180 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-1 SAHAJ INDIAN INCOME TAX RETURN [For ndvduls beng resdent other thn not ordnrly

Transcription

1 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 179 MINISTRY OF FINANCE (Deprtment of Revenue) (CENTRAL BOARD OF DIRECT TAXES]) NOTIFICATION New Delh, the 3rd Aprl, 2018 Income-tx G.S.R. 332(E). In exercse of the powers conferred by secton 139 red wth secton 295 of the Income-tx Act, 1961 (43 of 1961), the Centrl Bord of Drect Txes hereby mkes the followng rules further to mend the Income-tx Rules, 1962, nmely:- 1. (1) These rules my be clled the Income-tx (Second Amendment) Rules, (2) They shll be deemed to hve come nto force wth effect from the 1 st dy of Aprl, In the Income-tx rules, 1962 (herenfter referred to s the prncpl rules), n rule 12, () n sub-rule (1),- (I) (II) for the fgures 2017, the fgures 2018 shll be substtuted; n cluse (), () for the words n ndvdul, the words n ndvdul who s resdent other thn not ordnrly resdent nd shll be substtuted; () n sub-cluse (), fter the words brought forwrd loss, the words or loss to be crred forwrd shll be nserted; () n the provso, for tem (I), the followng shll be substtuted, nmely:- (I) hs ssets (ncludng fnncl nterest n ny entty) locted outsde Ind; (IA) hs sgnng uthorty n ny ccount locted outsde Ind; (IB) hs ncome from ny source outsde Ind; (IC) hs ncome to be pportoned n ccordnce wth provsons of 5A; ; secton (III) n cluse (c), for the words derved from propretory, the words under the hed shll be substtuted; (IV) n cluse (d), for the words dervng ncome from propretory, the words hvng ncome under the hed shll be substtuted; (b) n sub-rule (5), for the fgures 2016, the fgures 2017 shll be substtuted. 3. In the prncpl rules, n Appendx II, for Forms Forms Shj (ITR-1), Form ITR-2, Form ITR-3, Form Sugm (ITR-4), Form ITR-5, Form ITR-6, Form ITR-7 nd Form ITR-V, the followng Forms shll be respectvely substtuted, nmely:-

2 180 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-1 SAHAJ INDIAN INCOME TAX RETURN [For ndvduls beng resdent other thn not ordnrly resdent hvng Income from Slres, one house property, other sources (Interest etc.) nd hvng totl ncome upto Rs.50 lkh] (Refer nstructons for elgblty) Assessment Yer PART A GENERAL INFORMATION Nme PAN Adhr Number (12 dgt)/adhr Enrolment Id (28 dgt) (If elgble for Adhr) Moble No. Address: Flt/Door/Block No. Nme of Premses/Buldng/Vllge Rod/Street/Post Eml Offce Address Are/loclty Town/Cty/Dstrct Stte Country Pn code Return fled (Tck)[Plese see nstructon- ] On or before due dte- u/s139(1), Belted- u/s 139(4), Employer, f ny Revsed - u/s 139(5), u/s 119(2)(b), or n response to notce u/s 139(9)-Defectve, 142(1), 148, 153A/153C Govt. PSU Others If revsed/defectve, then enter Recept No. nd Dte of flng orgnl return (DD/MM/YYYY) / / If fled n response to notce u/s 139(9)/142(1)/148/153A/153C, enter dte of such notce / / Are you governed by Portuguese Cvl Code s per secton 5A? Tck) Yes No (If YES fll PAN of the Spouse) PART B GROSS TOTAL INCOME Whole- Rupee( ) only B1 Slry (excludng ll llownces, perqustes nd proft n leu of slry) Allownces not exempt Vlue of perqustes v Proft n leu of slry v v Deductons u/s 16 v v Income chrgeble under the hed Slres ( v v) B1 B2 Tck pplcble opton Self Occuped Let Out If let out, furnsh detls below Gross rent receved/ recevble/ letble vlue Tx pd to locl uthortes Annul Vlue ( ) v 30% of Annul Vlue v v Interest pyble on borrowed cptl v v Income chrgeble under the hed House Property ( v v) B2 ( ) B3 Income from Other Sources B3 B4 Gross Totl Income (B1+B2+B3) (If loss, put the fgure n negtve) B4( ) PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer nstructons for Deducton lmt s per Income-tx Act) 80C 80D 80G 80TTA Any Other (Plese specfy secton) Totl deductons C1 Totl Income (B4-C1) C2 PART D COMPUTATION OF TAX PAYABLE D1 Tx pyble on totl D2 Rebte u/s 87A D3 Tx fter Rebte D4 Cess, on D3 D5 Totl Tx nd D6 Relef u/s 89(1) D7 Interest u/s 234A D8 Interest u/s 234B D9 Interest u/s 234C D10 Fee u/s 234F D11 Totl Tx, Fee nd Interest (D5+D7+D8+D9+D10 D6) SALARY / PENSION HOUSE PROPERTY D12 Totl Txes Pd D13 Amount pyble (D11-D12) (f Exempt Income: 10 (38) 10(34) For reportng purpose Agrculturl Income D14 Refund (D12-D11) (f D12>D11) Others Pls. specfy PART E OTHER INFORMATION D15 Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) Sl. IFS Code of the Bnk Nme of the Bnk Account Number (tck one ccount for refund) I II Schedule-IT Detls of Advnce Tx nd Self-Assessment Tx pyments BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Tx pd Col (1) Col (2) Col (3) Col (4) R1 R2 Schedule-TDS Detls of TDS/TCS [As per Form 16/16A/27D ssued or Form 26QC furnshed by Deductor(s)/ Employer(s)/ Collector(s)] TAN of deductor/ PAN of the Tennt Nme of the Deductor/ Collector/Tennt Amount whch s subject to tx deducton Yer of tx deducton/ collecton Tx Deducted/ collected Amount out of (5) clmed ths Yer Col (1) Col (2) /collecton Col (3) Col (4) Col (5) Col (6) T1 T2

3 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 181 Stmp Recept No., Sel, Dte & Sgn of Recevng Offcl VERIFICATION I, son/ dughter of solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return s correct nd complete nd s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng ths return n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon). Dte: Sgn: If the return hs been prepred by Tx Return Preprer (TRP) gve further detls below: Identfcton No. of TRP Nme of TRP Counter Sgnture of TRP If TRP s enttled for ny rembursement from the Government, mount thereof

4 182 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-2 INDIAN INCOME TAX RETURN [For Indvduls nd HUFs not hvng ncome from profts nd gns of busness or professon] (Plese see Rule 12 of the Income-tx Rules, 1962) (Also see ttched nstructons) Assessment Yer Prt A-GEN GENERAL Frst nme Mddle nme Lst nme PAN Flt/Door/Block No. Nme of Premses/Buldng/Vllge Sttus (Tck) PERSONAL INFORMATION Rod/Street/Post Offce Are/loclty Dte of Brth/ Formton (DD/MM/YYYY) Indvdul HUF Adhr Number (12 dgt)/ Adhr Enrolment Id (28 dgt) (f elgble for Adhr) Town/Cty/Dstrct Stte Pn code/zp code Employer Ctegory(f n employment) (Tck) Govt. PSU Others Country Resdentl/Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Eml Address-1 (self) Eml Address-2 Income Tx Wrd/Crcle FILING STATUS () (b) (c) Return fled (Tck)[Plese see nstructon number-7] On or before due dte-139(1), After due dte-139(4), Revsed Return- 139(5), Modfed return- 92CD, under secton 119(2)(b), or In response to notce 139(9)-Defectve, 142(1), 148, 153A/153C If revsed/defectve/modfed, then enter Recept No. nd Dte of flng orgnl return (DD/MM/YYYY) / / If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C enter dte of such notce, or u/s 92CD enter dte of / / dvnce prcng greement (d) Resdentl Sttus Tck pplcble opton Resdent Non-Resdent Resdent but Not Ordnrly Resdent Do you wnt to clm the beneft under secton 115H? (pplcble n cse of resdent) Yes No (e) Whether ny trnscton hs been mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No (f) Are you governed by Portuguese Cvl Code s per secton 5A? Tck) Yes No (If YES plese fll Schedule 5A) (g) Prt B - TI Whether ths return s beng fled by representtve ssessee? (Tck) Yes No If yes, plese furnsh followng nformton - (1) Nme of the representtve (2) Address of the representtve (3) Permnent Account Number (PAN) of the representtve Computton of totl ncome PART-B 1 Slres (6 of Schedule S) 1 2 Income from house property (3b of Schedule HP) (enter nl f loss) 2 TOTAL INCOME 3 Cptl gns Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chrgeble t pplcble rte (7v of tem E of schedule CG) v Totl Short-term ( + + ) 3v Do not wrte or stmp n ths re (Spce for br code) For Offce Use Only Recept No. Dte Sel nd Sgnture of recevng offcl

5 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 183 b Long-term Long-term 10% (7v of tem E of schedule CG) b Long-term 20% (7v of tem E of schedule CG) b Totl Long-term (b + b) (enter nl f loss) 3b c Totl cptl gns (3v + 3b) (enter nl f loss) 3c 4 Income from other sources from sources other thn from ownng rce horses nd ncome chrgeble to tx t specl rte (1k of Schedule OS) (enter nl f loss) 4 b Income chrgeble to tx t specl rte (1fv of Schedule OS) 4b c from the ctvty of ownng nd mntnng rce horses ( 3e of Schedule OS) (enter nl f loss) 4c d Totl (4 + 4b + 4c) (enter nl f loss) 4d 5 Totl (1+2+3c+4d) 5 6 Losses of current yer set off gnst 5 (totl of 2x nd 3x of Schedule CYLA) 6 7 Blnce fter set off current yer losses ( 5-6) (totl of column 4 of Schedule CYLA+4b) 7 8 Brought forwrd losses set off gnst 7 (2x of Schedule BFLA) 8 9 Gross Totl ncome ( 7-8) (3x of Schedule BFLA +4b) 9 10 Income chrgeble to tx t specl rte under secton 111A, 112 etc. ncluded n Deductons under Chpter VI-A [ t of Schedule VIA nd lmted to ( 9-10)] Totl ncome ( 9-11) Income whch s ncluded n 12 nd chrgeble to tx t specl rtes (totl of () of schedule SI) Net grculturl ncome/ ny other ncome for rte purpose (4 of Schedule EI) Aggregte ncome ( ) [pplcble f ( 12-13) exceeds mxmum mount not chrgeble to tx] Losses of current yer to be crred forwrd (totl of row x of Schedule CFL) 16 Prt B -TTI Computton of tx lblty on totl ncome 1 Tx pyble on totl ncome Tx t norml rtes on 15 of Prt B-TI b Tx t specl rtes (totl of col. () of Schedule SI) c Rebte on grculturl ncome [pplcble f (12-13) of Prt B-TI exceeds mxmum mount not chrgeble to tx] d Tx Pyble on Totl Income (1 + 1b 1c) 1 1b 1c 1d COMPUTATION OF TAX LIABILITY 2 Rebte under secton 87A 2 3 Tx pyble fter rebte (1d - 2) 3 4 Surchrge 25% of 12() of Schedule SI 4 On [(3) (12() of Schedule SI)] 4 Totl Educton cess, ncludng secondry nd hgher educton cess on (3 + 4) 5 6 Gross tx lblty ( ) 6 7 Tx relef Secton 89 7 b Secton 90/ 90A (2 of Schedule TR) 7b c Secton 91 (3 of Schedule TR) 7c d Totl (7 + 7b+ 7c) 7d 8 Net tx lblty (6 7d) (enter zero f negtve) 8 9 Interest nd fee pyble Interest for defult n furnshng the return (secton 234A) 9 b Interest for defult n pyment of dvnce tx (secton 234B) 9b c Interest for deferment of dvnce tx (secton 234C) 9c d Fee for defult n furnshng return of ncome (secton 234F) 9d e Totl Interest nd Fee Pyble (9+9b+9c+9d) 9e 10 Aggregte lblty (8 + 9e) 10 Pge 183

6 184 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TAXES PAID BANK ACCOUNT 11 Txes Pd Advnce Tx (from column 5 of 19A) b TDS (totl of column 5 of 19B nd column 9 of 19C) c TCS (totl of column 5 of 19D) d Self-Assessment Tx (from column 5 of 19A) e Totl Txes Pd (11+11b+11c+11d) 12 Amount pyble (Enter f 10 s greter thn 11e, else enter 0) Refund (If 11e s greter thn 10) (Refund, f ny, wll be drectly credted nto the bnk ccount) b 11c 11d Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of non-resdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Nme of the Bnk Account Number Indcte the ccount n whch you Accounts held n Ind (SWIFT Code n (IBAN n cse of foregn Bnk prefer to get your refund credted, f cse of foregn Bnk Account) Accounts) ny (tck one ccount ) 15 Do you t ny tme durng the prevous yer, () hold, s benefcl owner, benefcry or otherwse, ny sset (ncludng fnncl nterest n ny entty) locted outsde Ind; or () hve sgnng uthorty n ny ccount locted outsde Ind; or () hve ncome from ny source outsde Ind? [pplcble only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] 11e Yes No VERIFICATION I, son/ dughter of, solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return nd schedules thereto s correct nd complete nd s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng return n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon) I further declre tht the crtcl ssumptons specfed n the greement hve been stsfed nd ll the terms nd condtons of the greement hve been compled wth. (Applcble n cse where return s furnshed under secton 92CD) Plce Dte 16 If the return hs been prepred by Tx Return Preprer (TRP) gve further detls below: Sgn here Identfcton No. of TRP Nme of TRP Counter Sgnture of TRP If TRP s enttled for ny rembursement from the Government, mount thereof TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY C Sl TDS ON OTHER INCOME Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl No BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Amount (Rs) (1) (2) (3) (4) (5) v NOTE Enter the totls of Advnce tx nd Self-Assessment tx n Sl No. 11 & 11d of Prt B-TTI Detls of Tx Deducted t Source from Slry [As per Form 16 ssued by Employer(s)] Sl No Tx Deducton Account Number (TAN) of the Employer Nme of the Employer Income chrgeble under Slres Totl tx deducted (1) (2) (3) (4) (5) I II NOTE Plese enter totl of column 5 n 11b of Prt B-TTI Detls of Tx Deducted t Source (TDS) on Income [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s)] No TAN of the Deductor/ PAN of the Buyer/ Tennt Nme of the Deductor/ Buyer/Tennt Unque TDS Certfcte Number Unclmed TDS brought forwrd (b/f) TDS of the current fn. Yer TDS credt out of (7) or (8) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) TDS credt out of (7) or (8) beng crred forwrd

7 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 185 D Fn. Yer Amount Deducted Deducted n the hnds of spouse Clmed Clmed n the hnds of n whch deducted b/f n own hnds s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) n own hnds spouse s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) NOTE Plese enter totl of column 9 n 11b of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tx Deducton nd Collecton Account Number of the Collector Nme of the Collector Income TDS PAN of spouse/ other person Tx Collected Amount out of (4) beng clmed Income TDS PAN of spouse/ other person Amount out of (4) beng clmed n the hnds of spouse, f secton 5A s pplcble (1) (2) (3) (4) (5) (6) TCS I I NOTE Plese enter totl of column (5) n 11c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1 S13) AS APPLICABLE Pge 185

8 186 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule S Nme of Employer Detls of Income from Slry PAN of Employer (f vlble) Address of employer Town/Cty Stte Pn code 1 Slry (Excludng ll exempt/ non-exempt llownces, perqustes & proft n leu of slry s they re shown seprtely below) 1 SALARIES 2 Allownces not exempt (refer Form 16 from employer) 2 3 Vlue of perqustes (refer Form 16 from employer) 3 4 Profts n leu of slry (refer Form 16 from employer) 4 5 Deducton u/s 16 (Entertnment llownce by Government nd tx on employment) 5 6 Income chrgeble under the Hed Slres ( ) 6 7 Allownces exempt under secton 10 (Not to be ncluded n 6 bove) 7 Trvel concesson/ssstnce receved [(sec. 10(5)] 7 Tx pd by employer on non-monetry perquste [(sec. 10(10CC)] 7 Allownce to meet expendture ncurred on house rent [(sec. 10(13A)] 7 v Other llownces 7v Schedule HP Detls of Income from House Property (Plese refer to nstructons) Address of property 1 Town/ Cty Stte PIN Code 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Your percentge of shre n the property Nme of Co-owner(s) PAN of Co-owner(s)e Percentge Shre n Property I II HOUSE PROPERTY 2 [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out Self-occuped Deemed let out I II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two f let out for prt of the yer) 1 b The mount of rent whch cnnot be relzed 1b c Tx pd to locl uthortes 1c d Totl (1b + 1c) 1d e Annul vlue (1 1d) (nl, f self -occuped etc. s per secton 23(2)of the Act) f Annul vlue of the property owned (own percentge shre x 1e) g 30% of 1f h Interest pyble on borrowed cptl Totl (1g + 1h) j Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty Stte PIN Code 1g 1h 1e 1f 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Your percentge of shre n the property.

9 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 187 NOTE Nme of Co-owner(s) PAN of Co-owner(s) Percentge Shre n Property I II [Tck the pplcble opton] Let out Self-occuped Deemed let out Nme(s) of Tennt (f let out) I II Annul letble vlue or rent receved/ recevble (hgher of the two, f let out for whole of the yer, lower of the two, f let out for prt of the yer) b The mount of rent whch cnnot be relzed 2b c Tx pd to locl uthortes d Totl (2b + 2c) e Annul vlue (2 2d) f Annul vlue of the property owned (own percentge shre x 2e) g 30% of 2f h Interest pyble on borrowed cptl Totl (2g + 2h) j Income from house property 2 (2f 2) 3 Income under the hed Income from house property Unrelzed rent nd Arrers of rent receved durng the yer under secton 25A fter deductng 30% b Totl (1j + 2j + 3) (f negtve tke the fgure to 2 of schedule CYLA) 2c 2d 2g 2h PAN of Tennt(s) (f vlble) Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed 2 2e 2f 2 2j 3 3b Schedule CG Cptl Gns A Short-term Cptl Gns (STCG) (Sub-tems 3 nd 4 re not pplcble for resdents) Short-term Cptl Gns 1 From sle of lnd or buldng or both Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b + b) c Blnce ( bv) d Deducton under secton 54B (Specfy detls n tem D below) e Short-term Cptl Gns on Immovble property (1c - 1d) 2 From sle of equty shre or unt of equty orented Mutul Fund (MF) or unt of busness trust on whch STT s pd under secton 111A or 115AD(1)() provso (for FII) 3 Full vlue of consderton 2 b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (2 bv) d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) e Short-term cptl gn on equty shre or equty orented MF (STT pd) (2c +2d) For NON-RESIDENT, not beng n FII- from sle of shres or debentures of n Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) STCG on trnsctons on whch securtes trnscton tx (STT) s pd b STCG on trnsctons on whch securtes trnscton tx (STT) s not pd 4 For NON-RESIDENT- from sle of securtes (other thn those t A2) by n FII s per secton 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls b b bv 1c 1d b b bv 2c 2d A1e A2e A3 A3b

10 188 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (4 bv) d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f securty bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such securty to be gnored (Enter postve vlue only) e Short-term cptl gn on sle of securtes by n FII (other thn those t A2) (4c +4d) 5 From sle of ssets other thn t A1 or A2 or A3 or A4 bove In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per c secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (5 bv) d In cse of sset (securty/unt) loss to be dsllowed u/s 94(7) or 94(8)- for 5d exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) e STCG on ssets other thn t A1 or A2 or A3 or A4 bove (5c + 5d) 6 Amount deemed to be short term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yers shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer n whch sset trnsferred Secton under whch deducton clmed n tht yer B b Amount deemed to be short term cptl gns, other thn t 7 Totl mount deemed to be short term cptl gns (X + b) New sset cqured/constructed Yer n whch sset Amount utlsed out of cqured/constructed Cptl Gns ccount c b b bv 4c 4d b b bv 5c Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) Amount of STCG ncluded n A1-A6 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. No. Item No. A1 Amount of to A6 bove ncome n whch ncluded Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A4e A5e A6 I II Totl mount of STCG not chrgeble to tx n Ind s per DTAA A7 b Totl mount of STCG chrgeble t specl rtes n Ind s per DTAA A7b 8 Totl Short-term Cptl Gn (A1e+ A2e+ A3+ A3b+ A4e+ A5e+A6-A7) A8 B Long-term cptl gn (LTCG) (Sub-tems 4, 5 & 6 re not pplcble for resdents) 1 From sle of lnd or buldng or both

11 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 189 Long-term Cptl Gns Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) b Deductons under secton 48 Cost of cquston wth ndexton b Cost of Improvement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b + b) c Blnce ( bv) Deducton under secton 54/54B/54EC/54EE/54F/54GB (Specfy detls n tem D d below) e Long-term Cptl Gns on Immovble property (1c - 1d) 2 From sle of bonds or debenture (other thn cptl ndexed bonds ssued by Government) Full vlue of consderton b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (2 bv) d Deducton under sectons 54EC/54EE/54F (Specfy detls n tem D below) e LTCG on bonds or debenture (2c 2d) From sle of, () lsted securtes (other thn unt) or zero coupon bonds where provso under secton 112(1) s pplcble () GDR of n Indn compny referred n sec. 115ACA Full vlue of consderton 3 b Deductons under secton 48 Cost of cquston wthout ndexton b b b bv 1c 1d b b b bv Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (3 bv) 3c d Deducton under sectons 54EC/54EE/54F (Specfy detls n tem D below) 3d e Long-term Cptl Gns on ssets t B3 bove (3c 3d) B3e For NON-RESIDENTS- from sle of shres or debenture of Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) LTCG computed wthout ndexton beneft 4 b Deducton under sectons 54EC/54EE/54F (Specfy detls n tem D below) 4b c LTCG on shre or debenture (4-4b) B4c For NON-RESIDENTS- from sle of, () unlsted securtes s per sec. 112(1)(c), () bonds or GDR s referred n sec. 115AC, () securtes by FII s referred to n sec. 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s c per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (5 bv) 5c d Deducton under sectons 54EC/54EE/54F (Specfy detls n tem D below) 5d e Long-term Cptl Gns on ssets t 5 bove n cse of NON-REESIDENT (5c 5d) B5e 6 From sle of foregn exchnge sset by NON-RESIDENT INDIAN (If opted under chpter XII-A) LTCG on sle of specfed sset (computed wthout ndexton) 6 b Less deducton under secton 115F (Specfy detls n tem D below) 6b 2c 2d b b b bv B1e B2e

12 190 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c Blnce LTCG on sle of specfed sset (6 6b) B6c d LTCG on sle of sset, other thn specfed sset (computed wthout ndexton) 6d e Less deducton under secton 115F (Specfy detls n tem D below) 6e f Blnce LTCG on sle of sset, other thn specfed sset (6d 6e) B6f 7 From sle of ssets where B1 to B6 bove re not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wth ndexton Cost of mprovement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (7 bv) 7c d Deducton under sectons 54EC/54EE/54F (Specfy detls n tem D below) 7d e Long-term Cptl Gns on ssets t B7 bove (7c-7d) B7e 8 Amount deemed to be long-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yer shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Sl. Prevous yer n whch sset trnsferred Secton under whch deducton clmed n tht yer /54F/ 54GB B New sset cqured/constructed Yer n whch sset cqured/constructed b Amount deemed to be long-term cptl gns, other thn t Totl mount deemed to be long-term cptl gns (X + X + b) Amount utlsed out of Cptl Gns ccount c b b b bv Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) 9 Amount of LTCG ncluded n B1- B8 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. No. Amount of ncome Item No. B1 to B8 bove n whch ncluded Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act B8 Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of LTCG not chrgeble to tx s per DTAA B9 b Totl mount of LTCG chrgeble t specl rtes s per DTAA B9b 10 Totl long term cptl gn chrgeble under I.T. Act [B1e +B2e +B3e + B4c + B5e +B6c+ B6f+ B7e+ B8 - B9] (In B10 cse of loss tke the fgure to 5x of schedule CFL) C Income chrgeble under the hed CAPITAL GAINS (A8 + B10) (tke B10 s nl, f loss) (If C s negtve, tke the fgure C to 4x of schedule CFL nd f t s postve, tke the fgure to respectve row n tem E) D Informton bout deducton clmed gnst Cptl Gns 1 In cse of deducton u/s 54/54B/54EC/54EE/54F/54GB/115F gve followng detls Deducton clmed u/s 54 Dte of trnsfer of orgnl sset dd/mm/yyyy Cost of new resdentl house Dte of purchse/constructon of new resdentl house dd/mm/yyyy b v Amount deposted n Cptl Gns Accounts Scheme before v due dte v Amount of deducton clmed v Deducton clmed u/s 54B Dte of trnsfer of orgnl sset b dd/mm/yyyy Cost of new grculturl lnd Dte of purchse of new grculturl lnd b dd/mm/yyyy b

13 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 191 c d e f g v Amount deposted n Cptl Gns Accounts Scheme before bv due dte v Amount of deducton clmed bv Deducton clmed u/s 54EC Dte of trnsfer of orgnl sset c dd/mm/yyyy Amount nvested n specfed/notfed bonds (not exceedng ffty lkh rupees) Dte of nvestment c dd/mm/yyyy v Amount of deducton clmed cv Deducton clmed u/s 54EE Dte of trnsfer of orgnl sset d dd/mm/yyyy Amount nvested n specfed sset d Dte of nvestment d dd/mm/yyyy v Amount of deducton clmed dv Deducton clmed u/s 54F Dte of trnsfer of orgnl sset e dd/mm/yyyy Cost of new resdentl house e Dte of purchse/constructon of new resdentl house e dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed ev Deducton clmed u/s 54GB Dte of trnsfer of orgnl resdentl property f dd/mm/yyyy PAN of the elgble compny Amount utlsed for subscrpton of equty shres of elgble compny v Dte of subscrpton of shres fv dd/mm/yyyy v Cost of new plnt nd mchnery purchsed by the elgble fv compny v Dte of purchse of plnt nd mchnery fv dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before fv due dte v Amount of deducton clmed fv Deducton clmed u/s 115F (for Non-Resdent Indns) Dte of trnsfer of orgnl foregn exchnge sset g dd/mm/yyyy c ev f f Amount nvested n new specfed sset or svngs certfcte g Dte of nvestment g dd/mm/yyyy v Amount of deducton clmed gv h Totl deducton clmed (1 + 1b + 1c + 1d + 1e + 1f + 1g) 1h E Set-off of current yer cptl losses wth current yer cptl gns (excludng mounts ncluded n A7 & B9 whch s chrgeble under DTAA) F Sl. Type of Cptl Gn Loss to be set off (Fll ths row f computed fgure s negtve) Gn of current yer (Fll ths column only f computed fgure s postve) 15% (A2e+A3) Short term 30% A4e cptl gn v pplcble rte (A1e+A3b+A5e+ A6) v Long term 10% (B3e+ B5e+B6c) cptl gn v 20% (B1e+B2e+B4c+ B6f+ B7e+B8) v Totl loss set off ( + + v + v + v) v Loss remnng fter set off ( v) Informton bout ccrul/recept of cptl gn Short term cptl loss set off Long term cptl loss set off 15% 30% pplcble rte 10% 20% Current yer s cptl gns remnng fter set off (7= ) (A2e+A3) A4e (A1e+A3b+A5e +A6) (B3e+ B5e+B6c) Type of Cptl gn / Dte Upto 15/6 () 16/6 to 15/9 () 1 Short-term cptl gns txble t the rte of 15% Enter vlue from tem 3 of schedule BFLA, f ny. (B1e+B2e+ B4c+ B6f+ B7e+B8) 16/9 to 15/12 () 16/12 to 15/3 (v) 16/3 to 31/3 (v)

14 192 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 2 Short-term cptl gns txble t the rte of 30% Enter vlue from tem 3v of schedule BFLA, f ny. 3 Short-term cptl gns txble t pplcble rtes Enter vlue from tem 3v of schedule BFLA, f ny. 4 Long- term cptl gns txble t the rte of 10% Enter vlue from tem 3v of schedule BFLA, f ny. 5 Long- term cptl gns txble t the rte of 20% Enter vlue from tem 3v of schedule BFLA, f ny. NOTE Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed

