Acknowledgement Number:317290680270923

FORM 3CB [See rule 6G(1)(b)]

Audit report under section 44AB of the Income-tax Act, 1961, in the case of a person referred to in clause (b) of sub-rule (1) of rule 6G

1. We have examined the balance sheet as on 31st March 2023 , and the Profit and loss account
for the period beginning from 01-Apr-2022 to ending on 31-Mar-2023 attached herewith, of

Name ANJU SINGH (PROP. M/S HERITAGE HOSPITAL)

Address HARSEAKPUR NO 2, NEAR CHANDI MATA MANDIR ,

GORAKHPUR , 31-Uttar Pradesh , 91-India , Pincode -
273003

PAN AYJPA2311D

Aadhaar Number of the assessee, if available

2. We certify that the balance sheet and the Profit and loss account are in agreement with the books of account maintained at the head office at HARSEAKPUR NO 2,
NEAR CHANDI MATA MANDIR, GORAKHPUR-273003 and 0 branches.

3. a. We report the following observations/comments/discrepancies/inconsistencies if any: A)The account has been prepared on mercantile basis. B ) Fixed Assets
has been stated at cost Less depreciation. Depreciation has been charged on the rates as per Income Tax Rules 1962. C) Party statements were not
produced to us, hence balance lying in party accounts are subject to confirmation. D) Cash in Hand as on 31/03/2023 has been certified by the Assessee. E)
Value of Closing Stock as on 31/03/2023 has been taken and valued by the Proprietor F)Assessee declared that no payment has been made to the persons
specified under Section 40 A (2)(b) of the Income Tax Act, 1961. G) In the opinion of the assessee Current Assets are approximately of the value stated in the
balance sheet if realised in the ordinary course of business.

b. Subject to above,-

A. We have obtained all the information and explanations which, to the best of Our knowledge and belief, were necessary for the purposes of the audit.

B. In Our opinion, proper books of account have been kept by the head office and branches of the assessee so far as appears from Our examination of the books.

C. In Our opinion and to the best of Our information and according to the explanations given to Us the said accounts, read with notes thereon, if any, give a true and fair
view:-

i. In the case of the balance sheet, of the state of the affairs of the assessee as at 31st March 2023 ; and

ii. In the case of the Profit and loss account, of the Profit of the assessee for the year ended on that date.

4. The statement of particulars required to be furnished under section 44AB is annexed herewith in Form No. 3CD.

5. In Our opinion and to the best of Our information and according to the explanations given to Us , the particulars given in the said Form No. 3CD are true and correct,
subject to the following observations/qualifications, if any:

Sl.
Qualification Type Observations/Qualifications
No.

1 Valuation of closing stock is not possible Stocks are value taken as certified by the proprietor.

2 Records produced for verification of The assessee has not made any payments exceeding the limit in section 40A(3)/269SS/269T in Cash.
payments through account payee cheque However, it is not possible for us to verify whether the payments in excess the specified limit in section 40A(3)
were not sufficient /269SS/269T have been made otherwise than by account payee cheque or account payee bankdraft, as the
necessary evidence are not in possession of the assessee.

3 Information regarding demand raised or This has been reported as informed to us by the management.
refund issued during the previous year
under any tax laws other than Income-tax
Act, 1961 and Wealth tax Act, 1957 was
not made available

4 Others Reporting under clause 44 being statistical in nature and the assessee not maintaining any register or records
for analysis of purchases & expenses from registered & unregistered dealers since not mandatorily required
under Income Tax Act or under Goods and Service Tax Act or under any other Statutes. Furthure as per the
accounting records it is not possible for Us to extract the details required to be reported under this clause. In
view of which we are unable to report statistical inforfation under this Clause.

Accountant Details

Name DURGA PRASAD VIJAY DUBEY

Acknowledgement Number:317290680270923

Membership Number 405588

FRN(Firm Registration Number) 011377C

Address
5A 2ND FLOOR ,LAXMANPURI , NEAR BHOOTHNATH METRO STATION ,
Indira Nagar S.O (Lucknow) , Lucknow , LUCKNOW , 31-Uttar Pradesh , 91-
India , Pincode - 226016

Date of signing Tax Audit Report 23-Aug-2023

Place 27.57.74.49

Date 27-Sep-2023

This form has been digitally signed by DURGA PRASAD DUBEY having PAN AJFPD7603N from IP Address 27.57.74.49 on 27/09/2023 03:23:16 PM Dsc Sl.No and issuer
,C=IN,O=Verasys Technologies Pvt Ltd.,OU=Certifying Authority
Acknowledgement Number:317290680270923

FORM 3CD [See rule 6G(2)]

Statement of particulars required to be furnished under section 44AB of the Income-tax Act, 1961

PART - A

1. Name of the Assessee ANJU SINGH (PROP. M/S HERITAGE HOSPITAL)

2. Address of the Assessee

HARSEAKPUR NO 2, NEAR CHANDI MATA MANDIR , Arogyamandir S.O ,
Gorakhpur , GORAKHPUR , 31-Uttar Pradesh , 91-India , Pincode - 273003

3. Permanent Account Number (PAN) AYJPA2311D

Aadhaar Number of the assessee, if available

4. Whether the assessee is liable to pay indirect tax like excise duty, service tax, sales tax, goods and services tax,customs Yes
duty,etc. if yes, please furnish the registration number or,GST number or any other identification number allotted for the same ?

