/s 16 (iva + ivb + ivc) iv 0

a Standard deduction u/s 16(ia) iva 0

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) B2

0

B3 Type Of House Property B3

i Gross rent received/ receivable/ lettable value during the year i 0

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

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

vi Arrears/Unrealized Rent received during the year Less 30% vi 0

Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put the figure in
negative) Note:- Maximum loss from house property that can be set-off in computing income
vii B3 0
of this year is INR 2, 00,000. To avail the benefit of carry forward and set of loss, please use
ITR -3/5.

B4 Income from Other Sources B4 38,291

Sl.
Nature of Income Description ( If Any Other selected) Total Amount
No.

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

1 Any Other Insurance commission 38,091

2 Any Other Other Income 200

Quarterly breakup of Dividend Income Quarterly breakup of Income from retirement benefit
account maintained in a notified country u/s 89A
(taxable portion)

(i) Up to 15-Jun-2022 0 (i) Up to 15-Jun-2022 0

From 16-Jun-2022 to From 16-Jun-2022 to 15-

(ii) 0 (ii) 0
15-Sep-2022 Sep-2022
From 16-Sep-2022 to From 16-Sep-2022 to
(iii) 0 (iii) 0
15-Dec-2022 15-Dec-2022
From 16-Dec-2022 to From 16-Dec-2022 to
(iv) 0 (iv) 0
15-Mar-2023 15-Mar-2023
From 16-Mar-2023 to From 16-Mar-2023 to
(v) 0 (v) 0
31-Mar-2023 31-Mar-2023

Less: Deduction u/s 57(iia) (in case of family pension only) 0

Less: Income claimed for relief from taxation u/s 89A 0

Gross Total Income (B1+B2+B3+B4) To avail the benefit of carry forward and set off of loss,
B5 B5 6,49,887
please use ITR-3/5.

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

PART C - DEDUCTIONS AND TAXABLE TOTAL INCOME

Sl.No. Section Amount System Calculated

80C - Life insurance premium, deferred annuity, contributions to 1,50,000

C1 1,50,000
provident fund, subscription to certain equity shares or debentures, etc.

C2 80CCC - Payment in respect Pension Fund 0 0

C3 80CCD(1) - Contribution to pension scheme of Central Government 0 0

C4 80CCD(1B) -Contribution to pension scheme of Central Government 0 0

80CCD(2) - Contribution to pension scheme of Central Government by 0

C5 0
employer

C6 80D - Deduction in respect of health insurance premia 0 0

80DD - Maintenance including

C7 medical treatment of a dependent 0 0
who is a person with disability

80DDB - Medical treatment of

C8 0 0
specified disease

C9 80E - Interest on loan taken for higher education 0 0

C10 80EE - Interest on loan taken for residential house property 0 0

80EEA - Deduction in respect of interest on loan taken for certain house 0

C11 0
property

C12 80EEB - Deduction in respect of purchase of electric vehicle 0 0

C13 80G - Donations to certain funds, charitable institutions 0 0

C14 80GG - Rent paid 0 0

C15 80GGC - Donation to Political party 0 0

C16 80TTA - Interest on deposits in saving bank Accounts 0 0

C17 80TTB- Interest on deposits in case of senior citizens. 0 0

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

80U - In case of a person with

C18 0 0
disability

C19 80CCH - Contribution to Agnipath Scheme 0 0

C20 Total deductions (Add items C1 to C19) 1,50,000 1,50,000

C21 Taxable Total Income (B5 - C20) 4,99,890

PART D - TAX COMPUTATIONS AND TAX STATUS

D1 Tax payable on total income D1 12,495

D2 Rebate on 87A D2 12,495

D3 Tax payable after Rebate (D1-D2) D3 0

D4 Health and Education Cess @ 4% on (D3) D4 0

D5 Total Tax, and Cess (D3 + D4) D5 0

D6 Relief u/s 89 (Please ensure to submit Form 10E to claim this relief) D6 0

D7 Balance Tax after Relief (D5 – D6) D7 0

D8 Total Interest u/s 234A D8 0

D9 Total Interest u/s 234B D9 0

D10 Total Interest u/s 234C D10 0

D11 Fee u/s 234F D11 0

D12 Total Tax, Fee and Interest (D7 + D8 + D9 + D10 + D11) D12 0

D13 Total Advance Tax Paid D13 0

D14 Total Self-Assessment Tax Paid D14 0

D15 Total TDS Claimed ( total of column 4 of Schedule-TDS1 and column 6 of Schedule- D15 1,218
TDS2 )