15 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 193 Schedule OS Income from other sources 1 Income Dvdends, Gross b Interest, Gross c Rentl ncome from mchnery, plnts, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng rce horses) Menton the nture OTHER SOURCES Wnnngs from lotteres, crossword puzzles etc. 1d Csh credts u/s 68 b Unexplned nvestments u/s 69 c Unexplned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B e Unexplned expendture etc. u/s 69C f Amount borrowed or repd on hund u/s 69D Totl ( + b + c + d + e + f) Income of the nture referred to n secton 56(2)(x) whch s chrgeble to tx Aggregte vlue of sum of money receved wthout consderton b In cse mmovble property s receved wthout consderton, stmp duty vlue of property In cse mmovble property s receved for c ndequte consderton, stmp duty vlue of property n excess of such consderton d In cse ny other property s receved wthout consderton, fr mrket vlue of property In cse ny other property s receved for ndequte e consderton, fr mrket vlue of property n excess of such consderton Totl (+ b + c +d + e) v v Totl (1d + 1d+ 1d + 1dv) e Totl (1 + 1b + 1c + 1dv) f Income ncluded n 1e chrgeble to tx t specl rte (to be tken to schedule SI) Income by wy of wnnngs from lotteres, crossword puzzles, rces, gmes, gmblng, bettng etc. (u/s 115BB) Dvdend Income from domestc compny tht exceeds Rs.10 Lkh (u/s 115BBDA) Deemed Income chrgeble to tx u/s 115BBE v Income from ptent chrgeble u/s 115BBF v Income from trnsfer of crbon credts u/s 115BBG v Any other ncome chrgeble to tx t the rte specfed under Chpter XII/XII-A v Income chrgeble t specl rtes under DTAA Sl. No. Amount of ncome Nture of ncome Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act 1 1b 1c 1d 1d 1dv 1dv Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II III Totl mount of ncome chrgeble t specl rtes under DTAA v Income ncluded n 1e chrgeble to tx t specl rte (1f +1f + 1f+1fv+1fv+1fv +1fv ) g Gross mount chrgeble to tx t norml pplcble rtes (1e-1fv) h Deductons under secton 57 (other thn those reltng to ncome under 1f, 1f, 1f, 1fv, 1fv, 1fv & 1fv for non-resdents) Expenses / Deductons h Deprecton h Totl h Amounts not deductble u/s 58 1 j Profts chrgeble to tx u/s 59 1j k Income from other sources (other thn from ownng rce horses nd mount chrgeble to tx t specl 1k rte) (1g h j) (If negtve tke the fgure to 3x of schedule CYLA) 2 Income from other sources (other thn from ownng rce horses) (1fv + 1k) (enter 1k s nl, f negtve) 2 3 Income from the ctvty of ownng nd mntnng rce horses Recepts 3 b Deductons under secton 57 n relton to (4) 3b 1e 1f 1f 1f 1fv 1fv 1fv 1fv 1fv 1g

16 194 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c Amounts not deductble u/s 58 3c d Profts chrgeble to tx u/s 59 3d e Blnce (3 3b + 3c + 3d) (f negtve tke the fgure to 6x of Schedule CFL) 3e 4 Income under the hed Income from other sources (2 + 3e) (tke 3e s nl f negtve) 4 NOTE Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed. Schedule CYLA Detls of Income fter Set off of current yer losses Sl.No Hed/ Source of Income Income of current yer (Fll ths column only f ncome s zero or postve) House property loss of the current yer set off Other sources loss (other Current yer s thn loss from rce Income remnng horses) of the current yer fter set off set off =1-2-3 CURRENT YEAR LOSS ADJUSTMENT Loss to be set off (3b of Schedule HP) (1k of Schedule-OS) Slres (6 of Schedule S) House property (3b of Schedule HP) v Short-term cptl gn 15% (7 of tem E of schedule CG) v Short-term cptl gn 30% v Short-term cptl gn txble t pplcble rtes (7 of tem E of schedule CG) (7v of tem E of schedule CG) v Long term cptl gn 10% (7v of tem E of schedule CG) v Long term cptl gn 20% x x Other sources (excludng proft from ownng rce horses nd mount chrgeble to specl rte of tx) Proft from ownng nd mntnng rce horses x Totl loss set off ( + + v + v + v + v + v + x + x) x Loss remnng fter set-off ( - x) (7v of tem E of schedule CG) (1k of schedule OS) (3e of schedule OS) Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT Sl. No. Detls of Income fter Set off of Brought Forwrd Losses of erler yers Hed/ Source of Income Income fter set off, f ny, of current yer s losses s per 4 of Schedule CYLA) Slres (4 of schedule CYLA) Brought forwrd loss set off Current yer s ncome remnng fter set off House property (4 of schedule CYLA) (B/f house property loss) Short-term cptl gn 15% (4vof schedule CYLA) (B/f short-term cptl loss) v Short-term cptl gn 30% (4vof schedule CYLA) (B/f short-term cptl loss) v Short-term cptl gn txble t pplcble rtes (4vof schedule CYLA) (B/f short-term cptl loss) v Long-term cptl gn 10% (4vof schedule CYLA) (B/f short-term or long-term cptl loss) v Long term cptl gn 20% (4v of schedule CYLA) (B/f short-term or long-term cptl loss) Other sources (excludng proft from v ownng rce horses nd wnnngs from lottery, gme etc.) (4xof schedule CYLA) x Proft from ownng nd mntnng rce horses (4xof schedule CYLA) (B/f loss from horse rces) x x Totl of brought forwrd loss set off ( v2 + v2+v2+v2+x2) Current yer s ncome remnng fter set off Totl ( v3 + v3+ v3+ v3 + v3+ x3) Schedule CFL CARRY FORWARD OF LOSS Detls of Losses to be crred forwrd to future yers Assessment Yer Dte of Flng (DD/MM/YYYY) House property loss Short-term cptl loss Long-term Cptl loss Loss from ownng nd mntnng rce horses

17 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 195 v v v v v x x x x Totl of erler yer losses Adjustment of bove losses n Schedule BFLA (Current yer losses) Totl loss crred forwrd to future yers (2 of schedule BFLA) (2x of schedule CYLA) ((2v+3v+4v) of tem E of schedule CG) ((5v+6v)of tem E of schedule CG) (2x of schedule BFLA) (3e of schedule OS, f ve) Schedule VI-A Deductons under Chpter VI-A 1 Prt B- Deducton n respect of certn pyments 80C b 80CCC c 80CCD(1) d 80CCD(1B) e 80CCD(2) f 80CCG TOTAL DEDUCTIONS g 80D h 80DD 80DDB j 80E k 80EE l 80G m 80GG n 80GGA o 80GGC 2 Prt C, CA nd D- Deducton n respect of certn ncomes/other deducton p 80QQB q 80RRB r 80TTA s 80U t Totl deductons under Chpter VI-A (Totl of to s) t Schedule 80G DETAILS OF DONATIONS A Detls of dontons enttled for deducton under secton 80G Dontons enttled for 100% deducton wthout qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Totl B Dontons enttled for 50% deducton wthout qulfyng lmt C D Nme nd ddress of donee PAN of Donee Amount of donton Totl Dontons enttled for 100% deducton subject to qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Totl Dontons enttled for 50% deducton subject to qulfyng lmt Elgble Amount of donton Elgble Amount of donton Elgble Amount of donton

18 196 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Nme nd ddress of donee PAN of Donee Amount of donton Totl E Totl dontons (A + B + C + D) Elgble Amount of donton Income of specfed persons (spouse, mnor chld etc.) ncludble n ncome of the ssessee (ncome of the mnor chld, n excess of Rs. Schedule SPI 1,500 per chld, to be ncluded) Sl No Nme of person PAN of person (optonl) Reltonshp Nture of Income Amount (Rs) Schedule SI SPECIAL RATE Income chrgeble to tx t specl rtes (plese see nstructons No. 9 for rte of tx) Sl No Secton Specl rte (%) Income 1 111A (STCG on shres unts on whch STT pd) 15 (3 of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pd) 30 (3v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexton) 10 (prt of 3v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (prt of 3v of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (prt of 3v of schedule BFLA) 6 115ACA (LTCG for n employee of specfed compny on GDR) 10 (prt of 3v of schedule BFLA) 7 115AD (LTCG for FIIs on securtes) 10 (prt of 3v of schedule BFLA) 8 115E (LTCG for non-resdent ndn on specfed sset) 10 (prt of 3v of schedule BFLA) (LTCG on others) 20 (3v of schedule BFLA) BB (Wnnngs from lotteres, puzzles, rces, gmes etc.) 30 (1f of schedule OS) BBDA (Dvdend ncome from domestc compny exceedng Rs.10 lkh) 10 (1f of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (1f of schedule OS) BBF (Tx on ncome from ptent) 10 (1fv of schedule OS) BBG (Tx on ncome from trnsfer of crbon credts) 10 (1fv of schedule OS) 115AC (Income of non-resdent from bonds or GDR purchsed n foregn 15 currency) 10 (prt of 1fv of schedule OS) Chrgeble under DTAA rte (prt of 1fv of schedule OS + A7b 16 nd B9b of schedule CG) Totl Tx thereon Schedule EI EXEMPT INCOME Detls of Exempt Income (Income not to be ncluded n Totl Income) 1 Interest ncome 1 2 Dvdend ncome from domestc compny (mount not exceedng Rs. 10 lkh) 2 3 Long-term cptl gns from trnsctons on whch Securtes Trnscton Tx s pd 3 4 Gross Agrculturl recepts (other thn ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on grculture Unbsorbed grculturl loss of prevous eght ssessment yers v Net Agrculturl ncome for the yer ( ) (enter nl f loss) 4 5 Others, ncludng exempt ncome of mnor chld 5 6 Totl ( ) 6 Schedule PTI Pss Through Income detls from busness trust or nvestment fund s per secton 115UA, 115UB Sl. Nme of busness trust/ PAN of the busness trust/ Sl. Hed of ncome Amount of ncome TDS on such mount, nvestment fund nvestment fund f ny 1. House property PASS THROUGH INCOME v Cptl Gns Short term b Long term Other Sources Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s

19 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s NOTE Plese refer to the nstructons for fllng out ths schedule. Schedule FSI Sl. Country Code 1 Txpyer Identfcton Number Detls of Income from outsde Ind nd tx relef Sl. Hed of ncome Income from outsde Ind (ncluded n PART B-TI) Slry House Property Busness or Professon v Cptl Gns v Other sources Tx pd outsde Ind Tx pyble on such ncome under norml provsons n Ind Tx relef vlble n Ind (e)= (c) or (d) whchever s lower Relevnt rtcle of DTAA f relef clmed u/s 90 or 90A () (b) (c) (d) (e) (f) 2 Slry Totl House Property Busness or Professon v Cptl Gns v Other sources NOTE Totl Plese refer to the nstructons for fllng out ths schedule. Schedule TR 1 Summry of Tx relef clmed Country Code Summry of tx relef clmed for txes pd outsde Ind Txpyer Identfcton Number Totl txes pd outsde Ind (totl of (c) of Schedule FSI n respect of ech country) Totl tx relef vlble (totl of (e) of Schedule FSI n respect of ech country) Tx Relef Clmed under secton (specfy 90, 90A or 91) () (b) (c) (d) (e) Totl 2 Totl Tx relef vlble n respect of country where DTAA s pplcble (secton 90/90A) (Prt of totl of 1(d)) 2 3 Totl Tx relef vlble n respect of country where DTAA s not pplcble (secton 91) (Prt of totl of 1(d)) 3 4 NOTE Whether ny tx pd outsde Ind, on whch tx relef ws llowed n Ind, hs been refunded/credted by the foregn tx uthorty durng the yer? If yes, provde the detls below Amount of tx refunded Plese refer to the nstructons for fllng out ths schedule. b Assessment yer n whch tx relef llowed n Ind 4 Yes/No Schedule FA DETAILS OF FOREIGN ASSETS A Sl No Detls of Foregn Assets nd Income from ny source outsde Ind Detls of Foregn Bnk Accounts held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Country Nme nd Code Nme nd Address of the Bnk Account holder nme Sttus- Owner/ Benefcl owner/ Benefcry Account Number Account openng dte Pek Blnce Durng the Yer (n rupees) Interest ccrued n the ccount Interest txble nd offered n ths return Amount Schedule Item number of where offered schedule

20 198 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detls of Fnncl Interest n ny Entty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Nture of Nme nd Nture of Interest- Dte snce held Totl Investment Income ccrued from Nture of Income Drect/ (t cost) (n such Interest Benefcl rupees) Income txble nd offered n ths return owner/ Benefcry Nme nd Amount Schedule where Item number of entty Address of code offered schedule the Entty (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detls of Immovble Property held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Address of Ownershp- Dte of Totl Investment Income Nture of Income txble nd offered n ths return Nme nd code the Property Drect/ Benefcl owner/ Benefcry cquston (t cost) (n rupees) derved from the property Income Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detls of ny other Cptl Asset held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Nture of Ownershp- Dte of Totl Investment Income Nture of Income txble nd offered n ths return Nme nd code Asset Drect/ Benefcl owner/ Benefcry cquston (t cost) (n rupees) derved from the sset Income Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detls of ccount(s) n whch you hve sgnng uthorty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer nd whch hs not been ncluded n A to D bove. Sl No Nme of the Insttuton n Address of the Nme of the ccount Account Number Pek Blnce/ Investment Whether ncome ccrued s If (7) s yes, Income If (7) s yes, Income offered n ths return Amount Schedule where Item number of whch the ccount s held Insttuton holder durng the yer (n rupees) txble n your hnds? ccrued n the ccount offered schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detls of trusts, creted under the lws of country outsde Ind, n whch you re trustee, benefcry or settlor Sl If (8) s yes, Income offered n ths return No Amount Country Nme nd code Nme nd ddress of the trust Nme nd ddress of trustees Nme nd ddress of Settlor Nme nd ddress of Benefcres Dte snce poston held Whether ncome derved s txble n your hnds? If (8) s yes, Income derved from the trust Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detls of ny other ncome derved from ny source outsde Ind whch s not ncluded n,- () tems A to F bove nd, () ncome under the hed busness or professon If (6) s yes, Income offered n ths return Country Nme Nme nd ddress of the Whether txble n Income derved Nture of ncome nd code person from whom derved your hnds? Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Plese refer to nstructons for fllng out ths schedule. In cse of n ndvdul, not beng n Indn ctzen, who s n Ind on busness, employment or student vs, n sset cqured durng ny prevous yer n whch he ws non-resdent s not mndtory to be reported n ths schedule f no ncome s derved from tht sset durng the current prevous yer.

21 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 199 Schedule 5A Nme of the spouse PAN of the spouse Heds of Income 1 House Property 2 Busness or 3 Cptl gns 4 Other sources 5 Totl Informton regrdng pportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the hed Amount pportoned n the hnds of the spouse Amount of TDS deducted on ncome t () TDS pportoned n the hnds of spouse () () () (v) (v) Schedule AL Asset nd Lblty t the end of the yer (pplcble n cse where totl ncome exceeds Rs.50 lkh) A Detls of mmovble sset Sl. Descrpton Address Amount (cost) n Rs. No. (1) (2) (3) (4) DETAILS OF ASSETS AND LIABILITIES () () B Detls of movble sset Sl. Descrpton Amount (cost) n Rs. No. (1) (2) (3) () Jewellery, bullon etc. () Archeologcl collectons, drwngs, pntng, sculpture or ny work of rt () Vehcles, ychts, bots nd rcrfts (v) Fnncl sset Amount (cost) n Rs. () Bnk (ncludng ll deposts) (b) Shres nd securtes (c) Insurnce polces (d) Lons nd dvnces gven (e) Csh n hnd C Lblty n relton to Assets t (A + B) NOTE Plese refer to nstructons for fllng out ths schedule.

22 200 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-3 INDIAN INCOME TAX RETURN (For ndvduls nd HUFs hvng ncome from profts nd gns of busness or professon) (Plese see rule 12 of the Income-tx Rules,1962) (Also see ttched nstructons) Assessment Yer Prt A-GEN GENERAL Frst nme Mddle nme Lst nme PAN PERSONAL INFORMATION Flt/Door/Block No Nme Of Premses/Buldng/Vllge Sttus (Tck) Rod/Street/Post Offce Are/loclty Dte of Brth/Formton (DD/MM/YYYY) Indvdul Adhr Number (12 dgt)/ Adhr Enrolment Id (28 dgt) (f elgble for Adhr) HUF Town/Cty/Dstrct Stte Pn code/zp code Employer Ctegory (f n employment) (Tck) Govt. PSU Others Country Resdentl/Offce Phone Number wth STD code / Moble No. 1 Moble No. 2 Eml Address-1 (self) Income Tx Wrd/Crcle Eml Address-2 FILING STATUS AUDIT INFORMATION () (b) (c) Return fled (Tck)[Plese see nstructon number-7] On or Before due dte -139(1) After due dte -139(4) Revsed Return- 139(5), Modfed return- 92CD under secton 119(2)(b), or In response to notce 139(9)-Defectve 142(1) A/153C If revsed/defectve/modfed, then enter Recept No. / / nd Dte of flng orgnl return (DD/MM/YYYY) If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C enter dte of such notce, or u/s 92CD enter dte of dvnce prcng greement / / (d) Resdentl Sttus Tck pplcble opton Resdent Non-Resdent Resdent but Not Ordnrly Resdent (e) Do you wnt to clm the beneft under secton 115H? (pplcble n cse of resdent) Yes No Whether ny trnscton hs been mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No (f) Are you governed by Portuguese Cvl Code s per secton 5A? Tck) Yes No (If YES plese fll Schedule 5A) (g) Whether ths return s beng fled by representtve ssessee? (Tck) Yes No If yes, furnsh followng nformton - (1) Nme of the representtve (2) Address of the representtve (3) Permnent Account Number (PAN) of the representtve (h) In cse of non-resdent, s there permnent estblshment (PE) n Ind? (Tck) Yes No () Are you lble to mntn ccounts s per secton 44AA? (Tck) Yes No (b) Are you lble for udt under secton 44AB? (Tck) Yes No (c) For Offce Use Only If (b) s Yes, whether the ccounts hve been udted by n ccountnt? (Tck) Yes No If Yes, furnsh the followng nformton below (1) Dte of furnshng of the udt report (DD/MM/YYYY) / / (2) Nme of the udtor sgnng the tx udt report (3) Membershp No. of the udtor (4) Nme of the udtor (propretorshp/ frm) (5) Propretorshp/frm regstrton number (6) Permnent Account Number (PAN) of the propretorshp/ frm For Offce Use Only

23 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 201 Recept No. Dte Sel nd Sgnture of recevng offcl (7) Dte of report of the udt (d) If lble to furnsh other udt report, menton the dte of furnshng the udt report? (DD/MM/YY) (Plese see Instructon 6)) 92E 115JC NATURE OF BUSINESS S.No. NATURE OF BUSINESS OR PROFESSION, IF MORE THAN ONE BUSINESS OR PROFESSION INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS Code Trde nme of the Descrpton [Plese see nstructon No.7()] propretorshp, f ny () () () Prt A-BS SOURCES OF FUNDS APPLICATION OF FUNDS 1 Propretor s fund BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2018 OF THE PROPRIETORY BUSINESS OR PROFESSION (fll tems below n cse where regulr books of ccounts re mntned, otherwse fll tem 6) Propretor s cptl b Reserves nd Surplus Revluton Reserve b Cptl Reserve b Sttutory Reserve b v Any other Reserve bv v Totl (b + b + b + bv) bv c Totl propretor s fund ( + bv) 2 Lon funds Secured lons Foregn Currency Lons Rupee Lons A From Bnks B From others C Totl ( A + B) Totl ( + C) b Unsecured lons (ncludng deposts) From Bnks b From others b Totl (b + b) b c Totl Lon Funds ( + b) 3 Deferred tx lblty 3 4 Sources of funds (1c + 2c +3) 4 1 Fxed ssets Gross: Block b Deprecton c Net Block ( b) d Cptl work-n-progress e Totl (1c + 1d) A B C 1 1b 1c 1d 1c 2c 1e Pge 201

24 202 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 2 Investments Long-term nvestments Government nd other Securtes - Quoted Government nd other Securtes Unquoted Totl ( + ) b Short-term nvestments Equty Shres, ncludng shre pplcton money b Preference Shres b Debentures b v Totl (b + b + b) bv c Totl nvestments ( + bv) 3 Current ssets, lons nd dvnces Current ssets Inventores A Stores/consumbles ncludng pckng mterl B Rw mterls C Stock-n-process D Fnshed Goods/Trded Goods E Totl (A + B + C + D) Sundry Debtors Csh nd Bnk Blnces A Csh-n-hnd B Blnce wth bnks C Totl (A + B) v Other Current Assets v v Totl current ssets (E + + C + v) v b Lons nd dvnces Advnces recoverble n csh or n knd or for vlue to be receved b Deposts, lons nd dvnces to corportes nd others b Blnce wth Revenue Authortes b v Totl (b + b + b ) bv c Totl of current ssets, lons nd dvnces (v + bv) d Current lbltes nd provsons Current lbltes A Sundry Credtors B Lblty for Lesed Assets C Interest Accrued on bove D Interest ccrued but not due on lons E Totl (A + B + C + D) Provsons A Provson for Income Tx Provson for Leve B encshment/supernnuton/grtuty C Other Provsons D Totl (A + B + C) Totl (E + D) d e Net current ssets (3c d) 4 Mscellneous expendture not wrtten off or djusted 4 b Deferred tx sset c Proft nd loss ccount/ Accumulted blnce A B C D A B C D A B C 4b 4c A B 2c E C 3c E D 3e

25 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 203 NO ACCOUNT CASE d Totl (4 + 4b + 4c) 5 Totl, pplcton of funds (1e + 2c + 3e +4d) 5 6 In cse where regulr books of ccount of busness or professon re not mntned - (furnsh the followng nformton s on 31 st dy of Mrch, 2018, n respect of busness or professon) Amount of totl sundry debtors b Amount of totl sundry credtors c Amount of totl stock-n-trde d Amount of the csh blnce 4d 6 6b 6c 6d Prt A-P& L Proft nd Loss Account for the fnncl yer (fll tems 1 to 52 n cse where regulr books of ccounts re mntned, otherwse fll tem 53) 1 Revenue from opertons A Sles/ Gross recepts of busness (net of returns nd refunds nd duty or tx, f ny) Sle of goods Sle of servces Other opertng revenues (specfy nture nd mount) b b c Totl ( + b) c v Totl ( + + c) Av B Gross recepts from Professon B C Dutes, txes nd cess receved or recevble n respect of goods nd servces sold or suppled Unon Excse dutes Servce tx VAT/ Sles tx CREDITS TO PROFIT AND LOSS ACCOUNT v Centrl Goods & Servce Tx (CGST) v v Stte Goods & Servces Tx (SGST) v v Integrted Goods & Servces Tx (IGST) v v Unon Terrtory Goods & Servces Tx (UTGST) v v Any other duty, tx nd cess v x Totl ( v +v+ v+v+v) Cx D Totl Revenue from opertons (Av + B +Cx) 1D 2 Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sle of fxed ssets v v Proft on sle of nvestment beng securtes chrgeble to Securtes Trnscton Tx (STT) v v Proft on sle of other nvestment v v Proft on ccount of currency fluctuton v x Agrculturl ncome x x Any other ncome (specfy nture nd mount) x b xb c Totl (x + xb) xc x Totl of other ncome ( v + v + v + v + v + x + xc) 2x 3 Closng Stock Rw mterl 3 Work-n-progress 3 Pge 203

26 204 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] DEBITS TO PROFIT AND LOSS ACCOUNT Fnshed goods Totl ( ) 4 Totl of credts to proft nd loss ccount (1D + 2x + 3v) 4 5 Openng Stock Rw mterl Work-n-progress Fnshed goods v Totl ( ) 6 Purchses (net of refunds nd duty or tx, f ny) 6 7 Dutes nd txes, pd or pyble, n respect of goods nd servces purchsed Custom duty Counter velng duty Specl ddtonl duty v Unon excse duty v Servce tx v VAT/ Sles tx v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) x Integrted Goods & Servces Tx (IGST) x Unon Terrtory Goods & Servces Tx (UTGST) x Any other tx, pd or pyble v 7v 7v 7v 7v x Totl ( v + 7v + 7v + 7v + 7v + 7x + 7x + 7x) 8 Freght 8 9 Consumpton of stores nd spre prts 9 10 Power nd fuel Rents Reprs to buldng Reprs to mchnery Compenston to employees Slres nd wges Bonus Rembursement of medcl expenses v Leve encshment v Leve trvel benefts v Contrbuton to pproved supernnuton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed grtuty fund x Contrbuton to ny other fund 14x Any other beneft to employees n respect of whch n x expendture hs been ncurred 14x x Totl compenston to employees ( v + 14v + 14v + 14v + 14v + 14x + 14x) x Whether ny compenston, ncluded n 14x, pd to non-resdents x Yes / No b If Yes, mount pd to non-resdents xb 15 Insurnce 7x 7x 7x v 14v 14v 14v 14v Medcl Insurnce 15 Lfe Insurnce Keymn s Insurnce v Other Insurnce ncludng fctory, offce, cr, goods, etc. v Totl expendture on nsurnce ( v) 15v 16 Workmen nd stff welfre expenses v 3v 5v 7x 14x

27 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Entertnment Hosptlty Conference Sles promoton ncludng publcty (other thn dvertsement) Advertsement Commsson Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 23 Roylty Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 24 Professonl / Consultncy fees / Fee for techncl servces Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 25 Hotel, bordng nd Lodgng Trvelng expenses other thn on foregn trvelng Foregn trvellng expenses Conveynce expenses Telephone expenses Guest House expenses Club expenses Festvl celebrton expenses Scholrshp Gft Donton Rtes nd txes, pd or pyble to Government or ny locl body (excludng txes on ncome) Unon excse duty Servce tx VAT/ Sles tx v Cess v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) v Unon Terrtory Goods & Servces Tx (UTGST) x Any other rte, tx, duty or cess ncl STT nd CTT 36x Totl rtes nd txes pd or pyble ( v + 36v + 36v + 36v + 36v + x 36x) 37 Audt fee Other expenses (specfy nture nd mount) Totl ( + ) 38 Bd debts (specfy PAN of the person, f vlble, for whom Bd Debt for mount of Rs. 1 lkh or more s clmed 39 nd mount) v 36v 36v 36v 36v x Pge 205

28 206 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PROVISIONS FOR TAX AND APPROPRIATIONS NO ACCOUNT CASE Others (more thn Rs. 1 lkh) where PAN v s not vlble v Others (mounts less thn Rs. 1 lkh) v Totl Bd Debt ( v + 39v) 39 39v 39v 40 Provson for bd nd doubtful debts Other provsons 41 Proft before nterest, deprecton nd txes [4 (5v x + 8 to x + 15v + 16 to to x v )] 43 Interest Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 44 Deprecton nd mortston Proft before txes ( ) Provson for current tx Provson for Deferred Tx nd deferred lblty Proft fter tx ( ) Blnce brought forwrd from prevous yer Amount vlble for pproprton ( ) Trnsferred to reserves nd surplus Blnce crred to blnce sheet n propretor s ccount (50 51) In cse where regulr books of ccount of busness or professon re not mntned, furnsh the followng nformton for prevous yer n respect of busness or professon () For ssessee crryng on Busness Gross recepts 53() b Gross proft 53()b c Expenses 53()c d Net proft 53()d () For ssessee crryng on Professon Gross recepts 53 () b Gross proft 53 ()b c Expenses 53 ()c d Net proft 53 ()d Totl (53()d + 53()d) 53 39v Prt A- OI OTHER INFORMATION Other Informton (optonl n cse not lble for udt under secton 44AB) 1 Method of ccountng employed n the prevous yer (Tck) mercntle csh 2 Is there ny chnge n method of ccountng (Tck) Yes No Increse n the proft or decrese n loss becuse of devton, f ny, s per Income Computton 3 Dsclosure Stndrds notfed under secton 145(2) [column 11() of Schedule ICDS] 3 Decrese n the proft or ncrese n loss becuse of devton, f ny, s per Income Computton 3b Dsclosure Stndrds notfed under secton 145(2) [column 11b() of Schedule ICDS] 3b 4 Method of vluton of closng stock employed n the prevous yer Rw Mterl (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) b Fnshed goods (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) c Is there ny chnge n stock vluton method (Tck) Yes No d Increse n the proft or decrese n loss becuse of devton, f ny, from the method of 4d vluton specfed under secton 145A e Decrese n the proft or ncrese n loss becuse of devton, f ny, from the method of 4e vluton specfed under secton 145A 5 Amounts not credted to the proft nd loss ccount, beng - the tems fllng wthn the scope of secton 28 5

29 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k b the proform credts, drwbcks, refund of duty of customs or excse or servce tx, or refund of sles tx or vlue dded tx, or refund of GST, where such credts, drwbcks or refunds re dmtted s due by the uthortes concerned c esclton clms ccepted durng the prevous yer d ny other tem of ncome e cptl recept, f ny f Totl of mounts not credted to proft nd loss ccount (5+5b+5c+5d+5e) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 36 due to non-fulflment of condtons specfed n relevnt cluses Premum pd for nsurnce gnst rsk of dmge or destructon of stocks or store [36(1)()] 6 b Premum pd for nsurnce on the helth of employees [36(1)(b)] 6b Any sum pd to n employee s bonus or commsson for c servces rendered, where such sum ws otherwse pyble to 6c hm s profts or dvdend [36(1)()] d Any mount of nterest pd n respect of borrowed cptl [36(1)()] 6d e Amount of dscount on zero-coupon bond [36(1)()] 6e f Amount of contrbutons to recognsed provdent fund [36(1)(v)] 6f g Amount of contrbutons to n pproved supernnuton fund [36(1)(v)] 6g h Amount of contrbuton to penson scheme referred to n secton 80CCD [36(1)(v)] 6h Amount of contrbutons to n pproved grtuty fund [36(1)(v)] 6 j Amount of contrbutons to ny other fund 6j Any sum receved from employees s contrbuton to ny provdent fund or supernnuton fund or ny fund set up k under ESI Act or ny other fund for the welfre of employees 6k to the extent not credted to the employees ccount on or before the due dte [36(1)(v)] l Amount of bd nd doubtful debts [36(1)(v)] 6l m Provson for bd nd doubtful debts [36(1)(v)] n Amount trnsferred to ny specl reserve [36(1)(v)] Expendture for the purposes of promotng fmly plnnng o mongst employees [36(1)(x)] Amount of securtes trnscton pd n respect of p trnscton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] q Any other dsllownce r Totl mount dsllowble under secton 36 (totl of 6 to 6q) 7 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 37 Expendture of cptl nture [37(1)] 7 b Expendture of personl nture [37(1)] 7b c Expendture ld out or expended wholly nd exclusvely NOT for the purpose of busness or professon [37(1)] 7c d Expendture on dvertsement n ny souvenr, brochure, trct, pmphlet or the lke, publshed by poltcl prty [37(2B)] 7d e Expendture by wy of penlty or fne for volton of ny lw for 7e the tme beng n force f Any other penlty or fne 7f g Expendture ncurred for ny purpose whch s n offence or whch s prohbted by lw 7g h Amount of ny lblty of contngent nture 7h Any other mount not llowble under secton 37 7 j Totl mount dsllowble under secton 37 (totl of 7 to 7) 8 A Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40 Amount dsllowble under secton 40 ()(), on ccount of non-complnce wth the provsons of Chpter XVII-B A 5b 5c 5d 5e 6m 6n 6o 6p 6q 6r 5f 7j Pge 207