Sl. No. Type Registration /Identification Number

1 Goods and Services Tax 09AYJPA2311D1Z3

31-Uttar Pradesh

5. Status Individual

6. Previous year 01-Apr-2022 to 31-Mar-2023

7. Assessment year 2023-24

8. Indicate the relevant clause of section 44AB under which the audit has been conducted

Sl. No. Relevant clause of section 44AB under which the audit has been conducted

1 Clause 44AB(a)- Total sales/turnover/gross receipts of business exceeding specified limits

8(a). Whether the assessee has opted for taxation under section 115BA / 115BAA / 115BAB / 115BAC / 115BAD ? No

Section under which option exercised

PART - B

9.(a). If firm or Association of Persons, indicate names of partners/members and their profit sharing ratios. In case of AOP,
whether shares of members are indeterminate or unknown?

Sl. No. Name Profit Sharing Ratio (%)

No records added

(b). If there is any change in the partners or members or in their profit sharing ratio since the last date of the preceding year, the
particulars of such change ?

Sl. No. Date of change Name of Partner/Member Type of change Old profit sharing ratio (%) New profit Sharing Ratio (%) Remarks

No records added

10.(a). Nature of business or profession (if more than one business or profession is carried on during the previous year, nature of
every business or profession).

Sl. No. Sector Sub Sector Code

1 HEALTH CARE SERVICES General hospitals 18001

(b). If there is any change in the nature of business or profession, the particulars of such change ? No
Acknowledgement Number:317290680270923

Sl. No. Business Sector Sub Sector Code

No records added

11.(a). Whether books of accounts are prescribed under section 44AA, if yes, list of books so prescribed ? Yes

Sl. No. Books prescribed

1 CASH BOOK

2 BANK BOOK

3 SALES BOOK

4 PURCHASE BOOK

(b). List of books of account maintained and the address at which the books of accounts are kept. (In case books of account are
maintained in a computer system, mention the books of account generated by such computer system. If the books of accounts
are not kept at one location, please furnish the addresses of locations along with the details of books of accounts maintained at
each location.)

Books Address Line Address City Or Town Or

Sl. No. Zip Code / Pin Code Country State
maintained 1 Line 2 District

1 CASH HARSEAKPUR GORAKHPUR 273303 91-India 31-Uttar Pradesh

BOOK NO 2, NEAR
CHANDI MATA
MANDIR

2 BANK HARSEAKPUR GORAKHPUR 273303 91-India 31-Uttar Pradesh

BOOK NO 2, NEAR
CHANDI MATA
MANDIR

3 SALES HARSEAKPUR GORAKHPUR 273303 91-India 31-Uttar Pradesh

BOOK NO 2, NEAR
CHANDI MATA
MANDIR

4 PURCHASE HARSEAKPUR GORAKHPUR 273303 91-India 31-Uttar Pradesh

BOOK NO 2, NEAR
CHANDI MATA
MANDIR

(c). List of books of account and nature of relevant documents examined.

Sl. No. Books examined

1 CASH BOOK

2 BANK BOOK

3 SALES BOOK

4 PURCHASE BOOK

12. Whether the profit and loss account includes any profits and gains assessable on presumptive basis, if yes, indicate the No
amount and the relevant section (44AD, 44ADA, 44AE, 44AF, 44B, 44BB, 44BBA, 44BBB, Chapter XII-G, First Schedule or any
other relevant section.) ?

Sl. No. Section Amount

No records added
Acknowledgement Number:317290680270923

13.(a). Method of accounting employed in the previous year. Mercantile system

(b). Whether there had been any change in the method of accounting employed vis-a-vis the method employed in the immediately No
preceding previous year ?

(c). If answer to (b) above is in the affirmative, give details of such change , and the effect thereof on the profit or loss ?

Sl. No. Particulars Increase in profit Decrease in profit

No records added

(d). Whether any adjustment is required to be made to the profits or loss for complying with the provisions of income computation No
and disclosure standards notified under section 145(2) ?