D16 Total TCS Collected ( total of column (5) of Schedule-TCS ) D16 0

D17 Total Taxes Paid (D13 + D14 + D15 +D16) D17 1,218

D18 Amount payable (D12 - D17, If D12 > D17) D18 0

D19 Refund (D17 - D12, If D17 > D12) D19 1,220

PART E - OTHER INFORMATION DETAILS OF ALL BANK ACCOUNTS HELD IN INDIA AT ANY TIME DURING THE PREVIOUS YEAR
(EXCLUDING DORMANT ACCOUNTS)
Sl. Select Account for Refund
IFS Code of the Bank Name of the Bank Account Number
No. Credit

(1) (2) (3) (4) (5)

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

1 HDFC0001968 HDFC BANK 50100383443083

EXEMPT INCOME ONLY FOR REPORTING PURPOSES (IF AGRICULTURAL INCOME IS MORE THAN RS.5,000/-, USE ITR 3/5)
Sl.
Nature of Income Description (If 'Any Other' is selected) Amount
No.

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

Total 0

SCHEDULE BP - DETAILS OF INCOME FROM BUSINESS OR PROFESSION

COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD

Sl.
Name of Business Business code Description
No.

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

WHOLESALE AND RETAIL TRADE [Retail

1 Shubham Retail sale of other products n.e.c
sale of other products n.e.c]

E1 Gross Turnover or Gross Receipts i

Through a/c payee cheque or a/c payee bank draft or bank electronic clearing
a E1a 0
system received or prescribed electronic modes received before specified date

b Any other mode E2b 39,45,780

E2 Presumptive Income under section 44AD ii

a 6% of E1a or the amount claimed to have been earned, whichever is higher E2a 0

b 8% of E1b or the amount claimed to have been earned, whichever is higher E2b 6,11,596

c Total (a + b) E2c 6,11,596

COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA

Sl.
Name of Business Business code Description
No.

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

E3 Gross Receipts E3 0

Presumptive Income under section 44ADA (50% of E3) or the amount claimed to have
been earned, whichever is higher NOTE- If Income is less than 50% of Gross Receipts,
E4 E4 0
it is mandatory to have a tax audit under 44AB & other ITR as applicable has to be
filed
COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE
Sl.
Name of Business Business code Description
No.

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

Presumptive income u
/s 44AE for the goods
carriage (Computed @
Rs.1000 per ton per
Number of months for
month in case
which goods carriage
Sl. Registration No. of Whether owned/ Tonnage capacity of tonnage exceeds
was owned
No. goods carriage leased/hired goods carriage(in MT) 12MT, or else @ Rs.
/leased/hired by
7500 per month) or
assessee
the amount claimed to
have been actually
earned, whichever is
higher

(1) (2) (3) (4) (5) (6)

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

Presumptive Income from Goods Carriage under section 44AE [total of column (5)]
E5 NOTE- If the profits are lower than prescribed under S.44AE or the number of Vehicles E5 0
owned at any time exceed 10 then other ITR, as applicable, has to be filed

E6 Salary and interest paid to the partners NOTE - This is to be filled up only by firms E6 0

E7 Presumptive Income u/s 44AE (E5-E6) E7 0

E8 Income chargeable under the head 'Business or Profession (E2c+E4+E7) E8 6,11,596

E9 Information regarding turnover/gross receipt reported for GST

Sl. Annual Value of Outward Supplies as per the GST Return

GSTIN No.(s)
No. Filed

(1) (2) (3)

E10 Total of value of Outward Supplies as per the GST returns filed E10 0

FINANCIAL PARTICULARS OF THE BUSINESS NOTE- FOR E11 TO E25 FURNISH THE INFORMATION AS ON 31ST DAY OF MARCH, 2023

E11 Partners/ Members own capital E11 0

E12 Secured loans E12 0

E13 Unsecured loans E13 0

E14 Advances E14 0

E15 Sundry creditors E15 0

E16 Other liabilities E16 0

E17 Total capital and liabilities (E11+E12+E13+E14+E15+E16) E17 0

E18 Fixed assets E18 0

E19 Inventories E19 10,21,554

E20 Sundry debtors E20 5,68,230

E21 Balance with banks E21 0

E22 Cash-in-hand E22 1,78,458

E23 Loans and advances E23 0

E24 Other assets E24 0

E25 Total assets (E18+E19+E20+E21+E22+E23+E24) E25 17,68,242

SCHEDULE IT - DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS

Sl.
BSR Code Date of Deposit (DD/MM/YYYY) Challan No. Tax paid
No.
Col
Col (2) Col (3) Col (4) Col (5)
(1)