30 208 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Amount dsllowble under secton 40()() on ccount of b non-complnce wth the provsons of Chpter XVII-B Amount dsllowble under secton 40()(b), on ccount of c non-complnce wth the provsons of Chpter VIII of the Fnnce Act, 2016 Amount dsllowble under secton 40()() on ccount of d non-complnce wth the provsons of Chpter XVII-B Amount of tx or rte leved or ssessed on the bss of e profts [40()()] f Amount pd s welth tx [40()()] Amount pd by wy of roylty, lcense fee, servce fee etc. s g per secton 40()(b) Amount of nterest, slry, bonus, commsson or h remunerton pd to ny prtner or member [40(b)] Any other dsllownce j Totl mount dsllowble under secton 40(totl of A to A) Any mount dsllowed under secton 40 n ny precedng prevous yer but llowble durng B the prevous yer 9 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40A Amounts pd to persons specfed n secton 40A(2)(b) 9 b Amount pd otherwse thn by ccount pyee cheque or ccount pyee bnk drft or use of electronc clerng system through bnk ccount, dsllowble under secton 40A(3) 9b c Provson for pyment of grtuty [40A(7)] 9c d ny sum pd by the ssessee s n employer for settng up or s contrbuton to ny fund, trust, compny, AOP, or BOI or socety or ny other nsttuton [40A(9)] 9d e Any other dsllownce 9e f Totl mount dsllowble under secton 40A 9f Any mount dsllowed under secton 43B n ny precedng prevous yer but llowble durng the 10 prevous yer Any sum n the nture of tx, duty, cess or fee under ny lw 10 b Any sum pyble by wy of contrbuton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the 10b welfre of employees c Any sum pyble to n employee s bonus or commsson for servces rendered 10c d Any sum pyble s nterest on ny lon or borrowng from ny publc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton 10d Any sum pyble s nterest on ny lon or borrowng from ny e scheduled bnk or co-opertve bnk other thn prmry 10e grculturl credt or prmry co-opertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment 10f g Any sum pyble to the Indn Rlwys for the use of rlwy ssets 10g h Totl mount llowble under secton 43B (totl of 10 to 10g) 10h Any mount debted to proft nd loss ccount of the prevous yer but dsllowble under secton 11 43B Any sum n the nture of tx, duty, cess or fee under ny lw 11 b Any sum pyble by wy of contrbuton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the 11b welfre of employees c Any sum pyble to n employee s bonus or commsson for servces rendered 11c d Any sum pyble s nterest on ny lon or borrowng from ny publc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton 11d Any sum pyble s nterest on ny lon or borrowng from ny scheduled bnk or co-opertve bnk other thn prmry e 11e grculturl credt socety or prmry co-opertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment 11f g Any sum pyble to the Indn Rlwys for the use of rlwy 11g ssets Ab Ac Ad Ae Af Ag Ah A 8Aj 8B

31 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 209 h Totl mount dsllowble under Secton 43B (totl of 11 to 11g) 12 Amount of credt outstndng n the ccounts n respect of Unon Excse Duty b Servce tx c VAT/sles tx d Centrl Goods & Servce Tx (CGST) e Stte Goods & Servces Tx (SGST) f Integrted Goods & Servces Tx (IGST) g Unon Terrtory Goods & Servces Tx (UTGST) h Any other tx Totl mount outstndng (totl of 12 to 12h) 13 Amounts deemed to be profts nd gns under secton 33AB or 33ABA Any mount of proft chrgeble to tx under secton Amount of ncome or expendture of pror perod credted or debted to the proft nd loss ccount 15 (net) 15 Prt A QD QUANTITATIVE DETAILS Quntttve detls (optonl n cse not lble for udt under secton 44AB) () In the cse of trdng concern 1 Openng stock 1 2 Purchse durng the prevous yer 2 3 Sles durng the prevous yer 3 4 Closng stock 4 5 Shortge/ excess, f ny 5 (b) In the cse of mnufcturng concern 6 Rw mterls Openng stock b Purchses durng the prevous yer c Consumpton durng the prevous yer d Sles durng the prevous yer e Closng stock f Yeld fnshed products g Percentge of yeld h Shortge/ excess, f ny 7 Fnshed products/ By-products openng stock b purchse durng the prevous yer c quntty mnufctured durng the prevous yer d sles durng the prevous yer e closng stock f shortge/ excess, f ny 12 12b 12c 12d 12e 12f 12g 12h 11h b 6c 6d 6e 6f 6g 6h 7 7b 7c 7d 7e 7f Prt B TI TOTAL INCOME Computton of totl ncome 1 Slres (6of Schedule S) 1 2 Income from house property (3b of Schedule-HP) (enter nl f loss) 2 3 Profts nd gns from busness or professon Proft nd gns from busness other thn specultve busness nd specfed busness (A38 of Schedule BP) (enter nl f loss) Proft nd gns from specultve busness (B42 of Schedule BP) (enter nl f loss nd tke the fgure to schedule CFL) Proft nd gns from specfed busness (C48 of Schedule BP) (enter nl f loss nd tke the fgure to schedule CFL) v Income from ptent u/s 115BBF (3e of Schedule BP) Income from trnsfer of crbon credts u/s 115BBG (3f of v Schedule BP) v 3v Pge 209

32 210 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Totl ( v + 3v) (enter nl f 3v s loss) 4 Cptl gns Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chrgeble t pplcble rte (7v of tem E of schedule CG) v Totl Short-term ( + + ) b Long-term Long-term 10% (7v of tem E of schedule CG) b Long-term 20% (7v of tem E of schedule CG) Totl Long-term (b + b) (enter nl f loss) c Totl cptl gns (4v + 4b) (enter nl f loss) 5 Income from other sources from sources other thn from ownng rce horses nd ncome chrgeble to tx t specl rte (1k of Schedule OS) (enter nl f loss) b Income chrgeble to tx t specl rte (1fv of Schedule OS) c from the ctvty of ownng nd mntnng rce horses (3e of Schedule OS) (enter nl f loss) d Totl (5 + 5b + 5c) (enter nl f loss) 6 Totl ( v +4c +5d) 6 7 Losses of current yer to be set off gnst 6 (totl of 2xv,3xv nd 4xv of Schedule CYLA) 7 8 Blnce fter set off current yer losses (6 7) (totl of column 5 of Schedule CYLA+5b) 8 9 Brought forwrd losses to be set off gnst 8 (totl of 2x, 3x nd 4x of Schedule BFLA) 9 10 Gross Totl ncome (8-9) (5xv of Schedule BFLA+ 5b) Income chrgeble to tx t specl rte under secton 111A, 112 etc. ncluded n Deducton u/s 10AA (c of Sch. 10AA) Deductons under Chpter VI-A Prt-B, CA nd D of Chpter VI-A [(1 + 3) of Schedule VI-A nd lmted upto (10-11)] b Prt-C of Chpter VI-A [(2 of Schedule VI-A nd lmted upto ( )] c Totl ( b) [lmted upto (10-11)] 14 Totl ncome ( c) Income whch s ncluded n 14 nd chrgeble to tx t specl rtes (totl of () of schedule SI) Net grculturl ncome/ ny other ncome for rte purpose (4 of Schedule EI) Aggregte ncome ( ) [pplcble f (14-15) exceeds mxmum mount not chrgeble to tx] Losses of current yer to be crred forwrd (totl of row x of Schedule CFL) 18 Prt B TTI COMPUTATION OF TAX LIABILITY Computton of tx lblty on totl ncome 1 Tx pyble on deemed totl ncome under secton 115JC (4 of Schedule AMT) 1 b Surchrge on () (f pplcble) c Educton Cess, ncludng secondry nd hgher educton cess on (1+1b) bove d Totl Tx Pyble on deemed totl ncome (1+1b+1c) 2 Tx pyble on totl ncome Tx t norml rtes on 17 of Prt B-TI b Tx t specl rtes (totl of col. () of Schedule-SI) c Rebte on grculturl ncome [pplcble f (14-15) of Prt B-TI exceeds mxmum mount not chrgeble to tx] d Tx Pyble on Totl Income (2 + 2b 2c) e Rebte under secton 87A f Tx pyble fter rebte (2d 2e) g Surchrge 25% of 13() of Schedule SI On [(2f) (13() of Schedule SI)] Totl ( + ) h Educton cess, ncludng secondry nd hgher educton cess on (2f + 2g) 2 2b 4v b 4b 5 5b 5c 2c 2g 2g 3v 4c 5d 13 13b 13c 1b 1c 1d 2d 2e 2f 2g 2h

33 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 211 TAXES PAID BANK ACCOUNT Gross tx lblty (2f + 2g + 2h) 3 Gross tx pyble (hgher of 1d nd 2) 3 Credt under secton 115JD of tx pd n erler yers (pplcble f 2 s more thn 1d) (5 of 4 4 Schedule AMTC) 5 Tx pyble fter credt under secton 115JD (3-4) 5 6 Tx relef Secton 89 b Secton 90/ 90A ( 2 of Schedule TR) c Secton 91 ( 3 of Schedule TR) d Totl (6 + 6b+ 6c) 7 Net tx lblty (5-6d) (enter zero f negtve) 7 8 Interest nd fee pyble Interest for defult n furnshng the return (secton 234A) b Interest for defult n pyment of dvnce tx (secton 234B) c Interest for deferment of dvnce tx (secton 234C) d Fee for defult n furnshng return of ncome (secton 234F) e Totl Interest nd Fee Pyble (8+8b+8c+8d) 9 Aggregte lblty (7 + 8e) 9 10 Txes Pd Advnce Tx (from column 5 of 18A) b TDS (totl of column 5 of 18B nd column 8 of 18C) c TCS (column 7 of 18D) d Self-Assessment Tx (from column 5 of 18A) e Totl Txes Pd (10+10b+10c+10d) 11 Amount pyble (Enter f 9 s greter thn 10e, else enter 0) Refund (If 10e s greter thn 9) (Refund, f ny, wll be drectly credted nto the bnk ccount) b 6c 10 10b 10c 10d Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of non-resdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Accounts held n Ind (SWIFT Code n cse of foregn Bnk Account) Nme of the Bnk 8 8b 8c 8d Account Number (IBAN n cse of foregn Bnk Accounts) 14 Do you t ny tme durng the prevous yer,- () hold, s benefcl owner, benefcry or otherwse, ny sset (ncludng fnncl nterest n ny entty) locted outsde Ind; or () hve sgnng uthorty n ny ccount locted outsde Ind; or () hve ncome from ny source outsde Ind? [pplcble only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] 2 6d 8e 10e Indcte the ccount n whch you prefer to get your refund credted, f ny (tck one ccount ) Yes No VERIFICATION I, son/ dughter of solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return nd schedules thereto s correct nd complete nd s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng returns n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon).i further declre tht the crtcl ssumptons specfed n the greement hve been stsfed nd ll the terms nd condtons of the greement hve been compled wth. (Applcble n cse where return s furnshed under secton 92CD) Plce Dte 15 If the return hs been prepred by Tx Return Preprer (TRP) gve further detls below: Sgn here Identfcton No. of TRP Nme of TRP Counter Sgnture of TRP If TRP s enttled for ny rembursement from the Government, mount thereof TAX PAYMENTS Pge 211

34 212 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl No BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Amount (Rs) (1) (2) (3) (4) (5) v NOTE Enter the totls of Advnce tx nd Self-Assessment tx n Sl No. 10 & 10d of Prt B-TTI Detls of Tx Deducted t Source from Slry [As per Form 16 ssued by Employer(s)] Sl No Tx Deducton Account Nme of the Employer Income chrgeble under Slres Totl tx deducted Number (TAN) of the Employer (1) (2) (3) (4) (5) I II NOTE Plese enter totl of column 5 n 10b of Prt B-TTI

35 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 213 C Detls of Tx Deducted t Source (TDS) on Income [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s) ] TDS ON OTHER INCOME D TDS ON OTHER INCOME Sl No TAN of the Deductor/ PAN of the Buyer/ Tennt Nme of the Deductor/ Buyer/Tennt Unque TDS Certfcte Number Unclmed TDS brought forwrd (b/f) TDS of the current fn. Yer TDS credt out of (7) or (8) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) TDS credt out of (7) or (8) beng crred forwrd Fn. Yer Amount Deducted Deducted n the hnds of spouse Clmed Clmed n the hnds of n whch deducted b/f n own hnds s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) n own hnds spouse s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Income TDS PAN of spouse/ other person NOTE Plese enter totl of column 8 n 10b of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl. Tx Deducton nd Tx No. Collecton Account Number of the Collector Nme of the Collector Unclmed TCS brought forwrd (b/f) Fn. Yer n whch collected Amount b/f TCS of the current fn. yer Income TDS PAN of spouse/ other person Amount out of (5) or (6) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) Amount out of (5) or (6) beng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) NOTE Plese enter totl of column (7) n 10c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1-S22) AS APPLICABLE Pge 213

36 214 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule S Detls of Income from Slry Nme of Employer PAN of Employer (f vlble) Address of employer Town/Cty Stte Pn code SALARIES Slry (Excludng ll exempt/ non-exempt llownces, perqustes & proft n leu of slry s they re shown 1 1 seprtely below) 2 Allownces not exempt (refer Form 16 from employer) 2 3 Vlue of perqustes (refer Form 16 from employer) 3 4 Profts n leu of slry (refer Form 16 from employer) 4 5 Deducton u/s 16 (Entertnment llownce by Government nd tx on employment) 5 6 Income chrgeble under the Hed Slres ( ) 6 7 Allownces exempt under secton 10 (Not to be ncluded n 6 bove) 7 Trvel concesson/ssstnce receved [(sec. 10(5)] Tx pd by employer on non-monetry perquste [(sec. 10(10CC)] Allownce to meet expendture ncurred on house rent [(sec. 10(13A)] v Other llownces v Schedule HP Detls of Income from House Property (Plese refer to nstructons) Address of property 1 Town/ Cty Stte PIN Code 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Your percentge of shre n the property. Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property I II HOUSE PROPERTY 2 [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out Self-occuped Deemed let out I II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two f let out for prt of the yer) 1 b The mount of rent whch cnnot be relzed 1b c Tx pd to locl uthortes 1c d Totl (1b + 1c) 1d e Annul vlue (1 1d) (nl, f self -occuped etc. s per secton 23(2)of the Act) 1e f Annul vlue of the property owned (own percentge shre x 1e) 1f g 30% of 1f 1g h Interest pyble on borrowed cptl 1h Totl (1g+ 1h) 1 j Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty Stte PIN Code Is the property co-owned? Yes No (f YES plese enter followng detls) Your percentge of shre n the property Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property (optonl) I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN(s) of Tennt (f vlble) I

37 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 215 NOTE Let out Self-occuped II Deemed let out Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two, f let out for prt of the yer) b The mount of rent whch cnnot be relzed 2b c Tx pd to locl uthortes 2c d Totl (2b + 2c) 2d e Annul vlue (2 2d) f Annul vlue of the property owned (own percentge shre x 2e) g 30% of 2f 2g h Interest pyble on borrowed cptl 2h Totl (2g + 2h) 2 j Income from house property 2 (2f 2) 2j 3 Income under the hed Income from house property Unrelzed rent nd Arrers of rent receved durng the yer under secton 25A fter deductng 3 30% b Totl (1j + 2j +3) (f negtve tke the fgure to 2 of schedule CYLA) 3b Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed 2e 2f 2 Schedule BP Computton of ncome from busness or professon A From busness or professon other thn specultve busness nd specfed busness INCOME FROM BUSINESS OR PROFESSION 1 Proft before tx s per proft nd loss ccount (tem 45 nd 53 of Prt A-P&L ) 1 2 Net proft or loss from specultve busness ncluded n 1 (enter ve 2 sgn n cse of loss) 2b Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n cse of loss) 2b 3 Income/ recepts credted to proft nd loss ccount consdered under other heds of ncome/chrgeble u/s 115BBF/ chrgeble u/s 115BBG Slres 3 b House property 3b c Cptl gns d Other sources e u/s 115BBF f u/s 115BBG 3f Proft or loss ncluded n 1, whch s referred to n secton 4 44AD/44ADA/44AE/44B/44BB/44BBA/44BBB/44D/44DA/Chpter- 4 XII-G/ Frst Schedule of Income-tx Act 5 Income credted to Proft nd Loss ccount (ncluded n 1) whch s exempt Shre of ncome from frm(s) 5 b Shre of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nture nd mount) c c Totl (c + c) 5c d Totl exempt ncome (5 + 5b + 5c) 5d 6 Blnce (1 2 2b 3-3b 3c - 3d 3e - 3f 4 5d) Expenses debted to proft nd loss ccount consdered under other heds of ncome/relted to ncome chrgeble u/s 115BBF or u/s 115BBG Slres 3c 3d 3e 7 b House property 7b c Cptl gns d Other sources e u/s 115BBF f u/s 115BBG Expenses debted to proft nd loss ccount whch relte to exempt ncome 9 Totl (7 + 7b + 7c + 7d + 7e + 7f + 8) 9 10 Adjusted proft or loss (6+9) Deprecton nd mortston debted to proft nd loss ccount Deprecton llowble under Income-tx Act Deprecton llowble under secton 32(1)() nd 32(1)() (tem 6 of Schedule-DEP) 12 7c 7d 7e 7f 8

38 216 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Deprecton llowble under secton 32(1)() (Mke your own computton refer Appendx-IA of IT Rules) Totl ( ) 13 Proft or loss fter djustment for deprecton ( ) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 36 (6r of PrtA-OI) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 37 (7j of PrtA-OI) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40 (8Aj of PrtA-OI) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40A (9f of PrtA-OI) Any mount debted to proft nd loss ccount of the prevous yer but dsllowble under secton 43B (11h of PrtA-OI) Interest dsllowble under secton 23 of the Mcro, Smll nd Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AD/ 33AB/ 33ABA/ 35ABA /35ABB/ 40A(3A)/ 72A/80HHD/ 80-IA 22 Deemed ncome under secton 43CA Any other tem of ddton under secton 28 to 44DA Any other ncome not ncluded n proft nd loss ccount/ny other expense not llowble (ncludng ncome from slry, commsson, bonus nd nterest from frms n whch ndvdul/huf/prop. concern s prtner) Increse n proft or decrese n loss on ccount of ICDS djustments nd devton n method of vluton of stock (Column 3 + 4d of Prt A - OI) 26 Totl ( ) Deducton llowble under secton 32(1)() Deducton llowble under secton 32AD Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the mount debted to proft nd loss ccount (tem x(4) of Schedule ESR) (f mount deductble under secton 35 or 29 35CCC or 35CCD s lower thn mount debted to P&L ccount, t wll go to tem 24) 30 Any mount dsllowed under secton 40 n ny precedng prevous yer but llowble durng the prevous yer(8b of 30 PrtA-OI) 31 Any mount dsllowed under secton 43B n ny precedng prevous yer but llowble durng the prevous yer(10g of 31 PrtA-OI) 32 Any other mount llowble s deducton Decrese n proft or ncrese n loss on ccount of ICDS 33 djustments nd devton n method of vluton of stock (Column 3b + 4e of Prt A- OI) 34 Totl ( ) Income ( ) Profts nd gns of busness or professon deemed to be under - Secton 44AD 36 Secton 44ADA 36 Secton 44AE 36 v Secton 44B 36v v Secton 44BB 36v v Secton 44BBA 36v v Secton 44BBB 36v v Secton 44D 36v x Secton 44DA 36x (tem 4 of Form 3CE) x Frst Schedule of Income-tx Act 36x

39 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 217 x Totl (36 to 36x) 36x 37 Net proft or loss from busness or professon other thn specultve nd specfed 37 busness (35+36x) 38 Net Proft or loss from busness or professon other thn specultve busness nd specfed busness fter pplyng rule 7A, 7B or 8, f pplcble (If rule 7A, 7B or 8 s not pplcble, enter sme fgure s n 37) (If loss tke the fgure to 2 of tem E) A38 B Computton of ncome from specultve busness 39 Net proft or loss from specultve busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA Deductons n ccordnce wth secton 28 to 44DA Income from specultve busness ( ) (f loss, tke the fgure to 6x of schedule CFL) B42 C Computton of ncome from specfed busness under secton 35AD D 43 Net proft or loss from specfed busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA Deductons n ccordnce wth secton 28 to 44DA (other thn deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clmed) 46 Proft or loss from specfed busness ( ) Deductons n ccordnce wth secton 35AD(1) Income from Specfed Busness (46-47) (f loss, tke the fgure to 7x of schedule CFL) C48 49 Relevnt cluse of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from drop down menu) Income chrgeble under the hed Profts nd gns from busness or professon (A38+B42+C48) E Intr hed set off of busness loss of current yer Sl. v v Type of Busness ncome Loss to be set off (Fll ths row only f fgure s negtve) Income from specultve busness Income from specfed busness Totl loss set off ( + ) Loss remnng fter set off ( v) Income of current yer (Fll ths column only f fgure s zero or postve) Busness loss set off 45 C49 D Busness ncome remnng fter set off (1) (2) (3) = (1) (2) NOTE Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed (B42) (C48) (A38) Deprecton on Plnt nd Mchnery (Other thn ssets on whch full cptl expendture s llowble s deducton under ny Schedule DPM other secton) 1 Block of ssets Plnt nd mchnery DEPRECIATION ON PLANT AND MACHINERY 2 Rte (%) () Wrtten down vlue on the frst dy of prevous yer 3(b) Wrtten down vlue on the frst dy of prevous yer, of those block of ssets whch were elgble for 50%, 60% or 80% s per the old Tble 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed (3() + 3(b) + 4-5) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 () () ()

40 218 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 9 Amount on whch deprecton t hlf rte to be llowed (7-8) (enter 0, f result s negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Addtonl deprecton, f ny, on 4 13 Addtonl deprecton, f ny, on 7 14 Addtonl deprecton reltng to mmedtely precedng yer' on sset put to use for less thn 180 dys 15 Totl deprecton ( ) 16 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net ggregte deprecton (15-16) 18 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth trnsfer of sset/ ssets 20 Cptl gns/ loss under secton 50 ( () 3(b) ) (enter negtve only f block ceses to exst) 21 Wrtten down vlue on the lst dy of prevous yer ( ) (enter 0 f result s negtve) Schedule DOA Deprecton on other ssets (Other thn ssets on whch full cptl expendture s llowble s deducton) 1 Block of ssets Lnd Buldng (not ncludng lnd) Furnture nd Intngble Shps fttngs ssets 2 Rte (%) Nl DEPRECIATION ON OTHER ASSETS 3 Wrtten down vlue on the frst dy of prevous yer 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed ( ) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 9 Amount on whch deprecton t hlf rte to be llowed (7-8) (enter 0, f result s negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Totl deprecton (10+11) 13 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net ggregte deprecton (12-13) 15 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 14) 16 Expendture ncurred n connecton wth trnsfer of sset/ ssets 17 Cptl gns/ loss under secton 50 ( ) (enter negtve only f block ceses to exst) 18 Wrtten down vlue on the lst dy of prevous yer ( ) (enter 0 f result s negtve) () () () (v) (v) (v) (v)

41 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 219 Summry of deprecton on ssets (Other thn ssets on whch full cptl expendture s llowble s deducton under ny Schedule DEP other secton) 1 Plnt nd mchnery SUMMARY OF DEPRECIATION ON ASSETS Block enttled for 15 per cent 1 ( Schedule DPM -17 or 18 s pplcble) b Block enttled for 30 per cent 1b ( Schedule DPM - 17 or 18 s pplcble) c Block enttled for 40 per cent 1c ( Schedule DPM - 17 or 18 s pplcble) d Totl deprecton on plnt nd mchnery ( 1 + 1b + 1c) 1d 2 Buldng (not ncludng lnd) Block enttled for 5 per cent 2 (Schedule DOA- 14 or 15 s pplcble) b Block enttled for 10 per cent 2b (Schedule DOA- 14 or 15 s pplcble) c Block enttled for 40 per cent (Schedule 2c DOA- 14v or 15v s pplcble) d Totl deprecton on buldng (totl of 2 + 2b + 2c) 2d 3 Furnture nd fttngs(schedule DOA- 12v) 3 4 Intngble ssets (Schedule DOA- 12v) 4 5 Shps (Schedule DOA- 12v) 5 6 Totl deprecton (1d+2d+3+4+5) 6 Schedule DCG DEEMED CAPITAL GAINS Deemed Cptl Gns on sle of deprecble ssets 1Plnt nd mchnery Block enttled for 15 per 1 cent (Schedule DPM - 20) bblock enttled for 30 per 1b cent (Schedule DPM 20) cblock enttled for 40 per 1c cent (Schedule DPM - 20) dtotl ( 1 +1b + 1c) 2Buldng (not ncludng lnd) Block enttled for 5 per 2 cent (Schedule DOA- 17) bblock enttled for 10 per 2b cent (Schedule DOA- 17) cblock enttled for 40 per 2c cent (Schedule DOA- 17v) dtotl ( 2 + 2b + 2c) 2d 3Furnture nd fttngs ( Schedule DOA- 17v) 3 4Intngble ssets (Schedule DOA- 17v) 4 5Shps (Schedule DOA- 17v) 5 6Totl ( 1d+2d+3+4+5) 6 1d Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nture referred to n secton (1) Amount, f ny, debted to proft nd loss ccount (2) Amount of deducton llowble (3) v V v v 35(1)() 35(1)() 35(1)() 35(1)() 35(1)(v) 35(2AA) 35(2AB) Amount of deducton n excess of the mount debted to proft nd loss ccount (4) = (3) - (2)

42 220 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v x X 35CCC 35CCD Totl Schedule CG Cptl Gns A Short-term Cptl Gns (STCG) (Sub-tems 4 nd 5 re not pplcble for resdents) 1 From sle of lnd or buldng or both Short-term Cptl Gns Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b + b) bv c Blnce ( bv) 1c d Deducton under secton 54B/54D/ 54G/54GA (Specfy detls n tem D below) 1d e Short-term Cptl Gns on Immovble property (1c - 1d) A1e 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Short term cptl gns from slump sle (2-2b) A2c 3 From sle of equty shre or unt of equty orented Mutul Fund (MF) or unt of busness trust on whch STT s pd under secton 111A or 115AD(1)() provso (for FII) Full vlue of consderton 3 b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl ( + + ) bv c Blnce (3 bv) 3c Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset d bought/cqured wthn 3 months pror to record dte nd 3d dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) e Short-term cptl gn on equty shre or equty orented MF (STT pd) (3c +3d) A3e 4 For NON-RESIDENT, not beng n FII- from sle of shres or debentures of n Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) STCG on trnsctons on whch securtes trnscton tx (STT) s pd A4 5 b STCG on trnsctons on whch securtes trnscton tx (STT) s not pd A4b For NON-RESIDENTS- from sle of securtes (other thn those t A3 bove) by n FII s per secton 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl ( + + ) bv c Blnce (5 bv) 5c c

43 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 221 d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f securty bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such securty to be gnored (Enter postve vlue only) e Short-term cptl gn on sle of securtes (other thn those t A3 bove) by n FII (5c +5d) A5e 6 From sle of ssets other thn t A1 or A2 or A3 or A4 or A5 bove In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres c dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl ( + + ) bv c Blnce (6 bv) 6c d In cse of sset (securty/unt) loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng 6d out of sle of such sset to be gnored (Enter postve vlue only) e Deemed short term cptl gns on deprecble ssets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on ssets other thn t A1 or A2 or A3 or A4 or A5 bove (6c + 6d + 6e -6f) A6g 7 Amount deemed to be short term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yers shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer n whch sset trnsferred Secton under whch deducton clmed n tht yer D/54G/54GA New sset cqured/constructed Yer n whch sset cqured/constructed 5d Amount utlsed out of Cptl Gns ccount Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) B b Amount deemed to be short term cptl gns u/s 54B/54D/54G/54GA, other thn t Totl mount deemed to be short term cptl gns (X + X + b) Amount of STCG ncluded n A1-A7 but not chrgeble to tx or chrgeble t specl rtes s per 8 DTAA Sl. Amount of No. ncome Item No. A1 to A7 bove n whch ncluded Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of STCG not chrgeble to tx s per DTAA b Totl mount of STCG chrgeble t specl rtes s per DTAA 9 Totl Short-term Cptl Gn (A1e+ A2c+ A3e+ A4+ A4b+ A5e+ A6g+A7 -A8) A9 B Long-term cptl gn (LTCG) (Sub-tems 5, 6 & 7 re not pplcble for resdents) 1 From sle of lnd or buldng or both Long-term Cptl Gns Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) A7 A8 A8b