(e). If answer to (d) above is in the affirmative, give details of such adjustments:

Sl. No. ICDS Increase in profit Decrease in profit Net effect

No records added

(f). Disclosure as per ICDS:

Sl. No. ICDS Disclosure

14.(a). Method of valuation of closing stock employed in the previous year Lower of Cost or Market Rate

(b). In case of deviation from the method of valuation prescribed under section 145A, and the effect thereof on the profit or loss, No
please furnish:

Sl. No. Particulars Increase in profit Decrease in profit

No records added

15. Give the following particulars of the capital asset converted into stock-in-trade

Sl. Description of capital asset Date of acquisition Cost of acquisition Amount at which the asset is converted into stock-in trade
No. (a) (b) (c) (d)

No records added

16. Amounts not credited to the profit and loss account, being, -

(a). The items falling within the scope of section 28;

Sl. No. Description Amount

No records added

(b). The proforma credits, drawbacks, refunds of duty of customs or excise or service tax, or refunds of sales tax or value added tax or Goods & Services Tax, where such
credits, drawbacks or refunds are admitted as due by the authorities concerned;

Sl. No. Description Amount

No records added

(c). Escalation claims accepted during the previous year;

Acknowledgement Number:317290680270923

Sl. No. Description Amount

No records added

(d). any other item of income;

Sl. No. Description Amount

₹0

(e). Capital receipt, if any.

Sl. No. Description Amount

No records added

17. Where any land or building or both is transferred during the previous year for a consideration less than value adopted or
assessed or assessable by any authority of a State Government referred to in section 43CA or 50C, please furnish:

Sl. Details Address of Property Consideration Value Whether provisions

No. of received or adopted or of second proviso to
property accrued assessed or sub-section (1) of
Address Address City Or Zip Country State assessable section 43CA or
Line 1 Line 2 Town Or Code fourth proviso to
District /Pin clause (x) of sub-
Code section (2) of section
56 applicable ?

No records added

18. Particulars of depreciation allowable as per the Income-tax Act, 1961 in respect of each asset or block of assets, as the case
may be, in the following form:-

Sl. Method of Description Rate Opening Adjustment Adjustment Adjusted Purchase Total Deductions Other Depreciation Written
No. Depreciation of the Block of WDV/Actual made to the made to written Value Value of (C) Adjustments Allowable Down
of Depre written down the written down Purchases (D) Value at
Assets/Class ciatio value under down value value(A) (B) the end
of Assets n (%) section of of the
115BAC/115B Intangible year(A+B-
AD (for asset due C-D)
assessment to
year 2021-22 excluding
only) value of
goodwill of
a business
or
profession

1 WDV Furnitures & 10 ₹25,69,410 ₹0 ₹0 ₹25,69,410 ₹0 ₹0 ₹0 ₹0 ₹2,56,941 ₹

Fittings @ 23,12,469
10%

2 WDV Plant and 15 ₹16,83,680 ₹0 ₹0 ₹16,83,680 ₹15,48,678 ₹15,48,678 ₹0 ₹0 ₹3,68,703 ₹

Machinery @ 28,63,655
15%

19. Amount admissible under section-

Amount debited to Amounts admissible as per the provisions of the Income-tax Act, 1961 and also fulfils the conditions, if any
Sl.
Section profit and loss specified under the relevant provisions of Income-tax Act, 1961 or Income-tax Rules, 1962 or any other
No.
account guidelines, circular, etc., issued in this behalf.

No records added
Acknowledgement Number:317290680270923

20. (a).Any sum paid to an employee as bonus or commission for services rendered, where such sum was otherwise payable to him as profits or dividend. [Section 36(1)
(ii)]

Sl. No. Description Amount

No records added

(b).Details of contributions received from employees for various funds as referred to in section 36(1)(va):

Sl. Nature of Sum received from Due date for The actual amount The actual date of payment to the concerned
No. fund employees payment paid authorities

No records added

21.(a). Please furnish the details of amounts debited to the profit and loss account, Being in the nature of capital, personal,
advertisement expenditure etc.

Capital expenditure

Sl. No. Particulars Amount

No records added

Personal expenditure

Sl. No. Particulars Amount

No records added

Advertisement expenditure in any souvenir, brochure, tract, pamphlet or the like published by a political party

Sl. No. Particulars Amount

No records added

Expenditure incurred at clubs being entrance fees and subscriptions

Sl. No. Particulars Amount

No records added

Expenditure incurred at clubs being cost for club services and facilities used.