Total 0

SCHEDULE TCS - DETAILS OF TAX COLLECTED AT SOURCE [AS PER FORM 27D ISSUED BY THE COLLECTOR(S)]
Details of amount paid
Sl. Tax Collection Account Amount out of (4) being
Name of the Collector as mentioned in Form Tax Collected
No. Number of the Collector claimed
26AS

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

Col
Col (2) Col (3) Col (4) Col (5) Col (6)
(1)

Total 0

SCHEDULE TDS1 - DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY

[AS PER FORM 16 ISSUED BY EMPLOYER(S)]
Sl.
TAN Name of the Employer Income under Salary Tax deducted
No.
Col
Col (2) Col (3) Col (4) Col (5)
(1)

Total 0

SCHEDULE TDS2(I) - DETAILS OF TAX DEDUCTED AT SOURCE ON INCOME OTHER THAN SALARY [AS PER FORM 16 A ISSUED BY
DEDUCTOR(S)]
TDS credit
being claimed
this Year (only
Unclaimed TDS brought TDS of the Corresponding Receipt /
forward (b/f) if
current Fin. withdrawals offered
corresponding
Year (TDS
Tax Deduction receipt is
deducted
Account being offered TDS credit
Sl. during the FY
Number (TAN) for tax this being carried
No. 2022-23)
of the year not forward
Deductor applicable if
Fin. Year in TDS is
which TDS is TDS b/f deducted u/s Gross Amount Head of
deducted 194N) Income
TDS Deducted
TDS Claimed

(1) (2) (3) (4) (5) (6) (7) (8) (9)

Income from
1 MUMB08828B 0 70 70 1,386 0
Other Source
Income from
2 MUMB08828B 0 213 213 4,251 0
Other Source
Income from
3 MUMB08828B 0 70 70 1,386 0
Other Source
Income from
4 MUMB08828B 0 224 224 4,477 0
Other Source
Income from
5 DELZ02006E 0 10 10 200 0
Other Source
Income from
6 MUMB08828B 0 70 70 1,386 0
Other Source
Income from
7 MUMB08828B 0 208 208 4,159 0
Other Source
Income from
8 MUMB08828B 0 266 266 5,313 0
Other Source
Income from
9 MUMB08828B 0 87 87 1,733 0
Other Source

Total 1,218

SCH TDS 2(II) DETAILS OF TAX DEDUCTED AT SOURCE [AS PER FORM 16C / 16D FURNISHED BY PAYER(S)]

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

TDS credit
being
Unclaimed TDS brought TDS of the Corresponding Receipt
claimed this
forward (b/f) current offered
Year (only if
Financial correspondin
Year TDS Credit
PAN of the Aadhaar No g receipt is
Sl. being
Tenant / of the tenant being
No. carried
Deductor / Deductor offered for
forward
Fin. Year in tax this
which TDS b/f year) Gross Head of
deducted TDS Amount Income
Deducted
TDS Claimed

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Total 0

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

Medical Expenditure (This deduction to be claimed on which health insurance is

(iii) 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

Medical Expenditure (This deduction can be claimed on which health insurance is

(iii) not claimed at (i) above) 0

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

Amount of donation
City or Eligible
Sl. Name of Address Pin code PAN of
Town or State code Amount of
No. the Donee Donee Donation in Donation in Total
District Donation
cash other mode donation

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 151809980160523 Date of Filing : 16-May-2023*

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total A 0 0 0 0

B. DONATIONS ENTITLED FOR 50% DEDUCTION WITHOUT QUALIFYING LIMIT

City or Amount of donation Eligible

Sl. Name of PAN of
Address Town or State code Pin code Amount of
No. the Donee Donee Donation in Donation in Total
District Donation
cash other mode donation

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total B 0 0 0 0

C. DONATIONS ENTITLED FOR 100% DEDUCTION SUBJECT TO QUALIFYING LIMIT

City or Amount of donation Eligible

Sl. Name of PAN of
Address Town or State code Pin code Amount of
No. the Donee Donee Donation in Donation in Total
District Donation
cash other mode donation

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total C 0 0 0 0

D. DONATIONS ENTITLED FOR 50% DEDUCTION SUBJECT TO QUALIFYING LIMIT

ARN Amount of donation

City or Eligible
Sl. Name of PAN of (Donation
Address Town or State code Pin code Donation Amount of
No. the Donee Donee Reference Donation Total
District in other Donation
Number) in cash donation
mode

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Total D 0 0 0 0

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

VERIFICATION

I, SHUBHAM son/ daughter of SHIV KUMAR 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 JIIPS5042B

Place: CHARKHI DADRI

Date: 16-May-2023

If the return has been prepared by a Tax Return Preparer (TRP) give further details below:

TRP PIN (10 digit) Name of TRP Counter Signature of TRP

Amount to be paid to TRP 0

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”