44 222 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Deductons under secton 48 Cost of cquston wth ndexton Cost of Improvement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b + b) c Blnce ( bv) 1c d Deducton under secton 54/54B/54D/54EC/54EE/54F/54G/54GA/54GB (Specfy detls n tem D below) 1d e Long-term Cptl Gns on Immovble property (1c - 1d) B1e 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Blnce (2 2b) d Deducton u/s 54EC/54EE /54F (Specfy detls n tem D below) 2d e Long term cptl gns from slump sle (2c-2d) B2e 3 From sle of bonds or debenture (other thn cptl ndexed bonds ssued by Government) Full vlue of consderton 3 b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (3 bv) 3c d Deducton under sectons 54EC/54EE /54F (Specfy detls n tem D below) 3d e LTCG on bonds or debenture (3c 3d) B3e 4 From sle of, () lsted securtes (other thn unt) or zero coupon bonds where provso under secton 112(1) s pplcble () GDR of n Indn compny referred n sec. 115ACA Full vlue of consderton 4 b Deductons under secton 48 Cost of cquston wthout ndexton b 5 6 2c b b b bv b b b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (4 bv) 4c d Deducton under sectons 54EC/54EE /54F (Specfy detls n tem D 4d e Long-term Cptl Gns on ssets t B4 bove (4c 4d) B4e For NON-RESIDENTS- from sle of shres or debenture of Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) LTCG computed wthout ndexton beneft 5 b Deducton under sectons 54EC/54EE /54F (Specfy detls n tem D 5b c LTCG on shre or debenture (5-5b) B5c For NON-RESIDENTS- from sle of, () unlsted securtes s per sec. 112(1)(c), () bonds or GDR s referred n sec. 115AC, () securtes by FII s referred to n sec. 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns c (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (6 bv) 6c bv

45 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 223 d Deducton under sectons 54EC/54EE /54F (Specfy detls n tem D 6d e Long-term Cptl Gns on ssets t 6 bove n cse of NON-REESIDENT (6c 6d) B6e 7 From sle of foregn exchnge sset by NON-RESIDENT INDIAN (If opted under chpter XII-A) LTCG on sle of specfed sset (computed wthout ndexton) 7 b Less deducton under secton 115F (Specfy detls n tem D below) 7b c Blnce LTCG on sle of specfed sset (7 7b) B7c d LTCG on sle of sset, other thn specfed sset (computed wthout ndexton) 7d e Less deducton under secton 115F (Specfy detls n tem D below) 7e f Blnce LTCG on sle of sset, other thn specfed sset (7d 7e) B7f 8 From sle of ssets where B1 to B7 bove re not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres c dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wth ndexton b Cost of mprovement wth ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (8 bv) 8c d Deducton under secton 54D/54EC/54EE /54F/54G/54GA (Specfy 8d e Long-term Cptl Gns on ssets t B8 bove (8c-8d) B8e 9 Amount deemed to be long-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yer shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer n whch sset trnsferred Secton under whch deducton clmed n tht yer /54D/54F/54G/54GA B b Amount deemed to be long-term cptl gns, other thn t 10 Totl mount deemed to be long-term cptl gns (X + X + b) New sset cqured/constructed Amount not used for new sset or remned Yer n whch sset Amount utlsed out unutlzed n Cptl cqured/constructed of Cptl Gns ccount gns ccount (X) -Amount of LTCG ncluded n tems B1 to B9 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. No. Amount of ncome Item No. B1 to B9 Country nme bove n whch & Code ncluded Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of LTCG not chrgeble to tx s per DTAA b Totl mount of LTCG chrgeble t specl rtes s per DTAA B10b Totl long term cptl gn chrgeble under I.T. Act [B1e +B2e+ B3e +B4e + B5c + B6e + B7c + B7f 11 + B8e+ B9-B10] (In cse of loss tke the fgure to 9x of schedule CFL) B11 C Income chrgeble under the hed CAPITAL GAINS (A9 + B11) (tke B11s nl, f loss) D Informton bout deducton clmed gnst Cptl Gns 1 In cse of deducton u/s 54/54B/54D/54EC/54EE /54F/54G/54GA/115F gve followng detls Deducton clmed u/s 54 Dte of trnsfer of orgnl sset dd/mm/yyyy B9 B10 C

46 224 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b c d e f g h Cost of new resdentl house Dte of purchse /constructon of new resdentl house dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54B Dte of trnsfer of orgnl sset b dd/mm/yyyy Cost of new grculturl lnd Dte of purchse of new grculturl lnd b dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54D Dte of cquston of orgnl sset c dd/mm/yyyy Cost of purchse/ constructon of new lnd or buldng for ndustrl undertkng Dte of purchse of new lnd or buldng c dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54EC Dte of trnsfer of orgnl sset d dd/mm/yyyy Amount nvested n specfed/notfed bonds (not exceedng ffty lkh rupees) Dte of nvestment d dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54EE Dte of trnsfer of orgnl sset e dd/mm/yyyy Amount nvested n specfed sset Dte of nvestment e dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54F Dte of trnsfer of orgnl sset f dd/mm/yyyy Cost of new resdentl house Dte of purchse/constructon of new resdentl house f dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54G Dte of trnsfer of orgnl sset from urbn re g dd/mm/yyyy Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n n re other thn urbn re v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54GA v v b bv bv c cv cv d dv e ev f fv fv g g gv gv dd/mm/yyyy Dte of trnsfer of orgnl sset from urbn re h dd/mm/yyyy Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n SEZ h dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 115F (for Non-Resdent Indns) Dte of trnsfer of orgnl foregn exchnge sset dd/mm/yyyy Amount nvested n new specfed sset or svngs certfcte Dte of nvestment dd/mm/yyyy v Amount of deducton clmed Totl deducton clmed (1 + 1b + 1c + 1d + 1e + 1f + 1g + 1h + j 1) 2 In cse of deducton u/s 54GB, furnsh PAN of the compny E Set-off of current yer cptl losses wth current yer cptl gns (excludng mounts ncluded n A8 & B10 whch s chrgeble under DTAA) h hv hv v 1j

47 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 225 Sl. Type of Cptl Gn Gn of current yer (Fll ths column only f computed fgure s postve) Short term cptl loss set off 15% 30% pplcble rte Long term cptl loss set off 10% 20% Current yer s cptl gns remnng fter set off (7= ) NOTE Loss to be set off (Fll ths row f fgure computed s negtve) 15% (A3e+A4) Short term 30% A5e cptl gn v pplcble rte (A1e+A2c+A4b+ A6g +A7+A8b) v Long term 10% (B4e+ + B6e+B7c) v cptl gn (B1e+B2e+B3e+ B5c+ 20% B7f+B8e+B9) v Totl loss set off ( + + v + v + v) v Loss remnng fter set off ( v) F Informton bout ccrul/recept of cptl gn Type of Cptl gn / Dte Short-term cptl gns txble t the rte of 15% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t the rte of 30% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t pplcble rtes Enter vlue from tem 5v of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 10% Enter vlue from tem 5x of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 20% Enter vlue from tem 5x of schedule BFLA, f ny. (A3e+A4) A5e Upto 15/6 () (A1e+A2c+A4 b+a6g +A7+A8b) 16/6 to 15/9 () (B4e+ B6e+B7c) 16/9 to 15/12 () Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed (B1e+B2e+B3e + B5c+ B7f+B8e+B9) 16/12 to 15/3 (v) 16/3 to 31/3 (v) Schedule OS OTHER SOURCES Income from other sources 1 Income Dvdends, Gross b Interest, Gross c Rentl ncome from mchnery, plnts, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng rce horses)menton the nture Wnnngs from lotteres, crossword puzzles etc. 1d Csh credts u/s 68 b Unexplned nvestments u/s 69 c Unexplned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B e Unexplned expendture etc. u/s 69C f Amount borrowed or repd on hund u/s 69D Totl ( + b + c + d + e + f) 1d Income of the nture referred to n secton 56(2)(x) whch s chrgeble to tx Aggregte vlue of sum of money receved wthout consderton In cse mmovble property s receved wthout b consderton, stmp duty vlue of property In cse mmovble property s receved for c ndequte consderton, stmp duty vlue of property n excess of such consderton In cse ny other property s receved wthout d consderton, fr mrket vlue of property 1 1b 1c

48 226 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v v e In cse ny other property s receved for ndequte consderton, fr mrket vlue of property n excess of such consderton Totl (+ b + c +d + e) v Totl (1d + 1d+ 1d+ 1dv+1dv) e Totl (1 + 1b + 1c + 1dv) f Income ncluded n 1e chrgeble to tx t specl rte (to be tken to schedule SI) Income by wy of wnnngs from lotteres, crossword puzzles, rces, gmes, gmblng, bettng etc (u/s 115BB) Dvdend Income from domestc compny tht exceeds Rs.10 Lkh (u/s 115BBDA) Deemed Income chrgeble to tx u/s 115BBE v Income from ptent chrgeble u/s 115BBF v Income from trnsfer of credts u/s 115BBG 1d 1dv v Any other ncome chrgeble to tx t the rte specfed under Chpter XII/XII-A 1dv 1dv 1e 1f 1f 1f 1fv 1fv 1fv v Income chrgeble t specl rtes under DTAA Rte s per Whether Applcble rte Sl. Amount of Nture of Country nme Artcle of Trety TRC Secton of Rte s per [lower of (6) or No. ncome ncome & Code DTAA (enter NIL, f obtned I.T. Act I.T. Act not chrgeble) (9)] (Y/N) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II III Totl mount of ncome chrgeble t specl rtes under DTAA 1fv NOTE v Income ncluded n 1e chrgeble to tx t specl rte (1f +1f + 1f+1fv+1fv+1fv + 1fv) g Gross mount chrgeble to tx t norml pplcble rtes (1e 1fv) 1g h Deductons under secton 57 (other thn those reltng to ncome under 1f, 1f, 1f, 1fv, 1fv, 1fv & 1fv) Expenses / Deductons h Deprecton h Totl h Amounts not deductble u/s 58 1 j Profts chrgeble to tx u/s 59 1j k Income from other sources (other thn from ownng rce horses nd mount chrgeble to tx t specl rte) (1g h j) (If negtve tke the fgure to 4 of schedule CYLA) 2 Income from other sources (other thn from ownng rce horses) (1fv + 1k) (enter 1k s nl, f negtve) 2 3 Income from the ctvty of ownng nd mntnng rce horses Recepts 3 b Deductons under secton 57 n relton to (4) 3b c Amounts not deductble u/s 58 3c d Profts chrgeble to tx u/s 59 3d e Blnce (3 3b + 3c + 3d) (f negtve tke the fgure to 10x of Schedule CFL) 4 Income under the hed Income from other sources (2 + 3e) (tke 3e s nl f negtve) 4 Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed. 1fv 1k 3e Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Detls of Income fter set-off of current yers losses Sl.No Hed/ Source of Income Income of current yer (Fll ths column only f ncome s zero or postve) Loss to be set off -> Slres (7 of Schedule S) House property (3b of Schedule HP) House property loss of the current yer set off Busness Loss (other thn speculton loss or specfed busness loss) of the current yer set off Other sources loss (other thn loss from ownng rce horses) of the current yer set off Current yer s Income remnng fter set off = (3b of Schedule (2v of tem E of (1k of Schedule-OS) HP) Schedule BP)

49 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 227 BROUGHT FORWARD LOSS ADJUSTMENT v Income from Busness (excludng speculton proft nd ncome from specfed busness) or professon (A38 of Schedule BP) v Specultve Income (3 of tem E of schedule BP) v Specfed Busness Income (3 of tem E of schedule BP) v Short-term cptl gn 15% (7 of tem E of schedule CG) v Short-term cptl gn 30% (7 of tem E of schedule CG) x Short-term cptl gn txble t pplcble rtes (7v of tem E of schedule CG) x Long term cptl gn 10% (7v of tem E of schedule CG) x x x Long term cptl gn 20% Other sources (excludng proft from ownng rce horses nd mount chrgeble to specl rte of tx) Proft from ownng nd mntnng rce horses xv Totl loss set off xv Loss remnng fter set-off ( - xv) (7v of tem E of schedule CG) (1k of schedule OS) (3e of schedule OS) Schedule BFLA Detls of Income fter Set off of Brought Forwrd Losses of erler yers Sl. Hed/ Source of Income Income fter set off, f Brought forwrd loss set Brought forwrd No. ny, of current yer s off deprecton set losses s per 5 of off Schedule CYLA) Slres (5 of schedule CYLA) House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculton ncome nd ncome from specfed busness) v Speculton Income v Specfed Busness Income (5v of schedule CYLA) v Short-term cptl gn 15% v Short-term cptl gn 30% Short-term cptl gn txble t v pplcble rtes x Long-term cptl gn 10% x Long term cptl gn 20% (5x of schedule CYLA) Other sources ncome (excludng x proft from ownng nd mntnng rce horses nd mount chrgeble (5x of schedule CYLA) to specl rte of tx) Brought forwrd llownce under secton 35(4) set off Current yer s ncome remnng fter set off (B/f busness loss, other (5v of schedule CYLA) thn speculton or specfed busness loss) (B/f norml busness or (5v of schedule CYLA) speculton loss) (B/f norml busness or specfed busness loss) (B/f short-term cptl (5v of schedule CYLA) loss) (B/f short-term cptl (5v of schedule CYLA) loss) (B/f short-term cptl (5x of schedule CYLA) loss) (B/f short-term or long- (5x of schedule CYLA) term cptl loss) (B/f short-term or longterm cptl loss) Proft from ownng nd mntnng x (5x of schedule CYLA) (B/f loss from horse rces) rce horses Totl of brought forwrd loss set off ( v2 + v2+v2+ x v2+v2+x2+x2+x2) xv Current yer s ncome remnng fter set off Totl ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5 +x5) Schedule CFL CARRY FORWARD OF LOSS Sl. No. Assessment Yer Detls of Losses to be crred forwrd to future yers Dte of Flng (DD/MM/ YYYY) House property loss Loss from busness other thn loss from specultve busness nd specfed busness Loss from specultve busness Loss from specfed busness Short-term cptl loss Long-term Cptl loss Loss from ownng nd mntnng rce horses

50 228 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v v v v v x x x x Totl of erler yer losses b/f Adjustment of bove losses n Schedule BFLA (Current yer losses) Totl loss Crred forwrd to future yers (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2v of schedule BFLA) (B42 of schedule BP, f ve) (2v of schedule BFLA) (C48 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) (2x of schedule BFLA) (3e of schedule OS, f ve) Schedule UD Unbsorbed deprecton nd llownce under secton 35(4) Sl No Assessment Yer Deprecton Allownce under secton 35(4) Amount of brought forwrd unbsorbed deprecton Amount of deprecton set-off gnst the current yer ncome Blnce crred forwrd to the next yer Amount of brought forwrd unbsorbed llownce Amount of llownce set-off gnst the current yer ncome Blnce Crred forwrd to the next yer (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Yer v v Totl (3x of BFLA) (4x of BFLA) Schedule ICDS Effect of Income Computton Dsclosure Stndrds on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X b. Accountng Polces Vluton of Inventores (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Constructon Contrcts Revenue Recognton Tngble Fxed Assets Chnges n Foregn Exchnge Rtes Government Grnts Securtes (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Borrowng Costs Provsons, Contngent Lbltes nd Contngent Assets Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negtve) Schedule 10AA Deducton under secton 10AA Deductons n respect of unts locted n Specl Economc Zone DEDUCTIO N U/S 10AA Sl Undertkng Undertkng No.1 Assessment yer n whch unt begns to mnufcture/produce/provde servces Sl Amount of deducton (tem 17 of Annexure A of Form 56F for Undertkng 1)

51 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 229 b Undertkng No.2 c Totl deducton under secton 10AA ( + b) b (tem 17 of Annexure A of Form 56F for Undertkng 2) c Schedule 80G Detls of dontons enttled for deducton under secton 80G Dontons enttled for 100% deducton wthout A qulfyng lmt PAN of Donee Amount of donton Elgble Amount of Nme nd ddress of donee donton Totl DETAILS OF DONATIONS B Dontons enttled for 50% deducton wthout qulfyng lmt Nme nd ddress of donee Totl Dontons enttled for 100% deducton subject to C qulfyng lmt Nme nd ddress of donee Totl Dontons enttled for 50% deducton subject to D qulfyng lmt Nme nd ddress of donee Totl E Totl elgble mount of dontons (A + B + C + D) PAN of Donee Amount of donton Elgble Amount of donton PAN of Donee Amount of donton Elgble Amount of donton PAN of Donee Amount of donton Elgble Amount of donton Schedule 80-IA b c d Deducton n respect of profts of n undertkng referred to n secton 80- IA(4)() [Telecommuncton servces] Deducton n respect of profts of n undertkng referred to n secton 80- IA(4)() [Industrl prk nd SEZs] Deducton n respect of profts of n undertkng referred to n secton 80- IA(4)(v) [Power] Deducton n respect of profts of n undertkng referred to n secton 80- IA(4)(v) [Revvl of power genertng plnt] nd deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Cross-country nturl gs dstrbuton network] (tem 30 of Form 10CCB 1 Undertkng No. 1 of the undertkng) (tem 30 of Form 10CCB 2 Undertkng No. 2 of the undertkng) (tem 30 of Form 10CCB b1 Undertkng No. 1 of the undertkng) (tem 30 of Form 10CCB b2 Undertkng No. 2 of the undertkng) (tem 30 of Form 10CCB c1 Undertkng No. 1 of the undertkng) (tem 30 of Form 10CCB c2 Undertkng No. 2 of the undertkng) d1 Undertkng No. 1 d2 Undertkng No. 2 (tem 30 of Form 10CCB of the undertkng) (tem 30 of Form 10CCB of the undertkng) e Totl deductons under secton 80-IA ( b1 + b2 + c1 + c2+ d1 + d2) e Schedule 80-IB Deductons under secton 80-IB Deducton n respect of ndustrl undertkng locted n Jmmu & Kshmr [Secton 80-IB(4)] 1 Undertkng no. 1 2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng)

52 230 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b c d e f g h j Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd sttes specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd dstrcts [Secton 80-IB(5)] Deducton n the cse of multplex thetre [Secton 80- IB(7A)] Deducton n the cse of conventon centre [Secton 80- IB(7B)] Deducton n the cse of undertkng whch begns commercl producton or refnng of mnerl ol [Secton 80-IB(9)] Deducton n the cse of n undertkng developng nd buldng housng projects [Secton 80-IB(10)] Deducton n the cse of n undertkng opertng cold chn fclty [Secton 80-IB(11)] Deducton n the cse of n undertkng engged n processng, preservton nd pckgng of fruts, vegetbles, met, met products, poultry, mrne or dry products [Secton 80-IB(11A)] Deducton n the cse of n undertkng engged n ntegrted busness of hndlng, storge nd trnsportton of food grns [Secton 80-IB(11A)] Deducton n the cse of n undertkng engged n k opertng nd mntnng rurl hosptl [Secton 80- IB(11B)] Deducton n the cse of n undertkng engged n l opertng nd mntnng hosptl n ny re, other thn excluded re [Secton 80-IB(11C) m Totl deducton under secton 80-IB (Totl of 1 to l2) b1 Undertkng no. 1 b2 Undertkng no. 2 c1 Undertkng no. 1 c2 Undertkng no. 2 d1 Undertkng no. 1 d2 Undertkng no. 2 e1 Undertkng no. 1 e2 Undertkng no. 2 f1 Undertkng no. 1 f2 Undertkng no. 2 g1 Undertkng no. 1 g2 Undertkng no. 2 h1 Undertkng no. 1 h2 Undertkng no. 2 1 Undertkng no. 1 2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (10(v) of Form 10CCBA of the undertkng) (10(v) of Form 10CCBA of the undertkng) (10(v) of Form 10CCBB of the undertkng) (10(v) of Form 10CCBB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) j1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) j2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) k1 Undertkng no. 1 (11(v) of From 10CCBC) k2 Undertkng no. 2 (11(v) of From 10CCBC) l1 Undertkng no. 1 (11(d) of From 10CCBD) l2 Undertkng no. 2 (11(d) of From 10CCBD) m DEDUCTION U/S 80-IC Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE Deducton n respect of undertkng locted n Skkm b Deducton n respect of undertkng locted n Hmchl Prdesh c Deducton n respect of undertkng locted n Uttrnchl d Deducton n respect of undertkng locted n North-Est d Assm db Arunchl Prdesh dc Mnpur dd Mzorm de Meghly df Nglnd d1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) d2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) db1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) db2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dc1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dc2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dd1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dd2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) de1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) de2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) df1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) df2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dg Trpur dg1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) 1 Undertkng no. 1 2 Undertkng no. 2 b1 Undertkng no. 1 b2 Undertkng no. 2 c1 Undertkng no. 1 c1 Undertkng no. 2 (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng)

53 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 231 dg2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dh Totl deducton for undertkngs locted n North-est (totl of d1 to dg2) e Totl deducton under secton 80-IC or 80-IE ( + d + c + dh) dh e Schedule VI-A Deductons under Chpter VI-A 1 Prt B- Deducton n respect of certn pyments 80C b 80CCC c 80CCD(1) e 80CCD(2) g 80D 80DDB d 80CCD(1B) f 80CCG h 80DD j 80E k 80EE l 80G m 80GG n 80GGC TOTAL DEDUCTIONS Totl Deducton under Prt B (totl of to n ) 1 2 Prt C- Deducton n respect of certn ncomes o 80-IA (e of Schedule 80-IA) p 80-IAB q 80-IB (m of Schedule 80-IB) r 80-IBA s 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) t 80JJA u 80JJAA v 80QQB w 80RRB Totl Deducton under Prt C (totl of o to w ) 2 3 Prt CA nd D- Deducton n respect of other ncomes/other deducton x 80TTA y 80U Totl Deducton under Prt CA nd D (totl of x nd y) 3 4 Totl deductons under Chpter VI-A ( ) 4

54 232 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule AMT Computton of Alternte Mnmum Tx pyble under secton 115JC 1 Totl Income s per tem 14 of PART-B-TI 1 2 Adjustment s per secton 115JC(2) Deducton clmed under ny secton ncluded n Chpter VI- A under the hedng C. Deductons n respect of certn ncomes b Deducton clmed u/s 10AA c Deducton clmed u/s 35AD s reduced by the mount of deprecton on ssets on whch such deducton s clmed d Totl Adjustment (2+ 2b+ 2c) 3 Adjusted Totl Income under secton 115JC(1) (1+2d) 3 4 Tx pyble under secton 115JC [18.5% of (3)] (f 3 s greter thn Rs. 20 lkhs) 4 2 2b 2c 2d Schedule AMTC Computton of tx credt under secton 115JD 1 Tx under secton 115JC n ssessment yer (1d of Prt-B-TTI) 1 2 Tx under other provsons of the Act n ssessment yer (2 of Prt-B-TTI) 2 3 Amount of tx gnst whch credt s vlble [enter (2 1) f 2 s greter thn 1, otherwse 3 enter 0] 4 Utlston of AMT credt Avlble (Sum of AMT credt utlzed durng the current yer s subject to mxmum of mount mentoned n 3 bove nd cnnot exceed the sum of AMT Credt Brought Forwrd) S. No. Assessment Yer (A) AMT Credt v v v Current AY (enter 1-2, f 1>2 else enter 0) v Totl Gross (B1) Set-off n erler ssessment yers (B2) Blnce brought forwrd to the current ssessment yer (B3) = (B1) (B2) AMT Credt Utlsed durng the Current Assessment Yer (C) 5 Amount of tx credt under secton 115JD utlsed durng the yer [totl of tem no 4 (C)] 5 6 Amount of AMT lblty vlble for credt n subsequent ssessment yers [totl of 4 (D)] 6 Blnce AMT Credt Crred Forwrd (D)= (B3) (C) Schedule SPI Income of specfed persons (spouse, mnor chld etc.) ncludble n ncome of the ssessee (ncome of the mnor chld, n excess of Rs. 1,500 per chld, to be ncluded) Sl No Nme of person PAN of person (optonl) Reltonshp Nture of Income Amount (Rs) Schedule SI Income chrgeble to tx t specl rtes (plese see nstructons No. 7 for rte of tx) SPECIAL RATE Sl No Secton Specl rte (%) Income 1 111A (STCG on shres unts on whch where STT pd) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pd) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexton) 10 (prt of 5x of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (prt of 5x of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (prt of 5x of schedule BFLA) () Tx thereon ()

55 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k AC (Income of non-resdent from bonds or GDR purchsed n foregn currency) 10 (prt of 1f of schedule OS) 7 115ACA (LTCG for n employee of specfed compny on GDR) 10 (prt of 5x of schedule BFLA) 8 115AD (LTCG for FIIs on securtes) 10 (prt of 5x of schedule BFLA) 9 115E (LTCG for non-resdent ndn on specfed sset) 10 (prt of 5x of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) BB (Wnnngs from lotteres, puzzles, rces, gmes etc.) 30 (1f of schedule OS) BBDA (Dvdend ncome from domestc compny exceedng Rs.10lkh) 10 (1f of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (1f of schedule OS) BBF (Tx on ncome from ptent) Income under hed busness or professon 10 (3e of schedule BP) b Income under hed other sources 10 (1fv of schedule OS) BBG (Tx on ncome from trnsfer of crbon credts) Income under hed busness or professon 10 (3f of schedule BP) b Income under hed other sources 10 (1fv of schedule OS) A(b) (Income of non-resdent from Roylty) 25 (prt of 1fv of schedule OS) 17 Chrgeble under DTAA rte (prt of 1fv of schedule OS + A8b nd B10b of schedule CG) 18 Totl Schedule IF Informton regrdng prtnershp frms n whch you re prtner Number of frms n whch you re prtner FIRMS IN WHICH PARTNER Sl. No Nme of the Frm PAN of the frm Whether the frm s lble for udt? (Yes/No) Whether secton 92E s pplcble to frm? (Yes/ No) Percentge Shre n the proft of the frm Amount of shre n the proft Cptl blnce on 31 st Mrch n the frm 4 Totl Schedule EI Detls of Exempt Income (Income not to be ncluded n Totl Income) 1 Interest ncome 1 2 Dvdend ncome from domestc compny (mount not exceedng Rs. 10 lkh) 2 3 Long-term cptl gns from trnsctons on whch Securtes Trnscton Tx s pd 3 EXEMPT INCOME 4 Gross Agrculturl recepts (other thn ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on grculture Unbsorbed grculturl loss of prevous eght ssessment yers v Net Agrculturl ncome for the yer ( ) (enter nl f loss) 4 5 Others, ncludng exempt ncome of mnor chld (plese specfy) 5 6 Totl ( ) 6

56 234 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule PTI PASS THROUGH INCOME Sl. NOTE Pss Through Income detls from busness trust or nvestment fund s per secton 115UA, 115UB Nme of busness trust/ nvestment fund PAN of the busness trust/ nvestment fund Sl. Hed of ncome Amount of ncome 1. House property v Cptl Gns b Short term Long term Other Sources Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s 2. House property Plese refer to the nstructons for fllng out ths schedule. v Cptl Gns b Short term Long term Other Sources Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s TDS on such mount, f ny

57 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 235 Schedule FSI Sl. Country Code Txpyer Identfcton Number 1 Slry Detls of Income from outsde Ind nd tx relef Sl. Hed of ncome Income from outsde Ind (ncluded n PART B-TI) Tx pd outsde Ind Tx pyble on such ncome under norml provsons n Ind Tx relef vlble n Ind (e)= (c) or (d) whchever s lower Relevnt rtcle of DTAA f relef clmed u/s 90 or 90A () (b) (c) (d) (e) (f) INCOME FROM OUTSIDE INDIA House Property Busness or Professon v Cptl Gns v Other sources Slry Totl 2 House Property Busness or Professon v Cptl Gns v Other sources Totl NOTE Plese refer to the nstructons for fllng out ths schedule. Schedule TR Summry of tx relef clmed for txes pd outsde Ind 1 Detls of Tx relef clmed Country Code Txpyer Totl txes pd outsde Ind Identfcton (totl of (c) of Schedule FSI n Number respect of ech country) TAX RELIEF FOR TAX PAID OUTSIDE INDIA Totl tx relef vlble (totl of (e) of Schedule FSI n respect of ech country) Secton under whch relef clmed (specfy 90, 90A or 91) () (b) (c) (d) (e) Totl 2 Totl Tx relef vlble n respect of country where DTAA s pplcble (secton 90/90A) (Prt of totl of 1(d)) 2 3 Totl Tx relef vlble n respect of country where DTAA s not pplcble (secton 91) (Prt of totl of 1(d)) 3 4 Whether ny tx pd outsde Ind, on whch tx relef ws llowed n Ind, hs been refunded/credted by the foregn tx uthorty durng the yer? If yes, provde the detls below 4 Yes/No Amount of tx refunded NOTE Plese refer to the nstructons for fllng out ths schedule. b Assessment yer n whch tx relef llowed n Ind Schedule FA DETAILS OF FOREIGN ASSETS Detls of Foregn Assets nd Income from ny source outsde Ind A Detls of Foregn Bnk Accounts held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Nme nd Code Nme nd Address of the Bnk Account holder nme Sttus- Owner/ Benefcl owner/ Benefcry Account Number Account openng dte Pek Blnce Durng the Yer (n rupees) Interest ccrued n the ccount Interest txble nd offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () ()

58 236 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] B Detls of Fnncl Interest n ny Entty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Country Nture of Nme nd Nture of Dte snce Totl Income Nture of Nme nd entty Address of Interest- held Investment ccrued from Income Amount Schedule code the Entty Drect/ (t cost) (n such Interest where offered Benefcl rupees) owner/ Sl No Income txble nd offered n ths return Item number of schedule Benefcry (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detls of Immovble Property held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Address of the Property Dte of cquston Nture of Income Income txble nd offered n ths return Amount Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income derved from the property Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detls of ny other Cptl Asset held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Nture of Asset Dte of cquston Nture of Income Income txble nd offered n ths return Amount Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income derved from the sset Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detls of ccount(s) n whch you hve sgnng uthorty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer nd whch hs not been ncluded n A to D bove. Sl No Address of the Nme of the ccount Account Number If (7) s yes, Income offered n ths return Insttuton holder Amount Nme of the Insttuton n whch the ccount s held Pek Blnce/ Investment durng the yer (n rupees) Whether ncome ccrued s txble n your hnds? If (7) s yes, Income ccrued n the ccount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detls of trusts, creted under the lws of country outsde Ind, n whch you re trustee, benefcry or settlor Sl Country Nme nd Nme nd Nme nd Nme nd If (8) s yes, Income offered n ths No Nme nd ddress of ddress of ddress of ddress of return code the trust trustees Settlor Benefcres Amount Dte snce poston held Whether ncome derved s txble n your hnds? If (8) s yes, Income derved from the trust Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detls of ny other ncome derved from ny source outsde Ind whch s not ncluded n,- () tems A to F bove nd, () ncome under the hed busness or professon If (6) s yes, Income offered n ths return Country Nme Nme nd ddress of the Whether txble Income derved Nture of ncome nd code person from whom derved n your hnds? Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Plese refer to nstructons for fllng out ths schedule. In cse of n ndvdul, not beng n Indn ctzen, who s n Ind on busness, employment or student vs, n sset cqured durng ny prevous yer n whch he ws non-resdent s not mndtory to be reported n ths schedule f no ncome s derved from tht sset durng the current prevous yer.