Sl. No. Particulars Amount

No records added

Expenditure by way of penalty or fine for violation of any law for the time being in force

Sl. No. Particulars Amount

No records added

Expenditure by way of any other penalty or fine not covered above

Sl. No. Particulars Amount

No records added

Expenditure incurred for any purpose which is an offence or which is prohibited by law
Acknowledgement Number:317290680270923

Sl. No. Particulars Amount

No records added

(b). Amounts inadmissible under section 40(a);

i. as payment to non-resident referred to in sub-clause (i)

A. Details of payment on which tax is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which tax has been deducted but has not been paid on or before the due date specified in sub-section
(1) of section 139

Sl. Date of Amount Nature Name of Permanent Account Aadhaar Number of Address Address City Or Zip Code Country State Amount of
No. payment of of the Number of the payee,if the payee, if Line 1 Line 2 Town Or / Pin tax
payment payment payee available available District Code deducted

No records added

ii. as payment referred to in sub-clause (ia)

A. Details of payment on which tax is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which tax has been deducted but has not been paid on or before the due date specified in sub-section
(1) of section 139.

Sl. Date of Amount Nature Name Permanent Account Aadhaar Address Address City Or Zip Country State Amount Amount
No. payment of of of the Number of the Number of the Line 1 Line 2 Town Or Code / of tax deposite
payment payment payee payee,if available payee, if District Pin deducte d out of
available Code d "Amoun
t of tax
deducte
d"

No records added

iii. as payment referred to in sub-clause (ib)

A. Details of payment on which levy is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which levy has been deducted but has not been paid on or before the due date specified in sub-section
(1) of section 139.

Sl. Date of Amount Nature Name Permanent Account Aadhaar Address Address City Or Zip Country State Amount Amount
No. payment of of of the Number of the Number of the Line 1 Line 2 Town Or Code / of levy deposite
payment payment payee payee,if available payee, if District Pin deducted d out of
available Code "Amoun
t of Levy
deducte
d"

No records added

iv. Fringe benefit tax under sub-clause (ic) ₹0

v. Wealth tax under sub-clause (iia) ₹0

Acknowledgement Number:317290680270923

vi. Royalty, license fee, service fee etc. under sub-clause (iib) ₹0

vii. Salary payable outside India/to a non resident without TDS etc. under sub-clause (iii)

Sl. Date of Amount of Name of Permanent Account Number of the Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment the payee payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

viii. Payment to PF /other fund etc. under sub-clause (iv) ₹0

ix. Tax paid by employer for perquisites under sub-clause (v) ₹0

(c). Amounts debited to profit and loss account being, interest, salary, bonus, commission or remuneration inadmissible under
section 40(b)/40(ba) and computation thereof;

Sl. No. Particulars Section Amount debited to P/L A/C Amount admissible Amount inadmissible Remarks

No records added

(d). Disallowance/deemed income under section 40A(3):

A. On the basis of the examination of books of account and other relevant documents/evidence, whether the expenditure covered Yes
under section 40A(3) read with rule 6DD were made by account payee cheque drawn on a bank or account payee bank draft. If
not, please furnish the details ?

Sl. Date of Nature of Name of the Permanent Account Number of the Aadhaar Number of the payee,
Amount
No. Payment Payment payee payee, if available if available

No records added

B. On the basis of the examination of books of account and other relevant documents/evidence, whether payment referred to in Yes
section 40A(3A) read with rule 6DD were made by account payee cheque drawn on a bank or account payee bank draft. If not,
please furnish the details of amount deemed to be the profits and gains of business or profession under section 40A(3A) ?

Sl. Date of Nature of Name of the Permanent Account Number of the Aadhaar Number of the payee,
Amount
No. Payment Payment payee payee, if available if available

No records added

(e). Provision for payment of gratuity not allowable under section 40A(7); ₹0

(f). Any sum paid by the assessee as an employer not allowable under section 40A(9); ₹0

(g). Particulars of any liability of a contingent nature;

Sl. No. Nature of Liability Amount

No records added

(h). Amount of deduction inadmissible in terms of section 14A in respect of the expenditure incurred in relation to income which
does not form part of the total income;

Sl. No. Particulars Amount

No records added

(i). Amount inadmissible under the proviso to section 36(1)(iii). ₹0

22. Amount of interest inadmissible under section 23 of the Micro, Small and Medium Enterprises Development Act, 2006. ₹0
Acknowledgement Number:317290680270923

23. Particulars of any payments made to persons specified under section 40A(2)(b).

Sl. Name of Related PAN of Related Aadhaar Number of the related person, if Nature of Payment
Relation
No. Person Person available Transaction Made

No records added

24. Amounts deemed to be profits and gains under section 32AC or 32AD or 33AB or 33AC or 33ABA.

Sl. No. Section Description Amount

No records added

25. Any Amount of profit chargeable to tax under section 41 and computation thereof.

Sl. No. Name of person Amount of income Section Description of Transaction Computation if any

No records added

26.i. In respect of any sum referred to in clause (a),(b),(c),(d),(e),(f) or (g) of section 43B, the liability for which:-

A. pre-existed on the first day of the previous year but was not allowed in the assessment of any preceding previous year and was

a. paid during the previous year;

Sl. No. Section Nature of liability Amount

₹0

b. not paid during the previous year;

Sl. No. Section Nature of liability Amount

₹0

B. was incurred in the previous year and was

a. paid on or before the due date for furnishing the return of income of the previous year under section 139(1);

Sl. No. Section Nature of liability Amount

₹0

b. not paid on or before the aforesaid date.

Sl. No. Section Nature of liability Amount

₹0

State whether sales tax,goods & services Tax, customs duty, excise duty or any other indirect tax,levy,cess,impost etc.is passed No
through the profit and loss account ?
Acknowledgement Number:317290680270923

27.a. Amount of Central Value Added Tax Credits/ Input Tax Credit(ITC) availed of or utilised during the previous year and its No
treatment in profit and loss account and treatment of outstanding Central Value Added Tax Credits/Input Tax Credit(ITC) in
accounts.

CENVAT /ITC Amount Treatment in Profit & Loss/Accounts

Opening Balance ₹0

Credit Availed ₹0

Credit Utilized ₹0

Closing /Oustanding Balance ₹0

b. Particulars of income or expenditure of prior period credited or debited to the profit and loss account.

Sl. No. Type Particulars Amount Prior period to which it relates (Year in yyyy-yy format)

No records added

28. Whether during the previous year the assessee has received any property, being share of a company not being a company in
which the public are substantially interested, without consideration or for inadequate consideration as referred to in section 56(2)
(viia) ?

Please furnish the details of the same

Sl. Name of the PAN of the Aadhaar Name of the CIN of the No. of Amount of Fair Market
No. person from person, if Number of the company whose company Shares consideration value of the
which shares available payee, if shares are Received paid shares
received available received

No records added

29. Whether during the previous year the assessee received any consideration for issue of shares which exceeds the fair market
value of the shares as referred to in section 56(2) (viib) ?

Please furnish the details of the same

Sl. Name of the person from whom PAN of the Aadhaar Number of No. of Amount of Fair Market
No. consideration received for issue of person, if the payee, if shares consideration value of the
shares available available issued received shares

No records added

A.a. Whether any amount is to be included as income chargeable under the head 'income from other sources' as referred to in No
clause (ix) of sub-section (2) of section 56 ?

b. Please furnish the following details:

Sl. No. Nature of income Amount

No records added

B.a. Whether any amount is to be included as income chargeable under the head 'income from other sources' as referred to in No
clause (x) of sub-section (2) of section 56 ?

b. Please furnish the following details:

Acknowledgement Number:317290680270923

Sl. No. Nature of income Amount

No records added

30. Details of any amount borrowed on hundi or any amount due thereon (including interest on the amount borrowed) repaid, No
otherwise than through an account payee cheque. [Section 69D]

Sl. Name of the PAN of the Aadhaar Address Address City Or Zip Country State Amount Date of Amount Amount Dat
No. person from person, if Number of Line 1 Line 2 Town Or Code / borrowed borrowing due repaid e of
whom amount available the person, if District Pin including Rep
borrowed or available Code interest ay
repaid on hundi me
nt

No records added

A.a. Whether Primary adjustment to transfer price, as referred to in sub-section (1) of section 92CE, has been made during the No
previous year ?

b. Please furnish the following details:

Sl. Under which clause Amount (in Whether the excess money If yes, whether the If no, the amount (in Rs.) Expected date
No. of sub-section (1) of Rs.) of available with the associated excess money has of imputed interest of repatriation
section 92CE primary enterprise is required to be been repatriated income on such excess of money
primary adjustment adjustment repatriated to India as per the within the money which has not
is made ? provisions of sub-section (2) prescribed time ? been repatriated within
of section 92CE ? the prescribed time

No records added

B.a. Whether the assessee has incurred expenditure during the previous year by way of interest or of similar nature exceeding
one crore rupees as referred to in sub-section (1) of section 94B ?

b. Please furnish the following details

Sl. Amount of Earnings before Amount of expenditure Details of interest expenditure Details of interest expenditure
No. expenditure by interest,tax, by way of interest or of brought forward as per sub- carried forward as per sub-
way of interest or depreciation and similar nature as per (i) section (4) of section 94B.(iv) section (4) of section 94B.(v)
of similar nature amortization above which exceeds
incurred(i) (EBITDA) during the 30% of EBITDA as per (ii)
previous year(ii) above.(iii) Assessment Amount Assessment Amount
Year Year

No records added

C.a. Whether the assessee has entered into an impermissible avoidance arrangement, as referred to in section 96, during the No
previous year ?

b. Please furnish the following details

Sl. Nature of the impermissible avoidance Amount of tax benefit in the previous year arising, in aggregate, to all the parties to the
No. arrangement arrangement