59 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 237 Schedule 5A Nme of the spouse PAN of the spouse Heds of Income Informton regrdng pportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the hed Amount pportoned n the hnds of the spouse Amount of TDS deducted on ncome t () TDS pportoned n the hnds of spouse () () () (v) (v) 1 House Property 2 Busness or professon 3 Cptl gns 4 Other sources 5 Totl Asset nd Lblty t the end of the yer (other thn those ncluded n Prt A- BS) (pplcble n cse where totl ncome Schedule AL exceeds Rs.50 lkh) A Detls of mmovble sset Sl. Descrpton Address Amount (cost) n Rs. No. (1) (2) (3) (4) () DETAILS OF ASSETS AND LIABILITIES () B Detls of movble sset Sl. Descrpton Amount (cost) n Rs. No. (1) (2) (3) () Jewellery, bullon etc. () Archeologcl collectons, drwngs, pntng, sculpture or ny work of rt () Vehcles, ychts, bots nd rcrfts (v) Fnncl sset () Bnk (ncludng ll deposts) (b) Shres nd securtes (c) Insurnce polces (d) Lons nd dvnces gven (e) Csh n hnd Amount (cost) n Rs. C Interest held n the ssets of frm or ssocton of persons (AOP) s prtner or member thereof Sl. Nme nd ddress of the frm(s)/ AOP(s) PAN of the frm/ AOP Assessee s nvestment n the frm/ AOP on cost bss No. (1) (2) (3) (4) () () D Lblty n relton to Assets t (A + B + C) NOTE Plese refer to nstructons for fllng out ths schedule.

60 238 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-4 SUGAM INDIAN INCOME TAX RETURN FOR PRESUMPTIVE INCOME FROM BUSINESS & PROFESSION (Plese see Rule 12 of the Income-tx Rules, 1962) (Also see ttched nstructons) Assessment Yer (A1) Frst Nme (A2) Mddle Nme (A3) Lst Nme (A4) Permnent Account Number (A5) Dte of Brth/Formton (DD/MM/YYYY) (A6) Income Tx Wrd/Crcle (A7) Flt/Door/Buldng (A8) Nme of Premses/ Buldng/ Vllge (A9) Rod/Street (A10) Are/loclty (A11) Town/Cty/Dstrct (A12) Stte & Country (A13) Pn code/zp code (A14) Adhr Number (12 dgt)/ Adhr Enrolment Id (28 dgt) (f elgble for Adhr) (A15) Sttus Indvdul thn LLP) HUF Frm (other (A16) Moble No.1 /Resdentl/Offce Phone Number wth STD code (A17) Moble No. 2 (A18) Eml Address (A19)Fll only one- Tx Refundble Tx Pyble Nl Tx Blnce (A20) Fll only one-- Resdent Non-Resdent Resdent but Not Ordnrly Resdent (A21)Fll only one: Fled- On or before due dte -139(1), After due dte -139(4), Revsed Return-139(5) or In response to notce 139(9)-Defectve 142(1) A/153C or u/s 119(2)(b) (A22)Whether Person governed by Portuguese Cvl Code under Secton 5A (A23)If A22 s pplcble, PAN of the Spouse (A24)If revsed/defectve, then enter Recept No nd Dte of flng of orgnl return (DD/MM/YYYY) (A25)If fled n response to notce u/s 139(9) /142(1)/148/153A/153C, enter the dte of such notce PART B GROSS TOTAL INCOME DD / MM / YYYY B1 Income from Busness & Professon NOTE-Enter vlue from E8 of Schedule BP B1 B2 Slry (excludng ll llownces, perqustes nd proft n leu of slry) Allownces not exempt Vlue of perqustes v Proft n leu of slry v v Deductons u/s 16 v v Income chrgeble under the hed Slres ( v v) B2 (NOTE- Ensure to Fll Sch TDS1 gven n Pge 5) B3 Tck pplcble opton Self Occuped Let Out If let out, furnsh detls below Gross rent receved/ recevble/ letble vlue Tx pd to locl uthortes Annul Vlue ( ) v 30% of Annul Vlue v v Interest pyble on borrowed cptl v v Income chrgeble under the hed House Property ( v v) B3 ( ) (If loss, put the fgure n negtve) B4 Income from Other Sources B4( ) NOTE- Ensure to Fll Sch TDS2 gven n Pge 5 B5 Gross Totl Income (B1+B2+B3+B4) B5( ) SALARY / PENSION HOUSE PROPERTY DD/MM/YYYY Whole- Rupee( ) only FOR OFFICE USE ONLY STAMP RECEIPT NO. HERE SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL

61 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 239 PAN-- BANK ACCOUNT PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer to nstructons for lmts on Amount of Deductons s per Income Tx Act ) C1 80C C2 80CCC C3 80CCD (1) C4 80CCD(1B) C5 80CCD(2) C6 80CCG C7 80D C8 80DD C9 80DDB C10 80E C11 80EE C12 80G C13 80GG C14 80GGC C15 80QQB C16 80RRB C17 80TTA C18 80U C19 Totl deductons (Add tems C1 to C18) C19 C20 Txble Totl Income (B5 - C19 ) C20 PART D TAX COMPUTATIONS AND TAX STATUS D1 Tx pyble on totl ncome (C20) D1 D2 Rebte on 87A D2 D3 Tx pyble fter Rebte (D1-D2) D3 D4 Surchrge f pplcble D4 D5 Cess on (D3+D4) D5 D6 Totl Tx, Surchrge nd Cess ( D3+D4+D5) D6 D7 Relef u/s 89 D7 D8 Blnce Tx fter Relef (D6-D7) D8 D9 Totl Interest u/s 234A D9 D10 Totl Interest u/s 234B D10 D11 Totl Interest u/s 234C D11 D12 Fee u/s 234F D13 Totl Tx, Fee nd Interest(D8+D9+D10+D11+D12) D13 D14 Totl Advnce Tx Pd D15 Totl Self-Assessment Tx Pd D16 Totl TDS Clmed (totl of column 4 of Schedule-TDS1 nd column 7 of Schedule-TDS2) D16 D17 Totl TCS Collected (totl of column (5) of Schedule-TCS) D18 Totl Txes Pd (D14+D15+D16+D17) D19 Amount pyble (D13- D18, If D13> D18) D19 D20 Refund (D18 D13, If D18 > D13) D20 D21 Exempt ncome only for reportng purposes (If grculturl ncome s more thn Rs.5,000/-, use ITR 3/5) D21 Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of non- D22 resdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Accounts held n Ind (SWIFT Code n cse of foregn Bnk Account) Nme of the Bnk Account Number (IBAN n cse of foregn Bnk Accounts) D12 D14 D15 D17 D18 Indcte the ccount n whch you prefer to get your refund credted, f ny (tck one ccount ) VERIFICATION I, son/ dughter of solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return s correct nd complete nd s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng returns n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon) Plce: Dte : If the return hs been prepred by Tx Return Preprer (TRP) gve further detls s below: Sgn here

62 240 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TRP PIN (10 Dgt) Nme of TRP Counter Sgnture of TRP Amount to be pd to TRP

63 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 241 PAN-- S.No. NATURE OF BUSINESS OR PROFESSION IF MORE THAN ONE BUSINESS INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS Code Nme of the Busness Descrpton () () () SCHEDULE BP DETAILS OF INCOME FROM BUSINESS OR PROFESSION COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AD E1 Gross Turnover or Gross Recepts Through /c pyee cheque or /c pyee bnk drft or bnk electronc clerng system receved E1 before specfed dte b Any other mode E1b E2 Presumptve Income under secton 44AD 6% of E1 E2 b 8% of E1b E2b c Totl ( + b) E2c NOTE If Income s less thn the bove percentge of Gross Recepts, t s mndtory to hve tx udt under 44AB & regulr ITR 3 or 5 hs to be flled not ths form COMPUTATION OF PRESUMPTIVE INCOME UNDER 44ADA (PROFESSION) E3 Gross Recepts E3 E4 Presumptve Income under secton 44ADA (50% of E3) NOTE If Income s less thn 50% of Gross Recepts, t s mndtory to hve tx udt under 44AB & regulr ITR 3 or 5 hs to be flled not ths form E4 COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AE E5 Presumptve Income from Goods Crrge under secton 44AE E5 NOTE If the profts re lower thn prescrbed under S.44AE or the number of Vehcles owned t ny tme exceed 10 then the regulr ITR 3/5 form hs to be flled nd not ths form E6 Slry nd nterest pd to the prtners E6 NOTE Ths s to be flled up only by frms E7 Presumptve Income u/s 44AE (E5-E6) E7 E8 Income chrgeble under Busness or Professon (E2c+E4+E7 ) E8 INFORMATION REGARDING TURNOVER/GROSS RECEIPT REPORTED FOR GST E9 GSTR No. E9 E10 Amount of turnover/gross recept s per the GST return fled E10 FINANCIAL PARTICULARS OF THE BUSINESS NOTE For E11 to E25 furnsh the nformton s on 31 st dy of Mrch, 2018 E11 Prtners/ Members own cptl E11 E12 Secured lons E12 E13 Unsecured lons E13 E14 Advnces E14 E15 Sundry credtors E15 E16 Other lbltes E16 E17 Totl cptl nd lbltes (E11+E12+E13+E14+E15+E16) E17 E18 Fxed ssets E18 E19 Inventores E19 E20 Sundry debtors E20 E21 Blnce wth bnks E21 E22 Csh-n-hnd E22 E23 Lons nd dvnces E23 E24 Other ssets E24

64 242 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] E25 Totl ssets (E18+E19+E20+E21+E22+E23+E24) E25 NOTE Plese refer to nstructons for fllng out ths schedule (E15, E19, E20, E22 re mndtory nd others f vlble) Schedule AL Asset nd Lblty t the end of the yer (pplcble n cse where totl ncome exceeds Rs.50 lkh) A Detls of mmovble sset Sl. Descrpton Address Amount (cost) n Rs. No. (1) (2) (3) (4) DETAILS OF ASSETS AND LIABILITIES () () B Detls of movble sset Sl. Descrpton Amount (cost) n Rs. No. (1) (2) (3) () Jewellery, bullon etc. () Archeologcl collectons, drwngs, pntng, sculpture or ny work of rt () Vehcles, ychts, bots nd rcrfts (v) Fnncl sset Amount (cost) n Rs. () Bnk (ncludng ll deposts) (b) Shres nd securtes (c) Insurnce polces (d) Lons nd dvnces gven (e) Csh n hnd C Interest held n the ssets of frm or ssocton of persons (AOP) s prtner or member thereof Sl. Nme nd ddress of the frm(s)/ AOP(s) PAN of the frm/ AOP Assessee s nvestment n the frm/ AOP on cost bss No. (1) (2) (3) (4) () () D Lblty n relton to Assets t (A + B + C) NOTE Plese refer to nstructons for fllng out ths schedule.

65 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 243 PAN-- SCHEDULE IT DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS BSR Code Dte of Depost (DD/MM/YYYY) Chlln No. Tx pd R1 R2 R3 R4 R5 NOTE Col (1) Col (2) Col (3) Col (4) Enter the totls of Advnce tx nd Self-Assessment tx n D13 & D14 Schedule TCS Detls of Tx Collected t Source [As per Form 27D ssued by the Collector(s)] Sl No Tx Collecton Account Number of the Collector Nme of the Collector Detls of mount pd s mentoned n Form 26AS. Tx Collected Amount out of (4) beng clmed Amount out of (4) beng clmed n the hnds of spouse, f secton 5A s pplcble (1) Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) NOTE Plese enter totl of column (5) of Schedule-TCS n D16 SCHEDULE TDS1 DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 ssued by Employer(s)] TAN Nme of the Employer Income under Slry Tx deducted S1 Col (1) Col (2) Col (3) Col (4) S2 S3 NOTE Enter the totl of column 4 of Schedule-TDS1 nd column 7 of Schedule-TDS2 n D15 Schedule TDS2 Detls of Tx Deducted t Source on Income Other thn Slry [As per Form 16 A ssued or Form 26QC furnshed by Deductor(s)] T1 T2 TAN of the Deductor/PAN of the buyer/ Tennt Nme of the Deductor/Buyer/ Tennt Unque TDS Certfcte Number Yer of tx deducton Detls of Recept s mentoned n Form 26AS n own hnds Tx Deducted n the hnds of spouse s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) TDS credt out of (6) or (7) beng clmed ths yer n own hnds n the hnds of spouse s per secton 5A or ny other person s per rule 37BA(2) (f pplcble) Col (1) Col (2) Col (3) Col (4) Col 5 Col (6) Col (7) Col (8) Col (9) Income TDS PAN of spouse/ other person Income TDS PAN of spouse/ other person T3

66 244 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] T4 NOTE Plese enter totl of column 4 of Schedule-TDS1 nd column 7 of Schedule-TDS2 n D15 PAN-- Supplementry Schedule TDS 1(to be used only fter exhustng tem S1-S3 of Schedule TDS1 n mn form etc.) TAN Nme of the Employer Income under Slry Tx deducted Col (1) Col (2) Col (3) Col (4) S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 S25 S26 S27 S28 S29 S30

67 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 245 PAN-- Supplementry Schedule TDS 2(to be used only fter exhustng tem T1-T4 of Schedule TDS2 n mn form etc) T5 TAN of the deductor Nme of the Deductor Unque TDS Certfcte Number Deducted Yer Tx Deducted Amount out of (6) clmed ths Yer If A23 s pplcble, mount clmed n the hnds of spouse Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) Col (7) T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16 T17 T18 T19 T20 T21 T22 T23 T24 T25 T26 T27 T28 T29 T30 T31

68 246 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PAN-- Supplementry Schedule IT (to be used only fter exhustng tem R1-R5 of Schedule IT n mn form etc) BSR Code Dte of Depost (DD/MM/YYYY) Chlln No. Tx pd Col (1) Col (2) Col (3) Col (4) R6 R7 R8 R9 R10 R11 R12 R13 R14 R15 R16 R17 R18 R19 R20 R21 R22 R23 R24 R25 R26 R27 R28 R29 R30 R31

69 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 247 R32 PAN- Supplementry Schedule TCS (to be used only fter exhustng tem U1-U5 of Schedule TCS n mn form etc) U4 Tx Collecton Account Number Nme of the Collector Totl Collected Amount out of (3) clmed ths Yer If A23 s pplcble mount clmed n the hnds of spouse Col (1) Col (2) Col (3) Col (4) Col (5) U5 U6 U7 U8 U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 U20 U21 U22 U23 U24 U25 U26 U27 U28 U29 U30

70 248 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-5 INDIAN INCOME TAX RETURN [For persons other thn,- () ndvdul, () HUF, () compny nd (v) person flng Form ITR-7] (Plese see Rule 12 of the Income-tx Rules,1962) (Also see ttched nstructons) Assessment Yer Prt A-GEN Nme GENERAL PAN Is there ny chnge n the nme? If yes, plese furnsh the old nme Lmted Lblty Prtnershp Identfcton Number (LLPIN) ssued by MCA, f pplcble PERSONAL INFORMATION Flt/Door/Block No Nme of Premses/Buldng/Vllge Dte of formton (DDMMYYYY) Rod/Street/Post Offce Are/Loclty Sttus (frm-1, locl uthorty- 2, coopertve bnk-3, other coopertve socety-4, LLP-5, prvte dscretonry trust -6, ny other AOP/BOI- 7, rtfcl jurdcl person-8) Town/Cty/Dstrct Stte Pn code/zp code Income Tx Wrd/Crcle Country Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Eml Address -1 FILING STATUS Eml Address -2 Return fled [Plese see nstructon number-6] On or before due dte-139(1), After due dte-139(4), Revsed Return-139(5), () Modfed return- 92CD under secton 119(2)(b), OR In response to notce 139(9)- Defectve 142(1) A 153C If revsed/n response to notce for Defectve/Modfed, (b) then enter Recept No nd Dte of flng orgnl return (DD/MM/YYYY) / / (c) If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C enter dte of such notce, or u/s 92CD enter dte of dvnce prcng greement / / (d) Resdentl Sttus (Tck) Resdent Non-Resdent (e) Whether ny trnscton hs been mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No (f) In the cse of non-resdent, s there permnent estblshment (PE) n Ind (Tck) Yes No (g) Whether you re n FII / FPI? Yes/No (h) If yes, plese provde SEBI Regn. No. Whether ths return s beng fled by representtve ssessee? (Tck) Yes No If yes, plese furnsh followng nformton - (1) Nme of the representtve (2) Address of the representtve (3) Permnent Account Number (PAN) of the representtve Whether lble to mntn ccounts s per secton 44AA? (Tck) Yes No AUDIT INFORMATION b Whether lble for udt under secton 44AB? (Tck) Yes No c If (b) s Yes, whether the ccounts hve been udted by n ccountnt? (Tck) Yes No If Yes, furnsh the followng nformton- () Dte of furnshng of the udt report (DD/MM/YYYY) / / () () Nme of the udtor sgnng the tx udt report Membershp no. of the udtor (v) Nme of the udtor (propretorshp/ frm)

71 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 249 (v) (v) Propretorshp/frm regstrton number Permnent Account Number (PAN) of the udtor (propretorshp/ frm) d (v) Dte of udt report If lble to furnsh other udt report under the Income-tx Act, menton the dte of furnshng of the udt report? (DD/MM/YY) (Plese see Instructon 6()) 9292E 115JC PARTNERS/ MEMBERS/TRUST INFORMATION e A If lble to udt under ny Act other thn the Income-tx Act, menton the Act, secton nd dte of furnshng the udt report? Act nd secton (DD/MM/YY) Act nd secton (DD/MM/YY) Whether there ws ny chnge durng the prevous yer n the prtners/members of the frm/aop/boi (Tck) Yes No (In cse of socetes nd coopertve bnks gve detls of Mngng Commttee) If Yes, provde the followng detls Sl. Nme of the Prtner/member Admtted/Retred Dte of dmsson/retrement Percentge of shre (f determnte) B Is ny member of the AOP/BOI foregn compny? (Tck) Yes No C If Yes, menton the percentge of shre of the foregn compny n the AOP/BOI D E Whether totl ncome of ny member of the AOP/BOI (excludng hs shre from such ssocton or body) exceeds the mxmum mount whch s not chrgeble to tx n the cse of tht member? (Tck) Yes No Prtculrs of persons who were prtners/ members n the frm/aop/boi or settlor/trustee/benefcry n the trust on 31 st dy of Mrch, 2018 or dte of dssoluton Adhr Desgnted Sttus Percentge of Number/ Prtner Rte of Remuner S.No Nme nd Address shre (f PAN Enrolment Id Identfcton (see Interest on ton pd/ determnte) (f elgble for Number, n cse nstructon Cptl pyble Adhr) prtner n LLP No. 6()) (1) (2) (3) (4) (5) (6) (7) (8) (9) F To be flled n cse of persons referred to n secton 160(1)() or (v) 1 Whether shres of the benefcry re ndetermnte or unknown? Yes No For persons referred to n secton 160(1)() or (v) NATURE OF BUSINESS G 2 Whether the person referred n secton 160(1)(v) hs Busness Income? Yes No 3 Whether the person referred n secton 160(1)(v) s declred by Wll nd /or s exclusvely for the beneft of ny dependent reltve of the settlor nd/or s the only trust declred by the settlor? 4 If both the responses to "1" & "2" bove re "No", plese furnsh the followng detls: Yes No () Whether ny of the benefcres hs ncome exceedng bsc exempton lmt? Yes No () () (v) Whether the relevnt ncome or ny prt thereof s recevble under trust declred by ny person by wll nd such trust s the only trust so declred by hm? Whether the trust s non-testmentry trust creted before for the exclusve beneft of reltves/member of HUF of the settlor mnly dependent on hm/fmly? Whether the trust s creted on behlf of provdent fund, supernnuton fund, grtuty fund, penson fund or ny other fund creted bon fde by person crryng on Busness or professon exclusve for the employees n such Busness or Professon? Nture of busness or professon, f more thn one busness or professon ndcte the three mn ctvtes/ products S.No. () () Code [Plese see nstructon No.7()] Descrpton Yes No Yes No Yes No Pge 249

72 250 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Prt A-BS BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2018 OR DATE OF DISSOLUTION (fll tems A nd B n cse where regulr books of ccounts re mntned, otherwse fll tem C) A Sources of Funds 1 Prtners / members fund Prtners / members cptl b Reserves nd Surplus Revluton Reserve b Cptl Reserve b Sttutory Reserve b v Any other Reserve bv v Credt blnce of Proft nd loss ccount bv v Totl (b + b + b + bv + bv) c Totl prtners / members fund ( + bv) 2 Lon funds bv 1c Secured lons Foregn Currency Lons SOURCES OF FUNDS Rupee Lons A From Bnks A B From others B C Totl ( A + B) C Totl secured lons ( + C) b Unsecured lons (ncludng deposts) Foregn Currency Lons b Rupee Lons A From Bnks From persons specfed n secton 40A(2)(b) B of the I. T. Act C From others D Totl Rupee Lons ( A + B + C) Totl unsecured lons (b + D) c Totl Lon Funds ( + b) 3 Deferred tx lblty 3 A B C D B 2c 4 Advnces From persons specfed n secton 40A(2)(b) of the I. T. Act From others Totl Advnces ( + ) 4 5 Sources of funds (1c + 2c ) 5 B Applcton of funds 1 Fxed ssets Gross: Block 1 APPLICATION OF FUNDS b Deprecton c Net Block ( b) d Cptl work-n-progress e Totl (1c + 1d) 2 Investments Long-term nvestments Investment n property Equty nstruments A Lsted equtes B Unlsted equtes 1b 1c 1d A B 1e

73 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 251 C Totl Preference shres v Government or trust securtes v Debenture or bonds v v Mutul funds v Others v Totl Long-term nvestments ( + C + + v + v + v + v) b Short-term nvestments Equty nstruments A Lsted equtes B Unlsted equtes C Totl Preference shres Government or trust securtes v Debenture or bonds v Mutul funds v Others v Totl Short-term nvestments (C v + v + v) c Totl nvestments (v + bv) 3 Current ssets, lons nd dvnces Current ssets Inventores A Rw mterls B Work-n-progress C Fnshed goods Stock-n-trde (n respect of goods cqured D for trdng) Stores/consumbles ncludng pckng E mterl F Loose tools G Others H Totl (A + B + C + D + E + F + G) Sundry Debtors A Outstndng for more thn one yer A B Others B C Totl Sundry Debtors C Csh nd bnk blnces A Blnce wth bnks B Csh-n-hnd C Others C D Totl Csh nd csh equvlents (A + B + C) v Other Current Assets v Totl current ssets (H +C + D + v) v b Lons nd dvnces Advnces recoverble n csh or n knd or for vlue to be receved Deposts, lons nd dvnces to corporte nd others Blnce wth Revenue Authortes v Totl (b + b + b) v Lons nd dvnces ncluded n bv whch s v v v A B C v v v A B C D E F G b b b A B C v bv 2c H D v bv Pge 251

74 252 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] for the purpose of busness or professon v b not for the purpose of busness or professon vb c Totl (v + bv) d Current lbltes nd provsons Current lbltes A Sundry Credtors 1 Outstndng for more thn one yer 1 2 Others 2 3 Totl (1 + 2) A3 B Lblty for lesed ssets B C Interest Accrued nd due on borrowngs C D Interest ccrued but not due on borrowngs D E Income receved n dvnce E F Other pybles F G Totl (A3 + B + C + D + E + F) Provsons A Provson for Income Tx A 3c G NO ACCOUNT CASE Provson for Leve B encshment/supernnuton/grtuty C Other Provsons D Totl (A + B + C) Totl (E + D) e Net current ssets (3c d) 4 Mscellneous expendture not wrtten off or djusted 4 b Deferred tx sset Debt blnce n Proft nd loss ccount/ ccumulted c blnce d Totl (4 + 4b + 4c) 5 Totl, pplcton of funds (1e + 2c + 3e +4d) 5 C In cse where regulr books of ccount of busness or professon re not mntned, furnsh the followng nformton s on 31 st dy of Mrch, 2018, n respect of busness or professon 1 Amount of totl sundry debtors C1 2 Amount of totl sundry credtors C2 3 Amount of totl stock-n-trde C3 4 Amount of the csh blnce C4 B C 4b 4c E d 3e 4d Proft nd Loss Account for the fnncl yer (fll tems 1 to 53 n cse where regulr books of ccounts re Prt A-P& L mntned, otherwse fll tem 54) 1 Revenue from opertons CREDITS TO PROFIT AND LOSS ACCOUNT A Sles/ Gross recepts of busness (net of returns nd refunds nd duty or tx, f ny) Sle of goods Sle of servces Other opertng revenues (specfy nture nd mount) b c Totl ( + b) v Totl ( + + c) B Gross recepts from Professon Dutes, txes nd cess receved or recevble n respect of goods nd servces sold or C suppled Unon Excse dutes Servce tx b c Av B

75 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 253 DEBITS TO PROFIT AND LOSS ACCOUNT VAT/ Sles tx v Centrl Goods & Servce Tx (CGST) v v Stte Goods & Servces Tx (SGST) v v Integrted Goods & Servces Tx (IGST) v v Unon Terrtory Goods & Servces Tx (UTGST) v v Any other duty, tx nd cess v x Totl ( v + v + v + v + v) Cx D Totl Revenue from opertons (Av + B + Cx) 1D 2 Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sle of fxed ssets v Proft on sle of nvestment beng securtes chrgeble v to Securtes Trnscton Tx (STT) v v Proft on sle of other nvestment v v Proft on ccount of currency fluctuton v x Agrculturl ncome x x Any other ncome (specfy nture nd mount) x b xb c Totl (x + xb) xc x Totl of other ncome ( v + v + v + v + v + x + xc) 2x 3 Closng Stock Rw mterl 3 Work-n-progress 3 Fnshed goods 3 Totl ( ) 3v 4 Totl of credts to proft nd loss ccount (1D + 2x + 3v) 4 5 Openng Stock Rw mterl 5 Work-n-progress 5 Fnshed goods 5 v Totl ( ) 5v 6 Purchses (net of refunds nd duty or tx, f ny) 6 7 Dutes nd txes, pd or pyble, n respect of goods nd servces purchsed Custom duty 7 Counter velng duty 7 Specl ddtonl duty 7 v Unon excse duty 7v v Servce tx 7v v VAT/ Sles tx 7v v Centrl Goods & Servce Tx (CGST) 7v v Stte Goods & Servces Tx (SGST) 7v x Integrted Goods & Servces Tx (IGST) 7x x Unon Terrtory Goods & Servces Tx (UTGST) 7x x Any other tx, pd or pyble 7x x Totl ( v + 7v + 7v + 7v +7v + 7x + 7x + 7x) 7x 8 Freght 8 Pge 253