No records added

31.a.Particulars of each loan or deposit in an amount exceeding the limit specified in section 269SS taken or accepted during the previous year :-

Sl. Name of Address Permanent Aadhaar Amount Whether the Maximum Whether the In case the
No. the lender of the Account Number of of loan or loan/deposit amount loan or loan or
or lender or Number (if the lender deposit was squared outstanding deposit was deposit was
depositor depositor available or taken or up during the in the taken or taken or
with the depositor, accepted previous year account at accepted by accepted by
assessee) of if available ? any time cheque or cheque or
bank draft or bank draft,
Acknowledgement Number:317290680270923

the lender or during the use of whether the

depositor previous year electronic same was
clearing taken or
system accepted by
through a an account
bank account payee cheque
? or an account
payee bank
draft.

No records added

b.Particulars of each specified sum in an amount exceeding the limit specified in section 269SS taken or accepted during the previous year:-

Sl. Name of Address Permanent Account Aadhaar Amount Whether the specified In case the specified sum was
No. the of the Number (if available Number of of sum was taken or taken or accepted by cheque or
person person with the assessee) the person specified accepted by cheque or bank draft, whether the same
from from of the person from from whom sum bank draft or use of was taken or accepted by an
whom whom whom specified specified sum taken or electronic clearing account payee cheque or an
specified specified sum is received is received, if accepted system through a bank account payee bank draft.
sum is sum is available account ?
received received

No records added

Note: Particulars at (a) and (b) need not be given in the case of a Government company, a banking company or a corporation established by a Central, State or Provincial Act.

b.(a). Particulars of each receipt in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single transaction or in
respect of transactions relating to one event or occasion from a person, during the previous year, where such receipt is otherwise than by a cheque or bank draft or use of
electronic clearing system through a bank account

Permanent Account Number (if

Sl. Name of Address of Aadhaar Number of Nature of Amount of Date of
available with the assessee) of the
No. the payer the payer the payer, if available transaction receipt receipt
payer

No records added

b.(b). Particulars of each receipt in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single transaction or in
respect of transactions relating to one event or occasion from a person, received by a cheque or bank draft, not being an account payee cheque or an account payee
bank draft, during the previous year:-

Sl. Name of the Address of the Permanent Account Number (if available with the Aadhaar Number of the payer, Amount of
No. payer payer assessee) of the payer if available receipt

No records added

b.(c). Particulars of each payment made in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single
transaction or in respect of transactions relating to one event or occasion to a person, otherwise than by a cheque or bank draft or use of electronic clearing system
through a bank account during the previous year

Permanent Account Number (if Aadhaar Number of

Sl. Name of Address of Nature of Amount of Date of
available with the assessee) of the the payee, if
No. the payee the payee transaction payment payment
payee available

No records added

b.(d). Particulars of each payment made in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single
transaction or in respect of transactions relating to one event or occasion to a person, made by a cheque or bank draft, not being an account payee cheque or an account
payee bank draft, during the previous year

Sl. Name of the Address of the Permanent Account Number (if available with the Aadhaar Number of the payee, Amount of
No. payee payee assessee) of the payee if available payment

No records added

Note: Particulars at (ba), (bb), (bc) and (bd) need not be given in the case of receipt by or payment to a Government company, a banking Company, a post office savings bank,
a cooperative bank or in the case of transactions referred to in section 269SS or in the case of persons referred to in Notification No. S.O. 2065(E) dated 3rd July, 2017
Acknowledgement Number:317290680270923

c. Particulars of each repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T made during the previous year:-

Sl. Name Address Permanent Aadhaar Amount of Maximum amount Whether the In case the repayment
No. of the of the Account Number of repayment outstanding in repayment was was made by cheque
payee payee Number (if the payee, the account at made by cheque or or bank draft, whether
available with if available any time during bank draft or use of the same was repaid
the assessee) the previous year electronic clearing by an account payee
of the payee system through a cheque or an account
bank account ? payee bank draft.

No records added

d. Particulars of repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T received otherwise than by a cheque or
bank draft or use of electronic clearing system through a bank account during the previous year:-

Amount of repayment of loan or deposit or any specified

Name of Permanent Account Aadhaar Number
Sl. Address of advance received otherwise than by a cheque or bank draft or
the Number (if available with of the payer, if
No. the payer use of electronic clearing system through a bank account
payer the assessee) of the payer available
during the previous year

No records added

e. Particulars of repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T received by a cheque or bank draft
which is not an account payee cheque or account payee bank draft during the previous year:-

Amount of repayment of loan or deposit or any specified

Name of Permanent Account Aadhaar Number
Sl. Address of advance received by a cheque or bank draft which is not an
the Number (if available with of the payer, if
No. the payer account payee cheque or account payee bank draft during the
payer the assessee) of the payer available
previous year

No records added

Note: Particulars at (c), (d) and (e) need not be given in the case of a repayment of any loan or deposit or specified advance taken or accepted from Government, Government
company, banking company or a corporation established by a Central, State or Provincial Act

32.a. Details of brought forward loss or depreciation allowance, in the following manner, to the extent available

Amount as Amount as adjusted by Amount as

returned (if the withdrawal of additional assessed (give
All
assessed depreciation on account reference to
losses/allowances
Sl. Assessment Nature of depreciation is of opting for taxation relevant order)
not allowed under Remarks
No. Year loss/allowance less and no under section
section 115BAA /
appeal pending 115BAC/115BAD(To be Order
115BAC / 115BAD
then take filled in for assessment Amount U/s &
assessed) year 2021-22 only) Date

No records added

b. Whether a change in share holding of the company has taken place in the previous year due to which the losses incurred prior Not Applicable
to the previous year cannot be allowed to be carried forward in terms of section 79 ?

c. Whether the assessee has incurred any speculation loss referred to in section 73 during the previous year ? No

If yes, please furnish the details of the same. ₹0

d. Whether the assessee has incurred any loss referred to in section 73A in respect of any specified business during the previous No
year ?

If yes, please furnish the details of the same. ₹0

e. In case of a company, please state that whether the company is deemed to be carrying on a speculation business as referred No
in explanation to section 73.

If yes, please furnish the details of the same. ₹0

33. Section-wise details of deductions, if any admissible under Chapter VIA or Chapter III (Section 10A, Section 10AA). Yes
Acknowledgement Number:317290680270923

Amounts admissible as per the provision of the Income-tax Act,1961 and fulfils the conditions, if any, specified under
Sl. Section under which
the relevant provisions of Income-tax Act, 1961 or Income-tax Rules, 1962 or any other guidelines, circular, etc, issued
No. deduction is claimed
in this behalf.

1 80TTA ₹ 1,318

34.(a). Whether the assessee is required to deduct or collect tax as per the provisions of Chapter XVII-B or Chapter XVII-BB, Yes
please furnish ?

Sl. (1)Tax (2)Sectio (3)Nature of (4)Total (5)Total (6)Total (7)Amount (8)Total (9)Amount (10)Amount
No. deduction n payment amount of amount on amount on of tax amount of tax of tax
and payment or which tax which tax deducted on which deducted deducted or
collection receipt of was was or tax was or collected
Account the nature required to deducted collected deducted collected not
Number specified in be or out of (6) or on (8) deposited to
(TAN) column (3) deducted collected at collected the credit of
or specified at less the Central
collected rate out of than Government
out of (4) (5) specified out of (6)
rate out of and (8) (10)
(7)

1 ALDA06796G 194J Fees for ₹37,00,000 ₹37,00,000 ₹37,00,000 ₹3,70,000 ₹0 ₹3,70,000 ₹0

professional
or technical
services

2 ALDA06796G 194-I Rent ₹7,20,000 ₹7,20,000 ₹7,20,000 ₹72,000 ₹0 ₹72,000 ₹0

3 ALDA06796G 192 Salary ₹19,20,000 ₹19,20,000 ₹19,20,000 ₹1,92,000 ₹1,92,000 ₹0 ₹1,92,000

(b). Whether the assessee is required to furnish the statement of tax deducted or tax collected ? Yes

Please furnish the details:

Sl. Tax deduction and Type Due date Date of Whether the statement of tax deducted or collected Please furnish list of
No. collection Account of for furnishing, contains information about all details/transactions details/transactions
Number (TAN) Form furnishing if which are required to be reported which are not reported.
furnished

1 ALDA06796G 24Q 31-Jan- 14-Jan- Yes

2023 2023

2 ALDA06796G 24Q 31-May- 27-Apr- Yes

2023 2023

3 ALDA06796G 26Q 30-Nov- 24-May- Yes

2022 2023

4 ALDA06796G 26Q 31-May- 24-May- Yes

2023 2023

(c). Whether the assessee is liable to pay interest under section 201(1A) or section 206C(7) ? No

Please furnish:

Sl. Tax deduction and collection Account Amount of interest under section Amount paid out of column (2) along with date
No. Number (TAN)(1) 201(1A)/206C(7) is payable(2) of payment.(3)

Amount Date of payment

No records added

35.(a). In the case of a trading concern, give quantitative details of prinicipal items of goods traded;

Sl. Item Unit Opening Purchases during the Sales during the Closing Shortage/excess, if
No. Name Name stock pervious year pervious year stock any
Acknowledgement Number:317290680270923

No records added

(b). In the case of manufacturing concern,give quantitative details of the prinicipal items of raw materials, finished products and by-products.