76 254 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 9 Consumpton of stores nd spre prts 9 10 Power nd fuel Rents Reprs to buldng Reprs to mchnery Compenston to employees Slres nd wges Bonus Rembursement of medcl expenses v Leve encshment v Leve trvel benefts v Contrbuton to pproved supernnuton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed grtuty fund v 14v 14v 14v 14v x Contrbuton to ny other fund 14x x Any other beneft to employees n respect of whch n expendture hs been ncurred 14x Totl compenston to employees ( v + 14v + 14v + 14v + 14v + x 14x + 14x) Whether ny compenston, ncluded n 14x, pd to x non-resdents x Yes / No If Yes, mount pd to non-resdents xb 15 Insurnce Medcl Insurnce 15 Lfe Insurnce 15 Keymn s Insurnce 15 Other Insurnce ncludng fctory, offce, cr, goods, v etc. 15v v Totl expendture on nsurnce ( v) 16 Workmen nd stff welfre expenses Entertnment Hosptlty Conference Sles promoton ncludng publcty (other thn dvertsement) Advertsement Commsson Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 23 Roylty Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 24 Professonl / Consultncy fees / Fee for techncl servces Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 25 Hotel, bordng nd Lodgng Trvelng expenses other thn on foregn trvelng Foregn trvellng expenses Conveynce expenses 28 14x 15v

77 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 255 TAX AND APPR 29 Telephone expenses Guest House expenses Club expenses Festvl celebrton expenses Scholrshp Gft Donton Rtes nd txes, pd or pyble to Government or ny locl body (excludng txes on ncome) Unon excse duty Servce tx VAT/ Sles tx v Cess v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) 36v 36v v Unon Terrtory Goods & Servces Tx (UTGST) x Any other rte, tx, duty or cess ncl STT nd CTT 36x Totl rtes nd txes pd or pyble ( v + 36v+ 36v + 36v +36v + x 36x) 37 Audt fee Slry/Remunerton to Prtners of the frm (totl of col. (8) of tem E of Prtner s/members nformton under Prt A-Gen) 39 Other expenses (specfy nture nd mount) Totl ( + ) Bd debts (specfy PAN of the person, f vlble, for whom Bd Debt for mount of Rs. 1 lkh or more s 40 clmed nd mount) 40 Others (more thn Rs. 1 lkh) where v PAN s not vlble v Others (mounts less thn Rs. 1 lkh) v 40v v Totl Bd Debt ( v + 40v) 41 Provson for bd nd doubtful debts Other provsons 42 Proft before nterest, deprecton nd txes [4 (5v x + 8 to x + 15v + 16 to to x v )] 44 Interest Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny A To Prtners B To others Pd n Ind, or pd to resdent A To Prtners B To others Totl ( + b + + b) 45 Deprecton nd mortston Proft before txes ( ) Provson for current tx Provson for Deferred Tx nd deferred lblty v 36v 36v b b 36x v Pge 255

78 256 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NO ACCOUNT CASE 49 Proft fter tx ( ) Blnce brought forwrd from prevous yer Amount vlble for pproprton ( ) Trnsferred to reserves nd surplus Blnce crred to blnce sheet n prtner s ccount (51 52) In cse where regulr books of ccount of busness or professon re not mntned, furnsh the followng nformton for prevous yer n respect of busness or professon () For ssessee crryng on Busness Gross recepts 54() b Gross proft 54()b c Expenses 54()c d Net proft 54()d () For ssessee crryng on Professon Gross recepts 54() b Gross proft 54()b c Expenses 54()c d Net proft 54()d Totl (54()d + 54()d) 54 OTHER INFORMATION Prt A- OI Other Informton (optonl n cse not lble for udt under secton 44AB) 1 Method of ccountng employed n the prevous yer (Tck) mercntle csh 2 Is there ny chnge n method of ccountng (Tck) Yes No Increse n the proft or decrese n loss becuse of devton, f ny, s per Income 3 Computton Dsclosure Stndrds notfed under secton 145(2) [column 11() of Schedule 3 ICDS] Decrese n the proft or ncrese n loss becuse of devton, f ny, s per Income 3b Computton Dsclosure Stndrds notfed under secton 145(2) [column 11b() of Schedule 3b ICDS] 4 Method of vluton of closng stock employed n the prevous yer Rw Mterl (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) b Fnshed goods (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) c Is there ny chnge n stock vluton method (Tck) Yes No d Increse n the proft or decrese n loss becuse of devton, f ny, from the method of vluton specfed under secton 145A e Decrese n the proft or ncrese n loss becuse of devton, f ny, from the method of vluton specfed under secton 145A 5 Amounts not credted to the proft nd loss ccount, beng - the tems fllng wthn the scope of secton 28 b the proform credts, drwbcks, refund of duty of customs or excse or servce tx, or refund of sles tx or vlue dded tx, or refund of GST, where such credts, drwbcks or refunds re dmtted s due by the uthortes concerned c esclton clms ccepted durng the prevous yer d ny other tem of ncome e cptl recept, f ny f Totl of mounts not credted to proft nd loss ccount (5+5b+5c+5d+5e) 6 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 36 due to non-fulflment of condton specfed n relevnt cluses Premum pd for nsurnce gnst rsk of dmge or destructon of stocks or store [36(1)()] 6 Premum pd for nsurnce on the helth of employees b [36(1)(b)] 6b Any sum pd to n employee s bonus or commsson for c servces rendered, where such sum ws otherwse pyble 6c to hm s profts or dvdend [36(1)()] Any mount of nterest pd n respect of borrowed d cptl [36(1)()] 6d e Amount of dscount on zero-coupon bond [36(1)()] 6e 5 5b 5c 5d 5e 4d 4e 5f

79 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 257 Amount of contrbutons to recognsed provdent fund f [36(1)(v)] Amount of contrbutons to n pproved supernnuton g fund [36(1)(v)] Amount of contrbuton to penson scheme referred to n h secton 80CCD [36(1)(v)] Amount of contrbutons to n pproved grtuty fund [36(1)(v)] j Amount of contrbutons to ny other fund Any sum receved from employees s contrbuton to ny provdent fund or supernnuton fund or ny fund set up k under ESI Act or ny other fund for the welfre of employees to the extent not credted to the employees ccount on or before the due dte [36(1)(v)] l Amount of bd nd doubtful debts [36(1)(v)] m Provson for bd nd doubtful debts [36(1)(v)] n Amount trnsferred to ny specl reserve [36(1)(v)] 6n Expendture for the purposes of promotng fmly o 6o plnnng mongst employees [36(1)(x)] Amount of securtes trnscton pd n respect of p trnscton n securtes f such ncome s not ncluded n 6p busness ncome [36(1)(xv)] Expendture for purchse of sugrcne n excess of the q 6q government pproved prce [36(1)(xv)] r Any other dsllownce 6r s Totl mount dsllowble under secton 36 (totl of 6 to 6r) Totl number of employees employed by the compny (mndtory n cse compny hs t recognzed Provdent Fund) deployed n Ind deployed outsde Ind Totl 7 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 37 Expendture of cptl nture [37(1)] 7 b Expendture of personl nture [37(1)] 7b c Expendture ld out or expended wholly nd exclusvely NOT for the purpose of busness or professon [37(1)] 7c d Expendture on dvertsement n ny souvenr, brochure, trct, pmphlet or the lke, publshed by poltcl prty 7d [37(2B)] e Expendture by wy of penlty or fne for volton of ny lw for the tme beng n force 7e f Any other penlty or fne 7f g Expendture ncurred for ny purpose whch s n offence or whch s prohbted by lw 7g h Amount of ny lblty of contngent nture 7h Any other mount not llowble under secton 37 7 j Totl mount dsllowble under secton 37 (totl of 7 to 7) 8 A. Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40 Amount dsllowble under secton 40 ()(), on ccount of non-complnce wth the provsons of A Chpter XVII-B Amount dsllowble under secton 40()() on b ccount of non-complnce wth the provsons of Ab Chpter XVII-B Amount dsllowble under secton 40 ()(b), on ccount of c non-complnce wth the provsons of Chpter VIII of the Ac Fnnce Act, 2016 Amount dsllowble under secton 40()() on d ccount of non-complnce wth the provsons of Ad Chpter XVII-B e Amount of tx or rte leved or ssessed on the bss of Ae profts [40()()] f Amount pd s welth tx [40()()] Af 6f 6g 6h 6 6j 6k 6l 6m 6s 7j Pge 257

80 258 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Amount pd by wy of roylty, lcense fee, servce fee g etc. s per secton 40()(b) Ag Amount of nterest, slry, bonus, commsson or h Ah remunerton pd to ny prtner or member [40(b)] Any other dsllownce A j Totl mount dsllowble under secton 40(totl of A to A) Any mount dsllowed under secton 40 n ny precedng prevous yer but llowble B. durng the prevous yer 9 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40A Amounts pd to persons specfed n secton 40A(2)(b) Amount pd otherwse thn by ccount pyee cheque or ccount pyee bnk drft or use of electronc clerng b system through bnk ccount, dsllowble under secton 40A(3) c Provson for pyment of grtuty [40A(7)] ny sum pd by the ssessee s n employer for settng up d or s contrbuton to ny fund, trust, compny, AOP, or BOI or socety or ny other nsttuton [40A(9)] e Any other dsllownce f Totl mount dsllowble under secton 40A Any mount dsllowed under secton 43B n ny precedng prevous yer but llowble durng 10 the prevous yer Any sum n the nture of tx, duty, cess or fee under ny lw 10 Any sum pyble by wy of contrbuton to ny provdent b fund or supernnuton fund or grtuty fund or ny other 10b fund for the welfre of employees c Any sum pyble to n employee s bonus or commsson for servces rendered 10c Any sum pyble s nterest on ny lon or borrowng d from ny publc fnncl nsttuton or Stte fnncl 10d corporton or Stte Industrl nvestment corporton Any sum pyble s nterest on ny lon or borrowng e from ny scheduled bnk or co-opertve bnk other thn 10e prmry grculturl credt socety or prmry coopertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment 10f Any sum pyble to the Indn Rlwys for the use of g rlwy ssets 10g h Totl mount llowble under secton 43B (totl of 10 to 10g) Any mount debted to proft nd loss ccount of the prevous yer but dsllowble under 11 secton 43B Any sum n the nture of tx, duty, cess or fee under ny lw 11 b Any sum pyble by wy of contrbuton to ny provdent fund or supernnuton fund or grtuty fund or ny other 11b fund for the welfre of employees c Any sum pyble to n employee s bonus or commsson for servces rendered 11c d Any sum pyble s nterest on ny lon or borrowng from ny publc fnncl nsttuton or Stte fnncl 11d corporton or Stte Industrl nvestment corporton e Any sum pyble s nterest on ny lon or borrowng from ny scheduled bnk or co-opertve bnk other thn 11e prmry grculturl credt socety or prmry coopertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment 11f g Any sum pyble to the Indn Rlwys for the use of 11g rlwy ssets h Totl mount dsllowble under Secton 43B(totl of 11 to 11g) 12 Amount of credt outstndng n the ccounts n respect of Unon Excse Duty b Servce tx c VAT/sles tx d Centrl Goods & Servce Tx (CGST) 9 9b 9c 9d 9e 12 12b 12c 12d 8Aj 8B 9f 10h 11h

81 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 259 e Stte Goods & Servces Tx (SGST) f Integrted Goods & Servces Tx (IGST) g Unon Terrtory Goods & Servces Tx (UTGST) 12g h Any other tx 12h Totl mount outstndng (totl of 12 to 12h) Amounts deemed to be profts nd gns under secton 33AB or 33ABA or 33AC Any mount of proft chrgeble to tx under secton Amount of ncome or expendture of pror perod credted or debted to the proft nd loss ccount (net) Prt A QD QUANTITATIVE DETAILS TOTAL INCOME Quntttve detls (optonl n cse not lble for udt under secton 44AB) () In the cse of trdng concern 1 Openng stock 1 2 Purchse durng the prevous yer 2 3 Sles durng the prevous yer 3 4 Closng stock 4 5 Shortge/ excess, f ny 5 (b) In the cse of mnufcturng concern Prt B - TI 6 Rw mterls Openng stock b Purchses durng the prevous yer c Consumpton durng the prevous yer d Sles durng the prevous yer e Closng stock f Yeld fnshed products g Percentge of yeld h Shortge/ excess, f ny 7 Fnshed products/ By-products openng stock b purchse durng the prevous yer c quntty mnufctured durng the prevous yer d sles durng the prevous yer e closng stock f shortge/ excess, f ny Computton of totl ncome 1 Income from house property (3b of Schedule-HP) (enter nl f loss) 1 2 Profts nd gns from busness or professon Profts nd gns from busness other thn specultve busness nd specfed busness (A38 of Schedule BP)(enter nl f loss) Profts nd gns from specultve busness (B42 of Schedule BP) (enter nl f loss nd crry ths fgure to Schedule CFL) Profts nd gns from specfed busness (C48 of Schedule BP) (enter nl f loss nd crry ths fgure to Schedule CFL) v Income from ptent u/s 115BBF (3d of Schedule BP) v Income from trnsfer of crbon credts u/s 115BBG v Totl ( v + 2v) (enter nl, f loss nd crry ths fgure of loss to Schedule CYLA) 2v 3 Cptl gns Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chrgeble t pplcble rte (7v of tem E of schedule CG) 12e 12f v 2v b 6c 6d 6e 6f 6g 6h 7 7b 7c 7d 7e 7f Pge 259

82 260 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Totl Short-term ( + + ) b Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) b Totl Long-term (b + b) (enter nl f loss) c Totl cptl gns (3v + 3b) (enter nl f loss) 4 Income from other sources from sources other thn from ownng nd mntnng rce 4 horses nd ncome chrgeble to tx t specl rte (1k of Schedule OS) (enter nl f loss) b Income chrgeble to tx t specl rte (1fv of Schedule OS) 4b c from ownng nd mntnng rce horses (3e of Schedule OS) (enter nl f loss) d Totl (4 + 4b + 4c) 5 Totl (1 + 2v + 3c +4d) 5 6 Losses of current yer to be set off gnst 5 (totl of 2x,3x nd 4x of Schedule CYLA) 6 7 Blnce fter set off current yer losses (5 6) (totl of column 5 of schedule CYLA + 4b) 7 8 Brought forwrd losses to be set off losses gnst 7 (totl of 2x, 3 x nd 4x of Schedule BFLA) 8 9 Gross Totl ncome (7 8) (lso 5x of Schedule BFLA + 4b) 9 10 Income chrgeble to tx t specl rte under secton 111A, 112 etc. ncluded n Deducton u/s 10AA (c of Schedule 10AA) Deductons under Chpter VI-A Prt-B of Chpter VI-A [1 of Schedule VI-A nd lmted upto (9-10)] 3v b Prt-C of Chpter VI-A [2 of Schedule VI-A nd lmted upto (9-10-2)] c Totl ( b) [lmted upto (9-10)] 13 Totl ncome ( c) Income chrgeble to tx t specl rtes (totl of () of schedule SI) Net grculturl ncome/ ny other ncome for rte purpose (4 of Schedule EI) Aggregte ncome ( ) [pplcble f (13-14) exceeds mxmum mount not chrgeble to tx] Losses of current yer to be crred forwrd (totl of x of Schedule CFL) Deemed totl ncome under secton 115JC (3 of Schedule AMT) 18 b b 4c 3c 4d 12 12b 12c Prt B - TTI Computton of tx lblty on totl ncome 1 Tx pyble on deemed totl ncome under secton 115JC (4 of Schedule AMT) 1 COMPUTATION OF TAX LIABILITY b Surchrge on () bove (f pplcble) c Educton Cess, ncludng secondry nd hgher educton cess on 1+1b bove d Totl Tx Pyble on deemed totl ncome (1+1b+1c) 2 Tx pyble on totl ncome Tx t norml rtes on 16 of Prt B-TI b Tx t specl rtes (totl of col. () of Schedule-SI) c Rebte on grculturl ncome [pplcble f (13-14) of Prt B-TI exceeds mxmum mount not chrgeble to tx] d Tx Pyble on totl ncome (2+2b -2c)) e Surchrge 25% of 12() of Schedule SI 2e On [(2d) (12() of Schedule SI)] Totl ( + ) f Educton cess, ncludng secondry nd hgher educton cess on 2d+2e g Gross tx lblty (2d + 2e + 2f) 3 Gross tx pyble (hgher of 1d or 2g) 3 4 Credt under secton 115JD of tx pd n erler yers (pplcble f 2g s more thn 1d) (5 of Schedule AMTC) 5 Tx pyble fter credt under secton 115JD (3-4) 5 6 Tx relef 2 2b 2c 2e 1b 1c 1d 2d 2e 2f 2g 4

83 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 261 TAXES PAID AND BANK DETAILS BANK ACCOUNT Secton 90/90A (2 of Schedule TR) b Secton 91(3 of Schedule TR) c Totl (6 + 6b) 7 Net tx lblty (5 6c) (enter zero, f negtve) 7 8 Interest nd fee pyble Interest for defult n furnshng the return (secton 234A) b Interest for defult n pyment of dvnce tx (secton 234B) c Interest for deferment of dvnce tx (secton 234C) d Fee for defult n furnshng return of ncome (secton 234F) e Totl Interest nd Fee Pyble (8+8b+8c+8d) 9 Aggregte lblty (7 + 8e) 9 10 Txes Pd Advnce Tx (from column 5 of 16A) b TDS (totl of column 9 of 16B) c TCS (totl of column 7 of 16C) d Self-Assessment Tx (from column 5 of 16A) e Totl Txes Pd (10+10b+10c+10d) 11 Amount pyble (Enter f 9 s greter thn 10e, else enter 0) Refund (If 10e s greter thn 9) (refund, f ny, wll be drectly credted nto the bnk ccount) b 10 10b 10c 10d Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of nonresdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Nme of the Bnk Account Number Indcte the ccount n Accounts held n Ind (SWIFT Code n (IBAN n cse of foregn Bnk whch you prefer to get cse of foregn Bnk Account) Accounts) your refund credted, f ny (tck one ccount ) 14 Do you t ny tme durng the prevous yer,- () hold, s benefcl owner, benefcry or otherwse, ny sset (ncludng fnncl nterest n ny entty) locted outsde Ind; or () hve sgnng uthorty n ny ccount locted outsde Ind; or () hve ncome from ny source outsde Ind? [pplcble only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] VERIFICATION 8 8b 8c 8d 6c 8e 10e Yes I, (full nme n block letters), son/ dughter of, solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return nd the schedules thereto s correct nd complete s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng ths return n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon) I further declre tht the crtcl ssumptons specfed n the greement hve been stsfed nd ll the terms nd condtons of the greement hve been compled wth. (Applcble, n cse where return s furnshed under secton 92CD) Plce Dte Sgn here 15 TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Amount (Rs) No (1) (2) (3) (4) (5) NOTE Enter the totls of Advnce tx nd Self-Assessment tx n Sl No. 10 & 10d of Prt B-TTI Detls of Tx Deducted t Source (TDS) on Income [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s)] No Pge 261

84 262 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TDS ON INCOME Sl No TAN of the Nme of the Deductor/ PAN Deductor/Buyer/ of the Buyer/ Tennt Tennt Unque TDS Certfcte Number Unclmed TDS brought forwrd (b/f) TDS of the current fn. yer TDS credt out of (7) or (8) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) TDS credt out of (7) or (8) beng crred forwrd Fn. Yer n Amount Deducted Deducted n the hnds Clmed Clmed n the hnds of whch deducted b/f n own hnds of ny other person s per rule 37BA(2) (f pplcble) n own hnds ny other person s per rule 37BA(2) (f pplcble) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Income TDS PAN of other person Income TDS PAN of other person C TCS ON INCOME NOTE Plese enter totl of column (8) n 10b of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tx Deducton nd Tx Collecton Account Number of the Collector Nme of the Collector Unclmed TCS brought forwrd (b/f) TCS of the current fn. yer Amount out of (5) or (6) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) Amount out of (5) or (6) beng crred forwrd Fn. Yer n Amount b/f whch collected (1) (2) (3) (4) (5) (6) (7) (8) NOTE Plese enter totl of column (7) n 10c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1 S20) AS APPLICABLE

85 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 263 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule HP Detls of Income from House Property (Plese refer nstructons) Address of property 1 Town/ Cty Stte PIN Code 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Assessee s percentge of shre n the property HOUSE PROPERTY 2 Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out Deemed let out I II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two f let out for prt of the yer) 1 b The mount of rent whch cnnot be relzed 1b c Tx pd to locl uthortes 1c d Totl (1b + 1c) 1d e Annul vlue (1 1d) 1e f Annul vlue of the property owned (own percentge shre x 1e) 1f g 30% of 1f 1g h Interest pyble on borrowed cptl 1h Totl (1g + 1h) 1 j Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty Stte PIN Code Is the property co-owned? Yes No (f YES plese enter followng detls) Assessee s percentge of shre n the property Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out I Deemed let out II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two, f let out for prt of the yer) 2 b The mount of rent whch cnnot be relzed 2b c Tx pd to locl uthortes 2c d Totl (2b + 2c) 2d e Annul vlue (2 2d) 2e f Annul vlue of the property owned (own percentge shre x 2e) 2f g 30% of 2f 2g h Interest pyble on borrowed cptl 2h Totl (2g + 2h) 2 j Income from house property 2 (2f 2) 2j 3 Income under the hed Income from house property Unrelzed rent nd Arrers of rent receved durng the yer under secton 25A fter deductng 30% b Totl (1j + 2j +3) (f negtve tke the fgure to 2 of schedule CYLA) 3 3b Schedule BP Computton of ncome from busness or professon A From busness or professon other thn specultve busness nd specfed busness BUS INE SS 1 Proft before tx s per proft nd loss ccount (tem 46 & 54 of Prt A-P&L ) 1

86 264 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Net proft or loss from specultve busness ncluded n 1 (enter ve 2 sgn n cse of loss) Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 2b (enter ve sgn n cse of loss) 3 4 Income/ recepts credted to proft nd loss ccount consdered under other heds of ncome/chrgeble u/s 115BBF/ chrgeble u/s 115BBG Proft or loss ncluded n 1, whch s referred to n secton 44AD/ 44ADA/ 44AE/ 44B/ 44BB/ 44BBA/ 44BBB/ 44D/ 44DA/ 44DB/ House property b Cptl gns c Other sources d u/s 115BBF e u/s 115BBG u/s 115B b Other 5 Income credted to Proft nd Loss ccount (ncluded n 1) whch s exempt Shre of ncome from frm(s) 5 b Shre of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nture nd mount) Totl (c + c) 5c d Totl exempt ncome (5 + 5b + 5c) 5d 6 Blnce (1 2 2b 3-3b 3c 3d 3e 4 5d) 6 House property 7 Expenses debted to proft nd loss ccount b Cptl gns 7b consdered under other heds of 7 ncome/relted to ncome chrgeble u/s c Other sources 7c 115BBF/or u/s 115BBG d u/s 115BBF 7d e u/s 115BBG 7e 8 Expenses debted to proft nd loss ccount whch relte to exempt ncome 8 9 Totl (7 + 7b + 7c + 7d + 7e + 8) 9 10 Adjusted proft or loss (6+9) Deprecton nd mortston debted to proft nd loss ccount Deprecton llowble under Income-tx Act I Deprecton llowble under secton 32(1)() nd 32(1)() (column 6 of Schedule-DEP) 12 I Deprecton llowble under secton 32(1)() (Mke your own computton refer Appendx-IA of IT Rules) 12 I Totl ( ) 13 Proft or loss fter djustment for deprecton ( ) 13 Amounts debted to the proft nd loss ccount, to the extent 14 dsllowble under secton 36 (6s of Prt A-OI) 14 Amounts debted to the proft nd loss ccount, to the extent 15 dsllowble under secton 37 (7j of Prt A-OI) 15 Amounts debted to the proft nd loss ccount, to the extent 16 dsllowble under secton 40 8Aj of Prt A-OI) 16 Amounts debted to the proft nd loss ccount, to the extent 17 dsllowble under secton 40A (9f of PrtA-OI) 17 Any mount debted to proft nd loss ccount of the prevous 18 yer but dsllowble under secton 43B (11h of Prt A-OI) 18 Interest dsllowble under secton 23 of the Mcro, Smll nd 19 Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AC/ 32AD/ 33AB/ 21 33ABA/35ABA/35ABB/ 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ Deemed ncome under secton 43CA Any other tem of ddton under secton 28 to 44DB Any other ncome not ncluded n proft nd loss ccount/ny other expense not llowble (ncludng ncome from slry, commsson, bonus nd nterest from frms n whch ssessee s prtner) Increse n proft or decrese n loss on ccount of ICDS djustments nd devton n method of vluton of stock (Column 3 + 4d of Prt A- OI) c c b 3 3b 3c 3d 3e 4 4b 12

87 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Totl ( ) Deducton llowble under secton 32(1)() Deducton llowble under secton 32AD 28 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the mount debted to proft nd loss ccount (tem 29 x(4) of Schedule ESR) (f mount deductble under secton 35 or 29 35CCC or 35CCD s lower thn mount debted to P&L ccount, t wll go to tem 24) Any mount dsllowed under secton 40 n ny precedng 30 prevous yer but llowble durng the prevous yer(8b of 30 Prt A-OI) Any mount dsllowed under secton 43B n ny precedng 31 prevous yer but llowble durng the prevous yer(10g of 31 Prt A-OI) 32 Any other mount llowble s deducton Decrese n proft or ncrese n loss on ccount of ICDS djustments nd devton n method of vluton of stock (Column 3b + 4e of Prt A- OI) 34 Totl ( ) Income ( ) Profts nd gns of busness or professon deemed to be under - Secton 44AD 36 Secton 44ADA 36 Secton 44AE 36 v Secton 44B 36v v Secton 44BB 36v v Secton 44BBA 36v v Secton 44BBB 36v v Secton 44D 36v x Secton 44DA 36x (tem 4 of Form 3CE) x Secton 44DB 36x x Frst Schedule of Income-tx Act 36x x Totl (36 to 36x) 36x Net proft or loss from busness or professon other thn specultve nd specfed busness 37 (35+36x) Net Proft or loss from busness or professon other thn specultve busness nd specfed 38 busness fter pplyng rule 7A, 7B or 8, f pplcble (If rule 7A, 7B or 8 s not pplcble, enter sme fgure s n37) (If loss tke the fgure to 2 of tem E) B Computton of ncome from specultve busness 39 Net proft or loss from specultve busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DB Deductons n ccordnce wth secton 28 to 44DB Income from specultve busness ( ) (f loss, tke the fgure to 6x of schedule CFL) B42 C Computton of ncome from specfed busness under secton 35AD 43 Net proft or loss from specfed busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DB Deductons n ccordnce wth secton 28 to 44DB (other thn deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clmed) 46 Proft or loss from specfed busness ( ) Deductons n ccordnce wth secton 35AD(1) Income from Specfed Busness (46-47) (f loss, tke the fgure to 7x of schedule CFL) C48 49 Relevnt cluse of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from C49 drop down menu) D Income chrgeble under the hed Profts nd gns from busness or professon (A38+B42+C48) D E Intr hed set off of busness loss of current yer Sl. Type of Busness ncome 33 Income of current yer (Fll ths column only f fgure s zero or postve) Busness loss set off 37 A38 45 Busness ncome remnng fter set off (1) (2) (3) = (1) (2)

88 266 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Loss to be set off (Fll ths row only f fgure s negtve) Income from specultve busness Income from specfed busness v Totl loss set off ( + ) v Loss remnng fter set off ( v) (B42) (C48) (A38) Deprecton on Plnt nd Mchnery (Other thn ssets on whch full cptl expendture s llowble s deducton Schedule DPM under ny other secton) 1 Block of ssets Plnt nd mchnery DEPRECIATION ON PLANT AND MACHINERY 2 Rte (%) () Wrtten down vlue on the frst dy of prevous yer 3(b) Wrtten down vlue on the frst dy of prevous yer, of those block of ssets whch were elgble for 50%, 60% or 80% s per the old Tble 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed (3() + 3(b) + 4-5) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 9 Amount on whch deprecton t hlf rte to be llowed (7-8) (enter 0, f result n negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Addtonl deprecton, f ny, on 4 13 Addtonl deprecton, f ny, on 7 14 Addtonl deprecton reltng to mmedtely precedng yer' on sset put to use for less thn 180 dys 15 Totl deprecton* ( ) 16 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net ggregte deprecton (15-16) 18 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth trnsfer of sset/ ssets 20 Cptl gns/ loss under secton 50* ( () 3(b) ) (enter negtve only f block ceses to exst) 21 Wrtten down vlue on the lst dy of prevous yer* ( ) (enter 0 f result s negtve) () () () Schedule DOA Deprecton on other ssets (Other thn ssets on whch full cptl expendture s llowble s deducton) 1 Block of ssets Lnd Buldng (not ncludng lnd) Furnture nd Intngble Shps fttngs ssets 2 Rte (%) Nl DEPRECIA TION ON () () () (v) (v) (v) (v)