A. Raw materials:

Sales
Purchases
Consumption during Yield of
Sl. Item Unit Opening during the Closing Percentage Shortage/excess,
during the the finished
No. Name Name stock pervious stock of yield if any
pervious year pervious products
year
year

No records added

B. Finished products :

Sales during
Sl. Item Unit Opening Purchases during Quantity manufactured Closing Shortage/excess, if
the pervious
No. Name Name stock the pervious year during the pervious year stock any
year

No records added

C. By-products

Sales during
Sl. Item Unit Opening Purchases during Quantity manufactured Closing Shortage/excess, if
the pervious
No. Name Name stock the pervious year during the pervious year stock any
year

No records added

36.(a). Whether the assessee has received any amount in the nature of dividend as referred to in sub-clause (e) of clause (22) of No
section 2 ?
Please furnish the following details:-

Sl. No. Amount received Date of receipt

No records added

37. Whether any cost audit was carried out ? Not Applicable

Give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
cost auditor

38. Whether any audit was conducted under the Central Excise Act, 1944 ? Not Applicable

Give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
auditor.

39. Whether any audit was conducted under section 72A of the Finance Act, 1994 in relation to valuation of taxable services as Not Applicable
may be reported/identified by the auditor. ?

give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
auditor.

40. Details regarding turnover, gross profit, etc., for the previous year and preceding previous year:
Acknowledgement Number:317290680270923

Sl. No. Particulars Previous Year % Preceding previous Year %

(a) Total turnover of the assessee 46234601 0

(b) Gross profit / Turnover 10651992 46234601 23.04 0 0.00

(c) Net profit / Turnover 1172590 46234601 2.54 0 0.00

(d) Stock-in-Trade / Turnover 1018327 46234601 2.20 0 0.00

(e) Material consumed / Finished goods produced 0.00 0.00

41. Please furnish the details of demand raised or refund issued during the previous year under any tax laws other than Income-tax Act, 1961 and Wealth-tax Act, 1957
alongwith details of relevant proceedings.

Sl. Financial year to which Name of other Type (Demand Date of demand
Amount Remarks
No. demand/refund relates to Tax law raised/Refund received) raised/refund received

No records added

42.a. Whether the assessee is required to furnish statement in Form No.61 or Form No. 61A or Form No. 61B ? No

b. Please furnish

Whether the Form contains

Income-tax Department Type Date of If not, please furnish list of the
Sl. Due date for information about all details/
Reporting Entity of furnishing, if details/transactions which are
No. furnishing furnished transactions which are
Identification Number Form furnished not reported.
required to be reported ?

No records added

43.a. Whether the assessee or its parent entity or alternate reporting entity is liable to furnish the report as referred to in sub- No
section (2) of section 286 ?

b. Please furnish the following details:

Whether report has been furnished by the assessee or its parent entity or an alternate reporting entity?

Name of parent entity

Name of alternate reporting entity (if applicable)

Date of furnishing of report

c.Please enter expected date of furnishing the report

44. Break-up of total expenditure of entities registered or not registered under the GST.

Sl. Total amount of Expenditure in respect of entities registered under GST Expenditure relating to
No. Expenditure incurred entities not registered
during the year Relating to goods Relating to entities Relating to other Total payment to under GST
or services exempt falling under registered registered
from GST composition scheme entities entities

No records added

Accountant Details

Accountant Details
Acknowledgement Number:317290680270923

Name DURGA PRASAD VIJAY DUBEY

Membership Number 405588

FRN(Firm Registration Number) 011377C

Address
5A 2ND FLOOR ,LAXMANPURI , NEAR BHOOTHNATH METRO STATION ,
Indira Nagar S.O (Lucknow) , Lucknow , LUCKNOW , 31-Uttar Pradesh , 91-India ,
Pincode - 226016

Place 27.57.74.49

Date 27-Sep-2023

Additions Details (From Point No.18)

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Assets/Class of Use subsidy or grant or (1+2+3+4)
Change in
Assets reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Furnitures & Fittings No records added

@ 10%

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Assets/Class of Use subsidy or grant or (1+2+3+4)
Change in
Assets reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Plant and Machinery 1 31-Mar- 31- ₹ ₹0 ₹0 ₹0 ₹ 15,48,678

@ 15% 2023 Mar- 15,48,678
2023

Deductions Details (From Point No.18)

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Furnitures & Fittings @ 10% No records added

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Plant and Machinery @ 15% No records added

This form has been digitally signed by DURGA PRASAD DUBEY having PAN AJFPD7603N from IP Address 27.57.74.49 on 27/09/2023 03:23:16 PM Dsc Sl.No and issuer
,C=IN,O=Verasys Technologies Pvt Ltd.,OU=Certifying Authority