89 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Wrtten down vlue on the frst dy of prevous yer 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed ( ) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 9 Amount on whch deprecton t hlf rte to be llowed (7-8) (enter 0, f result n negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Totl deprecton* (10+11) 13 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net ggregte deprecton (12-13) 15 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 14) 16 Expendture ncurred n connecton wth trnsfer of sset/ ssets 17 Cptl gns/ loss under secton 50 ( ) (enter negtve only f block ceses to exst) 18 Wrtten down vlue on the lst dy of prevous yer* ( ) (enter 0 f result s negtve) Summry of deprecton on ssets (Other thn ssets on whch full cptl expendture s llowble s deducton under Schedule DEP ny other secton) 1 Plnt nd mchnery SUMMARY OF DEPRECIATION ON ASSETS Block enttled for 15 per cent 1 ( Schedule DPM - 17 or 18 s pplcble) b Block enttled for 30 per cent 1b ( Schedule DPM - 17 or 18 s pplcble) c Block enttled for 40 per cent 1c ( Schedule DPM - 17 or 18 s pplcble) d Totl deprecton on plnt nd mchnery ( 1 + 1b + 1c) 2 Buldng (not ncludng lnd) Block enttled for 5 per cent 2 (Schedule DOA- 14 or 15 s pplcble) b Block enttled for 10 per cent 2b (Schedule DOA- 14 or 15 s pplcble) c Block enttled for 40 per cent (Schedule 2c DOA- 14v or 15v s pplcble) d Totl deprecton on buldng (totl of 2 + 2b + 2c) 3 Furnture nd fttngs(schedule DOA- 12v) 3 4 Intngble ssets (Schedule DOA- 12v) 4 5 Shps (Schedule DOA- 12v) 5 6 Totl deprecton ( 1d+2d+3+4+5) 6 1d 2d Schedule DCG Deemed Cptl Gns on sle of deprecble ssets 1 Plnt nd mchnery Block enttled for 15 per cent 1 (Schedule DPM - 20)

90 268 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Block enttled for 30 per cent 1b (Schedule DPM 20) c Block enttled for 40 per cent 1c (Schedule DPM - 20) d Totl ( 1 +1b + 1c) 1d 2 Buldng (not ncludng lnd) Block enttled for 5 per cent 2 (Schedule DOA- 17) b Block enttled for 10 per cent 2b (Schedule DOA- 17) c Block enttled for 40 per cent (Schedule 2c DOA- 17v) d Totl ( 2 + 2b + 2c) 2d 3 Furnture nd fttngs ( Schedule DOA- 17v) 3 4 Intngble ssets (Schedule DOA- 17v) 4 5 Shps (Schedule DOA- 17v) 5 6 Totl ( 1d+2d+3+4+5) 6 Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nture referred to n secton (1) Amount, f ny, debted to proft nd loss ccount (2) Amount of deducton llowble (3) 35(1)() v v v v v x x 35(1)() 35(1)() 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Totl Amount of deducton n excess of the mount debted to proft nd loss ccount (4) = (3) - (2) Schedule CG Cptl Gns A Short-term Cptl Gns (STCG) (Sub-tems 4 & 5 re not pplcble for resdents) 1 From sle of lnd or buldng or both I Full vlue of consderton receved/recevble I Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose I of Cptl Gns ( or ) b Deductons under secton 48 I Cost of cquston wthout ndexton b I Cost of Improvement wthout ndexton b I Expendture wholly nd exclusvely n connecton wth trnsfer b Iv Totl (b + b + b) bv c Blnce ( bv) 1c Short-term Cptl Gns d Deducton under secton 54D/ 54G/54GA (Specfy detls n tem D below) 1d e Short-term Cptl Gns on Immovble property (1c - 1d) A1e 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) 3 b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Short term cptl gns from slump sle (2-2b) From sle of equty shre or unt of equty orented Mutul Fund (MF) or unt of busness trust on whch STT s pd under secton 111A or 115AD(1)() provso (for FII) Full vlue of consderton 3 b Deductons under secton 48 I Cost of cquston wthout ndexton b I Cost of Improvement wthout ndexton b I Expendture wholly nd exclusvely n connecton wth trnsfer b Iv Totl ( + + ) bv c Blnce (3 bv) 3c A2c

91 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd d 3d dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) e Short-term cptl gn on equty shre or equty orented MF (STT pd) (3c +3d) A3e For NON-RESIDENT, not beng n FII- from sle of shres or debentures of n Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) STCG on trnsctons on whch securtes trnscton tx (STT) s pd A4 b STCG on trnsctons on whch securtes trnscton tx (STT) s not pd For NON-RESIDENTS- from sle of securtes (other thn those t A3 bove) by n FII s per secton 5 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (5 bv) d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f securty bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such securty to be gnored (Enter postve vlue only) e Short-term cptl gn on securtes (other thn those t A3 bove) by n FII (5c +5d) 6 From sle of ssets other thn t A1 or A2 or A3 or A4 or A5 bove In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) c Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl ( + + ) bv c Blnce (6 bv) 6c d In cse of sset (securty/unt) loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng 6d out of sle of such sset to be gnored (Enter postve vlue only) e Deemed short term cptl gns on deprecble ssets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on ssets other thn t A1 or A2 or A3 or A4 or A5 bove (6c + 6d + 6e 6f) A6g 7 Amount deemed to be short term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yers shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer Secton under whch n whch sset deducton clmed n trnsferred tht yer New sset cqured/constructed c b b b bv 5c 5d Yer n whch sset Amount utlsed out of cqured/constructed Cptl Gns ccount Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) A4b A5e

92 270 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] D/54G/54GA b Amount deemed to be short term cptl gns u/s 54D/54G/54GA, other thn t 8 Amount deemed to be short term cptl gns (X + b) Amount of STCG ncluded n A1-A7 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. No. Amount of ncome Item No. A1 to A7 bove Country nme n whch & Code ncluded Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of STCG not chrgeble to tx n Ind s per DTAA b Totl mount of STCG chrgeble t specl rtes n Ind s per DTAA 9 Totl Short-term Cptl Gn (A1e+ A2c+ A3e+ A4+ A4b+ A5e+ A6g+A7 A8) A9 B Long-term cptl gn (LTCG) (Sub-tems 5 & 6 re not pplcble for resdents) 1 From sle of lnd or buldng or both Long-term Cptl Gns 5 I Full vlue of consderton receved/recevble I Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the I purpose of Cptl Gns ( or ) b Deductons under secton 48 I Cost of cquston wth ndexton I Cost of Improvement wth ndexton I Expendture wholly nd exclusvely n connecton wth trnsfer Iv Totl (b + b + b) c Blnce ( bv) Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n d tem D below) 1d e Long-term Cptl Gns on Immovble property (1c - 1d) 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Blnce (2 2b) d Deducton u/s 54EC/54EE e Long term cptl gns from slump sle (2c-2d) 3 From sle of bonds or debenture (other thn cptl ndexed bonds ssued by Government) Full vlue of consderton b Deductons under secton 48 I Cost of cquston wthout ndexton I Cost of mprovement wthout ndexton I Expendture wholly nd exclusvely n connecton wth trnsfer Iv Totl (b + b +b) c Blnce (3 bv) 3c d Deducton under sectons 54EC/54EE (Specfy detls n tem D below) 3d e LTCG on bonds or debenture (3c 3d) 4 From sle of lsted securtes (other thn unt) or zero coupon bonds where provso under secton 112(1) s pplcble Full vlue of consderton 4 b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (4 bv) 4c d Deducton under sectons 54EC/54EE (Specfy detls n tem D below) 4d e Long-term Cptl Gns on ssets t B4 bove (4c 4d) B4e For NON-RESIDENTS- from sle of shres or debenture of Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) LTCG computed wthout ndexton beneft 5 2c 2d b Deducton under sectons 54EC/54EE (Specfy detls n tem D below) 5b b b b bv 1c 3 b b b bv A7 A8 A8b B1e B2e B3e

93 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 271 c LTCG on shre or debenture (5-5b) B5c For NON-RESIDENTS- from sle of, () unlsted securtes s per sec. 112(1)(c), () unts referred n 6 sec. 115AB, () bonds or GDR s referred n sec. 115AC, (v) securtes by FII s referred to n sec. 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns c (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (6 bv) 6c d Deducton under sectons 54EC/54EE (Specfy detls n tem D below) 6d e Long-term Cptl Gns on ssets t 6 bove n cse of NON-REESIDENT (6c 6d) B6e 7 From sle of ssets where B1 to B6 bove re not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s c per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted Totl (c + ) b Deductons under secton 48 Cost of cquston wth ndexton b Cost of mprovement wth ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (7 bv) 7c d Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n tem D 7d e Long-term Cptl Gns on ssets t B7 bove (7c-7d) B7e 8 Amount deemed to be long-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yer shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. New sset cqured/constructed Amount not used for Prevous yer n Secton under whch whch sset deducton clmed n Amount utlsed out new sset or remned Yer n whch sset unutlzed n Cptl trnsferred tht yer of Cptl Gns cqured/constructed ccount gns ccount (X) /54D/54F/54G/54GA b Amount deemed to be long-term cptl gns, other thn t 9 Amount deemed to be long-term cptl gns (X + b) Amount of LTCG ncluded n tems B1 to B8 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. No. Amount of ncome Item No. B1 to B8 bove n whch ncluded Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) B8

94 272 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] I II 10 Totl mount of LTCG not chrgeble to tx n Ind s per DTAA B9 b Totl mount of LTCG chrgeble t specl rtes n Ind s per DTAA B9b Totl long term cptl gn [B1e +B2e+ B3e +B4e + B5c + B6e + B7e+ B8-B9] (In cse of loss tke the fgure to 9x of schedule CFL) B10 C Income chrgeble under the hed CAPITAL GAINS (A9+ B10) (tke B10 s nl, f loss) D Informton bout deducton clmed gnst Cptl Gns E 1 In cse of deducton u/s 54B/54D/54EC/54EE /54G/54GA gve followng detls b c d e f Deducton clmed u/s 54B Dte of trnsfer of orgnl sset dd/mm/yyyy Cost of new grculturl lnd Dte of purchse of new grculturl lnd dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54D Dte of cquston of orgnl sset b dd/mm/yyyy Cost of purchse/ constructon of new lnd or buldng for ndustrl undertkng Dte of purchse of new lnd or buldng b dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54EC Dte of trnsfer of orgnl sset c dd/mm/yyyy Amount nvested n specfed/notfed bonds Dte of nvestment c dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54EE Dte of trnsfer of orgnl sset d dd/mm/yyyy Amount nvested n specfed sset Dte of nvestment d dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54G Dte of trnsfer of orgnl sset e dd/mm/yyyy Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n n re other thn urbn re v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54GA v v b bv bv c cv d dv e e ev ev dd/mm/yyyy Dte of trnsfer of orgnl sset from urbn re f dd/mm/yyyy Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n SEZ f dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed g Totl deducton clmed (1 + 1b + 1c + 1d + 1e + 1f) Set-off of current yer cptl losses wth current yer cptl gns (excludng mounts ncluded n A8 & B9 whch s chrgeble under DTAA) Sl. Type of Cptl Gn Loss to be set off (Fll ths row f computed fgure s negtve) Gn of current yer (Fll ths column only f computed fgure s postve) Short term 15% (A3e+A4) cptl gn 30% A5e Short term cptl loss set off f fv fv g Long term cptl loss set off 15% 30% pplcble rte 10% 20% C Current yer s cptl gns remnng fter set off (7= ) (A3e+A4) A5e (A1e+A2c+A4b +A6g +A7) (B4e+ + B6e) (B1e+B2e+B3 e+ B5c+ B7e+B8)

95 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 273 v pplcble rte (A1e+A2c+A4b+A 6g +A7) v 10% (B4e+ + B6e) Long term cptl gn (B1e+B2e+B3e+ v 20% B5c+ B7e+B8) v Totl loss set off ( + + v + v + v) v Loss remnng fter set off ( v) F Informton bout ccrul/recept of cptl gn NOTE Type of Cptl gn / Dte Short-term cptl gns txble t the rte of 15% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t the rte of 30% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t pplcble rtes Enter vlue from tem 5v of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 10% Enter vlue from tem 5v of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 20% Enter vlue from tem 5x of schedule BFLA, f ny. Upto 15/6 () 16/6 to 15/9 () 16/9 to 15/12 () Plese nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths hed 16/12 to 15/3 (v) 16/3 to 31/3 (v) Schedule OS OTHER SOURCES Income from other sources 1 Income Dvdends, Gross b Interest, Gross c Rentl ncome from mchnery, plnts, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng rce horses) menton the nture Income by wy of wnnngs from lotteres, crossword puzzles etc. Csh credts u/s 68 b Unexplned nvestments u/s 69 c Unexplned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B e Unexplned expendture etc. u/s 69C f Amount borrowed or repd on hund u/s 69D Totl ( + b + c + d + e + f) Income of the nture referred to n secton 56(2)(x) whch s chrgeble to tx Aggregte vlue of sum of money receved wthout consderton In cse mmovble property s receved wthout b consderton, stmp duty vlue of property c d e In cse mmovble property s receved for ndequte consderton, stmp duty vlue of property n excess of such consderton In cse ny other property s receved wthout consderton, fr mrket vlue of property In cse ny other property s receved for ndequte consderton, fr mrket vlue of property n excess of such consderton Totl (+ b + c +d + e) v v v Totl (1d + 1d+ 1d + 1dv+1dv) e Totl (1 + 1b + 1c + 1dv) 1 1b 1c 1d 1d 1d 1dv f Income ncluded n 1e chrgeble to tx t specl rte (to be tken to schedule SI) Income by wy of wnnngs from lotteres, crossword puzzles, rces, gmes, gmblng, bettng etc (u/s 115BB) Dvdend Income from domestc compny tht exceeds Rs.10 Lkh (u/s 115BBDA) (only for frms) Deemed Income chrgeble to tx u/s 115BBE 1dv 1dv 1e 1f 1f 1f

96 274 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Income from ptent chrgeble u/s 11BBF v Income from trnsfer of crbon credts u/s 115BBG v Any other ncome chrgeble to tx t the rte specfed under chpter XII/XII-A v Income chrgeble t specl rtes txed under DTAA Sl. No. Amount of ncome Nture of ncome Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II 1fv 1fv 1fv 2 III Totl mount of ncome chrgeble t specl rtes under DTAA v Income ncluded n 1e chrgeble to tx t specl rte (1f +1f+1f+1fv+1fv+1fv + 1fv) g Gross mount chrgeble to tx t norml pplcble rtes (1e-1fv) Deductons under secton 57 (other thn those reltng to ncome under 1f, 1f, 1f, 1fv, 1fv, 1fv & h 1fv) Expenses / Deductons Deprecton Totl Amounts not deductble u/s 58 j Profts chrgeble to tx u/s 59 Income from other sources (other thn from ownng rce horses nd mount chrgeble to tx t k specl rte) (1g h j) (If negtve tke the fgure to 4 of schedule CYLA) Income from other sources (other thn from ownng nd mntnng rce horses) (1fv + 1k) (enter 1k s nl, f negtve) 3 Income from the ctvty of ownng rce horses Recepts 3 b Deductons under secton 57 n relton to (4) 3b c Amounts not deductble u/s 58 3c d Profts chrgeble to tx u/s 59 3d e Blnce (3 3b + 3c + 3d) (f negtve tke the fgure to 10x of Schedule CFL) 4 Income under the hed Income from other sources (2 + 3e) (tke 3e s nl f negtve) 4 h h h 1fv 1fv 1 1j 1k 2 3e 1g Schedule CYLA Detls of Income fter Set off of current yer losses Sl.No Hed/ Source of Income Income of current yer House property loss (Fll ths column only f of the current yer ncome s zero or set off postve) CURRENT YEAR LOSS ADJUSTMENT Loss to be set off House property (3b of Schedule HP) Busness (excludng speculton ncome nd ncome from specfed busness) Busness Loss (other thn speculton or specfed busness loss) of the current yer set off Other sources loss (other thn loss from rce horses nd mount chrgeble to specl rte of tx) of the current yer set off Current yer s Income remnng fter set off = ( A38 of Schedule BP) v Speculton ncome (3 of tem E of Sch. BP) v Specfed busness ncome u/s 35AD (3 of tem E of Sch. BP) v Short-term cptl gn (7 of tem E of schedule 15% CG) v Short-term cptl gn (7 of tem E of schedule 30% CG) v Short-term cptl gn txble t (7v of tem E of schedule pplcble rtes CG) x Long term cptl gn (7v of tem E of schedule 10% CG) x Long term cptl gn (7v of tem E of schedule 20% CG) x Other sources (excludng proft from ownng rce horses nd mount (1k of schedule OS) chrgeble to specl rte of tx) x Proft from ownng nd mntnng rce horses (3e of schedule OS) (3b of Schedule HP) x Totl loss set off (+ + v+ v+ v+ v+ v+ x+ x+ x+ x) (2v of tem E of Schedule BP) (1k of Schedule-OS)

97 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 275 xv Loss remnng fter set-off ( - x) Schedule BFLA Detls of Income fter Set off of Brought Forwrd Losses of erler yers Sl. Hed/ Source of Income Income fter set off, f Brought forwrd loss set Brought forwrd No. ny, of current yer s off deprecton set losses s per 5 of off Schedule CYLA) BROUGHT FORWARD LOSS ADJUSTMENT House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculton ncome nd ncome from specfed busness) Speculton Income v Specfed Busness Income Brought forwrd llownce under secton 35(4) set off Current yer s ncome remnng fter set off (5 of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) (B/f busness loss, other thn speculton or specfed busness loss) (B/f norml busness or speculton loss) (B/f norml busness or specfed busness loss) (B/f short-term cptl loss) (B/f short-term cptl loss) (B/f short-term cptl loss) (B/f short-term or longterm cptl loss) (B/f short-term or longterm cptl loss) v Short-term cptl gn 15% (5v of schedule CYLA) v Short-term cptl gn (5v of schedule CYLA) 30% v Short-term cptl gn txble t (5v of schedule CYLA) pplcble rtes Long-term cptl gn v 10% (5x of schedule CYLA) x Long term cptl gn 20% (5x of schedule CYLA) Other sources ncome (excludng x proft from ownng nd mntnng rce horses nd mount chrgeble (5x of schedule CYLA) to specl rte of tx) x Proft from ownng nd mntnng rce horses (5x of schedule CYLA) (B/f loss from horse rces) x Totl of brought forwrd loss set off x Current yer s ncome remnng fter set off Totl ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5) Schedule CFL Detls of Losses to be crred forwrd to future yers Sl. Assessment Yer Dte of House property No. Flng loss (DD/MM/ YYYY) CARRY FORWARD OF LOSS Loss from busness other thn loss from specultve busness nd specfed busness Loss from specultve busness Loss from specfed busness Short-term cptl loss Long-term Cptl loss Loss from ownng nd mntnng rce horses v v v v v x x x x Totl of erler yer losses b/f Adjustment of bove losses n Schedule BFLA (Current yer losses) Totl loss Crred forwrd to future yers (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2 of schedule BFLA) (B42 of schedule BP, f ve) (2v of schedule BFLA) (C48 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) Schedule UD Unbsorbed deprecton nd llownce under secton 35(4) Sl No Assessment Yer Deprecton Allownce under secton 35(4) (2x of schedule BFLA) (3e of schedule OS, f ve)

98 276 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Amount of brought forwrd unbsorbed deprecton Amount of deprecton set-off gnst the current yer ncome Blnce crred forwrd to the next yer Amount of brought forwrd unbsorbed llownce Amount of llownce set-off gnst the current yer ncome Blnce Crred forwrd to the next yer (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Yer v v Totl (3x of BFLA) (4x of BFLA)

99 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 277 Schedule ICDS Effect of Income Computton Dsclosure Stndrds on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X b. Accountng Polces Vluton of Inventores (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Constructon Contrcts Revenue Recognton Tngble Fxed Assets Chnges n Foregn Exchnge Rtes Government Grnts Securtes (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Borrowng Costs Provsons, Contngent Lbltes nd Contngent Assets Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negtve) Schedule 10AA Deducton under secton 10AA Deductons n respect of unts locted n Specl Economc Zone DEDUCTION U/S 10AA Sl Undertkng Undertkng No.1 b Undertkng No.2 Assessment yer n whch unt begns to mnufcture/produce/provde servces c Totl deducton under secton 10AA ( + b + c + d) Sl b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertkng 1) (tem 17 of Annexure A of Form 56F for Undertkng 2) c Schedule 80G Detls of dontons enttled for deducton under secton 80G Dontons enttled for 100% deducton wthout A qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton DETAILS OF DONATIONS B Totl Dontons enttled for 50% deducton wthout qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton Totl Dontons enttled for 100% deducton subject to C qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton Totl Dontons enttled for 50% deducton subject to D qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton

100 278 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Totl E Totl dontons (A + B + C + D) Schedule 80-IA Deductons under secton 80-IA Deducton n respect of profts of n enterprse referred to n secton 80-IA(4)() [Infrstructure fclty] Deducton n respect of profts of n undertkng b referred to n secton 80-IA(4)() [Telecommuncton servces] Deducton n respect of profts of n undertkng c referred to n secton 80-IA(4)() [Industrl prk nd SEZs] 1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) 2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) b1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) b2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) c1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) c2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) d Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Power] d1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) d2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) e Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Revvl of power genertng plnt] nd deducton n respect of profts of n undertkng referred to n secton 80- IA(4)(v) [Cross-country nturl gs dstrbuton network] e1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) e2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) f Totl deductons under secton 80-IA ( b1 + b2 + c1 + c2+ d1 + d2 + e1 + e2) f Schedule 80-IB b c d e f g h j k l Deductons under secton 80-IB Deducton n respect of ndustrl undertkng locted n Jmmu & Kshmr [Secton 80-IB(4)] Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd sttes specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd dstrcts [Secton 80-IB(5)] Deducton n the cse of multplex thetre [Secton 80- IB(7A)] Deducton n the cse of conventon centre [Secton 80- IB(7B)] Deducton n the cse of undertkng whch begns commercl producton or refnng of mnerl ol [Secton 80-IB(9)] Deducton n the cse of n undertkng developng nd buldng housng projects [Secton 80-IB(10)] Deducton n the cse of n undertkng opertng cold chn fclty [Secton 80-IB(11)] Deducton n the cse of n undertkng engged n processng, preservton nd pckgng of fruts, vegetbles, met, met products, poultry, mrne or dry products [Secton 80-IB(11A)] Deducton n the cse of n undertkng engged n ntegrted busness of hndlng, storge nd trnsportton of food grns [Secton 80-IB(11A)] Deducton n the cse of n undertkng engged n opertng nd mntnng rurl hosptl [Secton 80- IB(11B)] Deducton n the cse of n undertkng engged n opertng nd mntnng hosptl n ny re, other thn excluded re [Secton 80-IB(11C) 1 Undertkng no. 1 2 Undertkng no. 2 b1 Undertkng no. 1 b2 Undertkng no. 2 c1 Undertkng no. 1 c2 Undertkng no. 2 d1 Undertkng no. 1 d2 Undertkng no. 2 e1 Undertkng no. 1 e2 Undertkng no. 2 f1 Undertkng no. 1 f2 Undertkng no. 2 g1 Undertkng no. 1 g2 Undertkng no. 2 h1 Undertkng no. 1 h2 Undertkng no. 2 1 Undertkng no. 1 2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (10(v) of Form 10CCBA of the undertkng) (10(v) of Form 10CCBA of the undertkng) (10(v) of Form 10CCBB of the undertkng) (10(v) of Form 10CCBB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) j1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) j2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) k1 Undertkng no. 1 (11(v) of From 10CCBC) k2 Undertkng no. 2 (11(v) of From 10CCBC) l1 Undertkng no. 1 (11(d) of From 10CCBD) l2 Undertkng no. 2 (11(d) of From 10CCBD)

101 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 279 m Totl deducton under secton 80-IB (Totl of 1 to l2) m DEDUCTION U/S 80-IC Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE Deducton n respect of undertkng locted n Skkm b Deducton n respect of undertkng locted n Hmchl Prdesh c Deducton n respect of undertkng locted n Uttrnchl d Deducton n respect of undertkng locted n North-Est d Assm db Arunchl Prdesh dc Mnpur dd Mzorm de Meghly df Nglnd dg Trpur d1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) d2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) db1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) db2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dc1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dc2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dd1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dd2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) de1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) de2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) df1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) df2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dg1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dg2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dh Totl deducton for undertkngs locted n North-est (totl of d1 to dg2) e Totl deducton under secton 80-IC or 80-IE ( + d + c + dh) 1 Undertkng no. 1 2 Undertkng no. 2 b1 Undertkng no. 1 b2 Undertkng no. 2 c1 Undertkng no. 1 c1 Undertkng no. 2 dh e (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) Schedule VI-A Deductons under Chpter VI-A 1 Prt B- Deducton n respect of certn pyments 80G b 80GGC Totl Deducton under Prt B ( + b) 1 TOTAL DEDUCTIONS 2 Prt C- Deducton n respect of certn ncomes c 80-IA (f of Schedule 80-IA) d 80-IAB e 80-IAC f 80-IB (m of Schedule 80-IB) g 80-IBA h 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) 80JJA j 80JJAA k 80LA (9 of Annexure to Form 10CCF) l 80P Totl Deducton under Prt C (totl of c to l ) 2 3 Totl deductons under Chpter VI-A (1 + 2) 3 Schedule AMT Computton of Alternte Mnmum Tx pyble under secton 115JC 1 Totl Income s per tem 13 of PART-B-TI 1 2 Adjustment s per secton 115JC(2) Deducton Clmed under ny secton ncluded n Chpter VI-A under the hedng C. Deductons n respect of certn ncomes 2

102 280 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Deducton Clmed u/s 10AA c Deducton clmed u/s 35AD s reduced by the mount of deprecton on ssets on whch such deducton s clmed d Totl Adjustment (2+ 2b+ 2c) 3 Adjusted Totl Income under secton 115JC(1) (1+2d) 3 Tx pyble under secton 115JC [18.5% of (3)] (In the cse of Indvdul, HUF, AOP, BOI, AJP ths s 4 4 pplcble f 3 s greter thn Rs. 20 lkhs) 2b 2d Schedule AMTC Computton of tx credt under secton 115JD 1 Tx under secton 115JC n ssessment yer (1d of Prt-B-TTI) 1 2 Tx under other provsons of the Act n ssessment yer (2g of Prt-B-TTI) 2 3 Amount of tx gnst whch credt s vlble [enter (2 1) f 2 s greter thn 1, otherwse enter 0] 3 4 Utlston of AMT credt Avlble (Sum of AMT credt utlzed durng the current yer s subject to mxmum of mount mentoned n 3 bove nd cnnot exceed the sum of AMT Credt Brought Forwrd) S.No Assessment Yer (AY) (A) AMT Credt v v v Current AY (enter 1 v -2, f 1>2 else enter 0) v Totl Gross (B1) Set-off n erler ssessment yers (B2) Blnce brought forwrd to the current ssessment yer (B3) = (B1) (B2) 5 Amount of tx credt under secton 115JD utlsed durng the yer [totl of tem No. 4 (C)] 5 6 Amount of AMT lblty vlble for credt n subsequent ssessment yers [totl of 4 (D)] 6 AMT Credt Utlsed durng the Current Assessment Yer (C) Blnce AMT Credt Crred Forwrd (D)= (B3) (C) Schedule SI Income chrgeble to tx t specl rtes [Plese see nstructon Number-7() for secton nd rte of tx] Sl Secton/Descrpton Specl rte Income No (%) () 1 111A (STCG on shres/equty orented MF on whch STT pd) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pd) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexton) 10 (prt of 5v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (prt of 5v of schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (prt of 5v of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (prt of 5v of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (prt of 5v of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) 9 115B (Profts nd gns of lfe nsurnce busness) (prt of 4 of schedule BP) 115AC (Income of non-resdent from bonds or GDR purchsed n 10 foregn currency) 10 (prt of 1f of schedule OS) BB (Wnnngs from lotteres, puzzles, rces, gmes etc.) 30 (1f of schedule OS) SPECIAL RATE BBDA (Dvdend ncome from domestc compny exceedng Rs.10 lkh) 10 (1f of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (1f of schedule OS) BBF (Tx on ncome from ptent) Income under hed busness or professon 10 (3d of schedule BP) b Income under hed other sources 10 (1fv of schedule OS) BBG (Tx on ncome from trnsfer of crbon credts) Income under hed busness or professon 10 (3e of schedule BP) b Income under hed other sources 10 (1fv of schedule OS) Tx thereon ()

103 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k A(b) (Income of non-resdent from Roylty) 25 (prt of 1fv of schedule OS) 17 Chrgeble under DTAA rte (prt of 1fv of schedule OS + A8b nd B9b of schedule CG) Totl Schedule EI EXEMPT INCOME Detls of Exempt Income (Income not to be ncluded n Totl Income) 1 Interest ncome 1 2 Dvdend ncome 2 3 Long-term cptl gns from trnsctons on whch Securtes Trnscton Tx s pd 3 Gross Agrculturl recepts (other thn ncome to be excluded under rule 4 7A, 7B or 8 of I.T. Rules) Expendture ncurred on grculture Unbsorbed grculturl loss of prevous eght ssessment yers v Net Agrculturl ncome for the yer ( ) (enter nl f loss) 4 5 Others, ncludng exempt ncome of mnor chld (plese specfy) 5 6 Totl ( ) 6 Schedule PTI Pss Through Income detls from busness trust or nvestment fund s per secton 115UA, 115UB Sl. Nme of busness trust/ PAN of the busness Sl. Hed of ncome Amount of nvestment fund trust/ nvestment fund ncome 1. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s 2. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s NOTE Plese refer to the nstructons for fllng out ths schedule. PASS THROUGH INCOME TDS on such mount, f ny Schedule FSI INCOME FROM OUTSIDE INDIA AND TAX RELIEF Sl. Country Code Txpyer Identfcton Number 1 House Property Detls of Income from outsde Ind nd tx relef Sl. Hed of ncome Income from Tx pd Tx pyble on outsde Ind outsde Ind such ncome (ncluded n PART under norml B-TI) provsons n Ind Busness or Professon Cptl Gns v Other sources Tx relef vlble n Ind (e)= (c) or (d) whchever s lower Relevnt rtcle of DTAA f relef clmed u/s 90 or 90A () (b) (c) (d) (e) (f) Totl 2 House Property Busness or Professon

104 282 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Cptl Gns v Other sources Totl NOTE Plese refer to the nstructons for fllng out ths schedule.

105 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 283 Schedule TR Detls Summry of tx relef clmed for txes pd outsde Ind 1 Detls of Tx relef clmed Country Code Txpyer Totl txes pd outsde Ind Identfcton (totl of (c) of Schedule FSI n Number respect of ech country) TAX RELIEF FOR TAX PAID OUTSIDE INDIA Totl tx relef vlble (totl of (e) of Schedule FSI n respect of ech country) Secton under whch relef clmed (specfy 90, 90A or 91) () (b) (c) (d) (e) Totl 2 Totl Tx relef vlble n respect of country where DTAA s pplcble (secton 90/90A) (Prt of totl of 1(d)) 2 3 Totl Tx relef vlble n respect of country where DTAA s not pplcble (secton 91) (Prt of totl of 1(d)) 3 4 Whether ny tx pd outsde Ind, on whch tx relef ws llowed n Ind, hs been refunded/credted by the foregn tx uthorty durng the yer? If yes, provde the detls below 4 Yes/No Amount of tx refunded NOTE Plese refer to the nstructons for fllng out ths schedule. b Assessment yer n whch tx relef llowed n Ind Schedule FA Detls of Foregn Assets nd Income from ny source outsde Ind A Detls of Foregn Bnk Accounts held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Nme nd Code Nme nd Address of the Bnk Account holder nme Sttus- Owner/ Benefcl owner/ Benefcry Account Number Account openng dte Pek Blnce Durng the Yer (n rupees) Interest ccrued n the ccount Interest txble nd offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () DETAILS OF FOREIGN ASSETS () B Detls of Fnncl Interest n ny Entty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl Nture of Dte snce Nture of Income txble nd offered n ths return No entty held Income Country Nme nd code Nme nd Address of the Entty Nture of Interest- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income ccrued from such Interest Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detls of Immovble Property held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl Address of Dte of Nture of Income txble nd offered n ths return No the Property cquston Income Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income derved from the property Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detls of ny other Cptl Asset held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Nture of Asset Dte of cquston Nture of Income Income txble nd offered n ths return Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry (1) (2) (3) (4) () () Totl Investment (t cost) (n rupees) Income derved from the sset Amount Schedule where offered Item number of schedule (5) (6) (7) (8) (9) (10) (11) E Detls of ccount(s) n whch you hve sgnng uthorty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer nd whch hs not been ncluded n A to D bove.

106 284 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Sl No Nme of the Insttuton n whch the ccount s held Address of the Insttuton Nme of the ccount holder Account Number Pek Blnce/ Investment durng the yer (n rupees) Whether ncome ccrued s txble n your hnds? If (7) s yes, Income ccrued n the ccount If (7) s yes, Income offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detls of trusts, creted under the lws of country outsde Ind, n whch you re trustee, benefcry or settlor Sl Country Nme nd Nme nd Nme nd Nme nd Dte Whether If (8) s yes, If (8) s yes, Income offered n ths return No Nme nd ddress of ddress of ddress of ddress of snce ncome derved Income Amount Schedule Item number of code the trust trustees Settlor Benefcres poston s txble n derved from where offered schedule held your hnds? the trust (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detls of ny other ncome derved from ny source outsde Ind whch s not ncluded n,- () tems A to F bove nd, () ncome under the hed busness or professon If (6) s yes, Income offered n ths return Country Nme Nme nd ddress of the Whether txble Income derved Nture of ncome nd code person from whom derved n your hnds? Amount Schedule Item number of where offered schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Plese refer to nstructons for fllng out ths schedule.

107 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 285 FORM ITR-6 INDIAN INCOME TAX RETURN [For Compnes other thn compnes clmng exempton under secton 11] (Plese see rule 12 of the Income-tx Rules,1962) (Also see ttched nstructons) Assessment Yer Prt A-GEN Nme GENERAL PAN Is there ny chnge n the compny s nme? If yes, plese furnsh the old nme Corporte Identty Number (CIN) ssued by MCA PERSONAL INFORMATION Flt/Door/Block No Nme of Premses/Buldng/Vllge Dte of ncorporton (DD/MM/YYYY) / / Rod/Street/Post Offce Are/Loclty Type of compny (Tck ny one) () Domestc Compny () Foregn Compny Town/Cty/Dstrct Stte Country Pn code/zp code If publc compny wrte 6, nd f prvte compny wrte 7 (s defned n secton 3 of The Compny Act) Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Income Tx Wrd/Crcle Eml Address-1 Eml Address-2 () (b) (c) Return fled(tck)[plese see nstructon number-5] On or before due dte-139(1), After due dte-139(4), Revsed Return-139(5) Modfed return-92cd, under secton 119(2)(b),Or In response to notce 139(9)- Defectve, 142(1), 148, 153A, 153C If revsed/n response to defectve/modfed, then enter Recept No nd Dte of flng orgnl return / / (DD/MM/YYYY) If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C enter dte of such notce, or u/s 92CD enter dte of dvnce prcng greement (d) Resdentl Sttus (Tck) Resdent Non-Resdent / / (e) Whether optng for secton 115BA? (Yes/No) (pplcble on Domestc Compny) FILING STATUS (f) (g) Whether totl turnover/ gross recepts n the prevous yer exceeds 50 crore rupees? (Yes/No) (pplcble on Domestc Compny) Whether ssessee s resdent of country or specfed terrtory wth whch Ind hs n greement referred to n sec 90 (1) or Centrl Government hs dopted ny greement under sec 90A(1)? (h) In the cse of non-resdent, s there Permnent Estblshment (PE) n Ind (Tck) Yes No () (j) (k) Whether ssessee s requred to seek regstrton under ny lw for the tme beng n force reltng to compnes? Whether the fnncl sttements of the compny re drwn up n complnce to the Indn Accountng Stndrds specfed n Annexure to the compnes (Indn Accountng Stndrds) Rules, 2015 (Tck) Yes No Whether ssessee s locted n n Interntonl Fnncl Servces Centre nd derves ncome solely n convertble foregn exchnge? (Tck) Yes No (l) Whether the ssessee compny s under lqudton (Tck) Yes No (m) Whether you re n FII / FPI? Yes/No If yes, plese provde SEBI Regn. No. (n) (o) Whether ny trnscton hs been mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No Whether ths return s beng fled by representtve ssessee? (Tck) Yes No If yes, plese furnsh followng nformton - (1) Nme of the representtve ssessee (2) Address of the representtve ssessee (3) Permnent Account Number (PAN) of the representtve ssessee AUDIT INFORMATION () Whether lble to mntn ccounts s per secton 44AA? (Tck) Yes No (b) Whether lble for udt under secton 44AB? (Tck) Yes No (c) If (b) s Yes, whether the ccounts hve been udted by n ccountnt? (Tck) Yes No If Yes, furnsh the followng nformton below (1) Menton the dte of furnshng of udt report (DD/MM/YYYY)

108 286 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] (2) Nme of the udtor sgnng the tx udt report (d) (e) (3) Membershp No. of the udtor (4) Nme of the udtor (propretorshp/ frm) (5) Propretorshp/frm regstrton number (6) Permnent Account Number (PAN) of the udtor (propretorshp/ frm) (7) Dte of udt report If lble to furnsh other udt report under the Income-tx Act, menton the dte of furnshng the udt report? (DD/MM/YY) (Plese see Instructon 5()) 92E 115JB Menton the Act, secton nd dte of furnshng the udt report under ny Act other thn the Income-tx Act Act nd secton (DD/MM/YY) Act nd secton (DD/MM/YY) () Nture of compny (wrte 1 f holdng compny, wrte 2 f subsdry compny, wrte 3 f both, wrte 4 f ny other) HOLDING STATUS (b) (c) If subsdry compny, menton the detls of the Holdng Compny PAN Nme of Holdng Compny Address of Holdng Compny Percentge of Shres held If holdng compny, menton the detls of the subsdry compnes PAN Nme of Subsdry Compny Address of Subsdry Compny Percentge of Shres held () In cse of mlgmtng compny, menton the detls of mlgmted compny PAN Nme of Amlgmted Compny Address of Amlgmted Compny BUSINESS ORGANISATION (b) (c) (d) In cse of mlgmted compny, menton the detls of mlgmtng compny PAN Nme of Amlgmtng Compny In cse of demerged compny, menton the detls of resultng compny PAN Nme of Resultng Compny In cse of resultng compny, menton the detls of demerged compny PAN Nme of Demerged Compny Address of Amlgmtng Compny Address of Resultng Compny Address of Demerged Compny KEY PERSONS Prtculrs of Mngng Drector, Drectors, Secretry nd Prncpl offcer(s) who hve held the offce durng the prevous yer S.No. Nme Desgnton Resdentl Address PAN Drector Identfcton Number (DIN) ssued by MCA, n cse of Drector SHAREHOLDERS INFORMATION OWNERSHIP INFORMATION Prtculrs of persons who were benefcl owners of shres holdng not less thn 10% of the votng power t ny tme of the prevous yer S.No. Nme nd Address Percentge of shres held PAN (f llotted) In cse of unlsted compny, prtculrs of nturl persons who were the ultmte benefcl owners, drectly or ndrectly, of shres holdng not less thn 10% of the votng power t ny tme of the prevous yer (f vlble) S.No. Nme nd Address Percentge of shres held PAN (f llotted) NATU RE OF COMP Nture of compny (Tck) 1 Whether publc sector compny s defned n secton 2(36A) of the Income-tx Act Yes No

109 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Whether compny owned by the Reserve Bnk of Ind Yes No 3 Whether compny n whch not less thn forty percent of the shres re held (whether sngly or tken together) by the Government or the Reserve Bnk of Ind or corporton owned by tht Bnk Yes No 4 Whether bnkng compny s defned n cluse (c) of secton 5 of the Bnkng Regulton Act,1949 Yes No 5 Whether scheduled Bnk beng bnk ncluded n the Second Schedule to the Reserve Bnk of Ind Act Yes No 6 Whether compny regstered wth Insurnce Regultory nd Development Authorty (estblshed under sub-secton (1) of secton 3 of the Insurnce Regultory nd Development Authorty Act, 1999) 7 Whether compny beng non-bnkng Fnncl Insttuton Yes No Nture of busness or professon, f more thn one busness or professon ndcte the three mn ctvtes/ products S.No. Code [Plese see nstructon No.7()] Descrpton () () () Yes No I Prt A-BS EQUITY AND LIABILITIES Equty nd Lbltes 1 Shreholder s fund A B Shre cptl BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2018 OR AS ON THE DATE OF AMALGAMATION Authorsed A Issued, Subscrbed nd fully Pd up Subscrbed but not fully pd v Totl (A + A) Reserves nd Surplus Cptl Reserve B Cptl Redempton Reserve Securtes Premum Reserve v Debenture Redempton Reserve v Revluton Reserve v Shre optons outstndng mount v v Other reserve (specfy nture nd mount) b c Totl (v + vb) A A B B Bv Bv Bv v vb Bv Surplus.e. Blnce n proft nd loss ccount (Debt blnce Bv to be shown s ve fgure) x Totl (B + B + B + Bv + Bv + Bv + Bv + Bv) (Debt blnce to be shown s ve fgure) C Money receved gnst shre wrrnts D Totl Shreholder s fund (Av + Bx + 1C) 2 Shre pplcton money pendng llotment Pendng for less thn one yer Pendng for more thn one yer Totl ( + ) 2 3 Non-current lbltes A Long-term borrowngs Bonds/ debentures Foregn currency b Rupee b c Totl ( + b) c Term lons Foregn currency Av Bx 1C 1D

110 288 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Rupee lons 1 From Bnks b1 2 From others b2 3 Totl (b1 + b2) b3 c Totl Term lons ( + b3) c Deferred pyment lbltes v Deposts from relted prtes (see nstructons) v v Other deposts v v Lons nd dvnces from relted prtes (see nstructons) v v Other lons nd dvnces v v Long term mturtes of fnnce lese oblgtons v x Totl Long term borrowngs (c + c + + v + v + v + v + v) 3A B Deferred tx lbltes (net) 3B C Other long-term lbltes Trde pybles Others Totl Other long-term lbltes ( + ) 3C D Long-term provsons Provson for employee benefts Others Totl ( + ) 3D E Totl Non-current lbltes (3A + 3B + 3C + 3D) 3E 4 Current lbltes A Short-term borrowngs Lons repyble on demnd From Bnks b From Non-Bnkng Fnnce Compnes b c From other fnncl nsttutons c d From others d e Totl Lons repyble on demnd ( + b + c + d) Deposts from relted prtes (see nstructons) Lons nd dvnces from relted prtes (see nstructons) v Other lons nd dvnces v Other deposts v Totl Short-term borrowngs (e v + v) B Trde pybles Outstndng for more thn 1 yer Others Totl Trde pybles ( + ) e v v 4A 4B C Other current lbltes Current mturtes of long-term debt Current mturtes of fnnce lese oblgtons Interest ccrued but not due on borrowngs v Interest ccrued nd due on borrowngs v Income receved n dvnce v Unpd dvdends v Applcton money receved for llotment of securtes nd due for refund nd nterest ccrued v Unpd mtured deposts nd nterest ccrued thereon x Unpd mtured debentures nd nterest ccrued thereon x Other pybles v v v v v x x

111 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 289 x Totl Other current lbltes ( v + v + v + v + v + x + x) D Short-term provsons Provson for employee beneft Provson for Income-tx Proposed Dvdend v Tx on dvdend v v Other v v Totl Short-term provsons ( v + v) E Totl Current lbltes (4A + 4B + 4C + 4D) Totl Equty nd lbltes (1D E + 4E) 4C 4D 4E I II ASSETS 1 Non-current ssets A Fxed ssets Tngble ssets Gross block b Deprecton b c Imprment losses c d Net block ( b - c) d Intngble ssets Gross block b Amortzton b c Imprment losses c d Net block ( b - c) d Cptl work-n-progress v Intngble ssets under development v v Totl Fxed ssets (d + d + + v) Av B Non-current nvestments Investment n property Investments n Equty nstruments Lsted equtes b Unlsted equtes b c Totl ( + b) c Investments n Preference shres v Investments n Government or trust securtes v v Investments n Debenture or bonds v v Investments n Mutul funds v v Investments n Prtnershp frms v v Others Investments v x Totl Non-current nvestments ( + c + + v + v + v + v + v) Bx C Deferred tx ssets (Net) C D Long-term lons nd dvnces Cptl dvnces Securty deposts Lons nd dvnces to relted prtes (see nstructons) v Other Lons nd dvnces v v Totl Long-term lons nd dvnces ( v) Dv v Long-term lons nd dvnces ncluded n Dv whch s for the purpose of busness or professon v

112 290 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b c not for the purpose of busness or professon gven to shreholder, beng the benefcl owner of shre, or to ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act E Other non-current ssets Long-term trde recevbles Others Secured, consdered good b Unsecured, consdered good c Doubtful d Totl Other non-current ssets ( + b + c) Totl (d + ) v Non-current ssets ncluded n E whch s due from shreholder, beng the benefcl owner of shre, or from ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act F Totl Non-current ssets (Av + Bx + C + Dv + E) 2 Current ssets A B C D E Current nvestments Investment n Equty nstruments Lsted equtes b Unlsted equtes c Totl ( + b) Investment n Preference shres Investment n government or trust securtes v Investment n debentures or bonds v Investment n Mutul funds v Investment n prtnershp frms v Other nvestment v Totl Current nvestments (c v + v + v + v) Inventores Rw mterls Work-n-progress Fnshed goods v Stock-n-trde (n respect of goods cqured for trdng) v v Stores nd spres v v Loose tools v v Others v Totl Inventores ( v + v + v + v) Trde recevbles Outstndng for more thn 6 months Others Totl Trde recevbles ( + + ) Csh nd csh equvlents Blnces wth Bnks Cheques, drfts n hnd Csh n hnd v Others v v Totl Csh nd csh equvlents ( v) Dv Short-term lons nd dvnces Lons nd dvnces to relted prtes (see nstructons) Others vb vc b c d v b c v v v v v E 1F Av Bv C

113 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 291 Totl Short-term lons nd dvnces ( + ) v Short-term lons nd dvnces ncluded n E whch s for the purpose of busness or professon b not for the purpose of busness or professon v vb E c gven to shreholder, beng the benefcl owner of shre, or to ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act vc F Other current ssets F G Totl Current ssets (Av + Bv + C + Dv + E + F) 2G Totl Assets (1F + 2G) Prt A-BS Ind AS I Equty nd Lbltes 1 Equty BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2018 OR AS ON THE DATE OF BUSINESS COMBINATION [pplcble for compny whose fnncl sttements re drwn up n complnce to the Indn Accountng Stndrds specfed n Annexure to the compnes (Indn Accountng Stndrds) Rules, 2015] A Equty shre cptl Authorsed A Issued, Subscrbed nd fully pd up Subscrbed but not fully pd v Totl (A + A) B Other Equty Other Reserves Cptl Redempton Reserve b Debenture Redempton Reserve c Shre Optons Outstndng ccount d Other (specfy nture nd mount) e Totl other reserves ( + b + c + d) Retned ernngs (Debt blnce of sttement of P&L to be shown s ve fgure) Totl (Be + ) (Debt blnce to be shown s ve fgure) C Totl Equty (Av + B) 2 Lbltes A Non-current lbltes I Fnncl Lbltes Borrowngs Bonds or debentures 1 Foregn currency 1 2 Rupee 2 3 Totl (1 + 2) 3 b Term lons 1 Foregn currency b1 2 Rupee lons From Bnks From other prtes Totl ( + ) 3 Totl Term lons (b1 + b2) b3 c Deferred pyment lbltes d Deposts e Lons from relted prtes (see nstructons) f Long term mturtes of fnnce lese oblgtons f g Lblty component of compound fnncl nstruments A A b c d e b2 II Av B 1C c d e g

114 292 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] h Other lons Totl borrowngs (3 + b3 + c + d + e + f + g + h) j Trde Pybles j k Other fnncl lbltes (Other thn those specfed n II under provsons) II Provsons Provson for employee benefts b Others (specfy nture) c Totl Provsons III Deferred tx lbltes (net) IV Other non-current lbltes Advnces b Others (specfy nture) c Totl Other non-current lbltes Totl Non-Current Lbltes (I + Ij + Ik + IIC + III + IVc) B Current lbltes I Fnncl Lbltes Borrowngs Lons repyble on demnd 1 From Bnks 1 2 From Other prtes 2 3 Totl Lons repyble on demnd (1 + 2) 3 b Lons from relted prtes c Deposts d Other lons (specfy nture) Totl Borrowngs (3 + b + c + d) Trde pybles Other fnncl lbltes Current mturtes of long-term debt b Current mturtes of fnnce lese oblgtons c Interest ccrued d Unpd dvdends e Applcton money receved for llotment of securtes to the extent refundble nd nterest ccrued thereon f Unpd mtured deposts nd nterest ccrued thereon g Unpd mtured debentures nd nterest ccrued thereon h Others (specfy nture) Totl Other fnncl lbltes ( + b +c +d +e +f +g+ h) v Totl Fnncl Lbltes (I + I + I) II Other Current lbltes III Provsons Revenue receved n dvnce b Other dvnces (specfy nture) c Others (specfy nture) d Totl Other current lbltes ( + b+ c) Provson for employee benefts b Others (specfy nture) c Totl provsons ( + b) IV Current Tx Lbltes (Net) Totl Current lbltes (Iv + IId + IIIc+ IV) Totl Equty nd lbltes (1C + 2A +2B) b b b c d b c d e f g h b c b h k IIc III IVc 2A I I I Iv IId IIIc IV 2B I

115 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 293 II ASSETS 1 Non-current ssets A Property, Plnt nd Equpment Gross block b Deprecton b c Imprment losses c d Net block ( b - c) B Cptl work-n-progress C Investment Property Gross block b Deprecton b c Imprment losses c d Net block ( b - c) D Goodwll Gross block b Imprment losses b c Net block ( b ) E Other Intngble Assets Gross block b Amortston b c Imprment losses c d Net block ( b - c) F Intngble ssets under development G Bologcl ssets other thn berer plnts Gross block b Imprment losses b c Net block ( b ) H Fnncl Assets I Investments Investments n Equty nstruments Lsted equtes b Unlsted equtes b c Totl ( + b) Investments n Preference shres Investments n Government or trust securtes v Investments n Debenture or bonds v v Investments n Mutul funds v v Investments n Prtnershp frms v v Others Investments (specfy nture) v v Totl non-current nvestments (c v + v + v + v) II Trde Recevbles Secured, consdered good b Unsecured, consdered good b c Doubtful c d Totl Trde recevbles III Lons Securty deposts Lons to relted prtes (see nstructons) Other lons (specfy nture) Ad B Cd Dc Ed F Gc c HI HII

116 294 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] IV v Totl Lons ( + + ) v Lons ncluded n HIII bove whch s- for the purpose of busness or professon b not for the purpose of busness or professon c gven to shreholder, beng the benefcl owner of shre, or to ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act Other Fnncl Assets Bnk Deposts wth more thn 12 months mturty Others Totl of Other Fnncl Assets ( + ) I Deferred Tx Assets (Net) J Other non-current Assets Cptl Advnces Advnces other thn cptl dvnces Others (specfy nture) v Totl non-current ssets ( + + ) v Non-current ssets ncluded n J bove whch s due from shreholder, beng the benefcl owner of shre, or from ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act Totl Non-current ssets (Ad + B + Cd + Dc + Ed + F + Gc + HI + HII + HIII + HIV + I + J) 1 2 Current ssets A B I II Inventores Rw mterls Work-n-progress Fnshed goods v Stock-n-trde (n respect of goods cqured for trdng) v v Stores nd spres v v Loose tools v v Others v Totl Inventores ( v + v + v + v) Fnncl Assets Investments Investment n Equty nstruments Lsted equtes b Unlsted equtes c Totl ( + b) Investment n Preference shres Investment n government or trust securtes v Investment n debentures or bonds v Investment n Mutul funds v Investment n prtnershp frms v Other Investments v Totl Current nvestments (c v + v + v + v) Trde recevbles Secured, consdered good Unsecured, consdered good Doubtful v Totl Trde recevbles ( + + ) II III Csh nd csh equvlents Blnces wth Bnks (of the nture of csh nd csh equvlents) v v vb vc b c v v v v v HIII HIV I J 2A I

117 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 295 Cheques, drfts n hnd Csh on hnd v Others (specfy nture) v v Totl Csh nd csh equvlents ( v) III IV Bnk Blnces other thn III bove V Lons Securty Deposts Lons to relted prtes (see nstructons) Others(specfy nture) v Totl lons ( + + ) V v Lons nd dvnces ncluded n V bove whch s- for the purpose of busness or professon b not for the purpose of busness or professon c VI Other Fnncl Assets gven to shreholder, beng the benefcl owner of shre, or to ny concern or on behlf/ beneft of such shreholder s per secton 2(22)(e) of I.T. Act Totl Fnncl Assets (I + II + III + IV + V + VI) C Current Tx Assets (Net) 2C D Other current ssets Advnces other thn cptl dvnces Others(specfy nture) Totl Totl Current ssets (2A + 2B + 2C + 2D) 2 Totl Assets (1 + 2) v vb vc IV VI 2B 2D II Prt A-P& L CREDITS TO PROFIT AND LOSS ACCOUNT 1 Revenue from opertons Proft nd Loss Account for the fnncl yer (fll tems 1 to 52 n cse where regulr books of ccounts re mntned, otherwse fll tem 53) A Sles/ Gross recepts of busness (net of returns nd refunds nd duty or tx, f ny) Sle of products/goods Sle of servces Other opertng revenues (specfy nture nd mount) b c Totl ( + b) v Interest (n cse of fnnce compny) v Other fnncl servces (n cse of fnnce compny v Totl ( + + c + v + v) B Dutes, txes nd cess receved or recevble n respect of goods nd servces sold or suppled Unon Excse dutes Servce tx VAT/ Sles tx v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) v Unon Terrtory Goods & Servces Tx (UTGST) v Any other duty, tx nd cess x Totl ( v + v + v + v + v) C Totl Revenue from opertons (Av + Bx) 2 Other ncome I I I Ib Ic Iv V v v v v v Av Bx 1C

118 296 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] DEBITS TO PROFIT AND LOSS ACCOUNT Interest ncome (n cse of compny, other thn fnnce compny) Dvdend ncome Proft on sle of fxed ssets v Proft on sle of nvestment beng securtes chrgeble to Securtes Trnscton Tx (STT) v Proft on sle of other nvestment v Rent v Commsson v Proft on ccount of currency fluctuton x Agrculturl ncome x Any other ncome (specfy nture nd mount) b c Totl (x + xb) x Totl of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Rw mterl 3 Work-n-progress Fnshed goods Totl ( ) 4 Totl of credts to proft nd loss ccount (1C + 2x + 3v) 4 5 Openng Stock Rw mterl 5 Work-n-progress Fnshed goods v Totl ( ) 6 Purchses (net of refunds nd duty or tx, f ny) 6 7 Dutes nd txes, pd or pyble, n respect of goods nd servces purchsed Custom duty 7 Counter velng duty Specl ddtonl duty v Unon excse duty v Servce tx v VAT/ Sles tx v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) x Integrted Goods & Servces Tx (IGST) x Unon Terrtory Goods & Servces Tx (UTGST) x Any other tx, pd or pyble 7x Totl ( v + 7v + 7v + 7v+7v+7x+7x+7x) 8 Freght 8 9 Consumpton of stores nd spre prts 9 10 Power nd fuel Rents Reprs to buldng Reprs to plnt, mchnery or furnture Compenston to employees I I v v v v v x x xb xc v 7v 7v 7v 7v Slres nd wges 14 Bonus Rembursement of medcl expenses 7x 7x 7x x 3v 5v 7x

119 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 297 v Leve encshment v Leve trvel benefts v Contrbuton to pproved supernnuton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed grtuty fund x Contrbuton to ny other fund 14v 14v 14v 14v 14v Any other beneft to employees n respect of whch n x 14x expendture hs been ncurred Totl compenston to employees ( v + 14v + 14v + 14v + 14v + 14x + x 14x) Whether ny compenston, ncluded n 14x, pd to nonresdent x x Yes / No 15 Insurnce If Yes, mount pd to non-resdents Medcl Insurnce 15 Lfe Insurnce Keymn s Insurnce v Other Insurnce ncludng fctory, offce, cr, goods, etc. v Totl expendture on nsurnce ( v) 16 Workmen nd stff welfre expenses Entertnment Hosptlty Conference Sles promoton ncludng publcty (other thn dvertsement) Advertsement Commsson Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 23 Roylty Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 24 Professonl / Consultncy fees / Fee for techncl servces Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 25 Hotel, bordng nd Lodgng Trvelng expenses other thn on foregn trvelng Foregn trvelng expenses Conveynce expenses Telephone expenses Guest House expenses Club expenses Festvl celebrton expenses Scholrshp Gft Donton Rtes nd txes, pd or pyble to Government or ny locl body (excludng txes on ncome) 14x xb v Unon excse duty 36 Servce tx 36 14x 15v

120 298 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PROVISIONS FOR TAX AND APPROPRIATIONS NO ACCOUNT CASE VAT/ Sles tx v Cess v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) v Unon Terrtory Goods & Servces Tx (UTGST) x Any other rte, tx, duty or cess ncl. STT nd CTT x Totl rtes nd txes pd or pyble ( v + 36v + 36v + 36v + 36v+ 36x) 37 Audt fee Other expenses (specfy nture nd mount) 39 Totl ( + ) Bd debts wrtten off (specfy PAN of the person, f t s vlble, for whom Bd Debt for mount of Rs. 1 lkh or more s clmed nd mount) v Others (more thn Rs. 1 lkh) where PAN s not vlble v Others (mounts less thn Rs. 1 lkh) v Totl Bd Debt ( v + 39v) 40 Provson for bd nd doubtful debts Other provsons Proft before nterest, deprecton nd txes [4 (5v x + 8 to x + 15v + 16 to to x v )] 43 Interest v 39v Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny 36 36v 36v 36v 36v 36v To others Totl ( + ) 44 Deprecton nd mortzton Proft before txes ( ) Provson for current tx Provson for Deferred Tx nd deferred lblty Proft fter tx ( ) Blnce brought forwrd from prevous yer Amount vlble for pproprton ( ) Approprtons 36x Trnsfer to reserves nd surplus 51 Proposed dvdend/ Interm dvdend Tx on dvdend/ Tx on dvdend for erler yers Approprton towrds Corporte Socl Responsblty (CSR) v ctvtes (n cse of compnes covered under secton 135 of 51v Compnes Act, 2013) v Any other pproprton v Totl ( v+51v) 52 Blnce crred to blnce sheet (50-51v) In cse where regulr books of ccount of busness or professon re not mntned, furnsh the followng nformton for prevous yer n respect of busness or professon Gross recepts b Gross proft c Expenses d Net proft 51v 36x 38 39v v 53 53b 53c 53d

121 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 299 Prt A-P& L Ind AS CREDITS TO PROFIT AND LOSS ACCOUNT DEBITS TO PROFIT AND LOSS 1 Revenue from opertons Proft nd Loss Account for the fnncl yer (fll tems 1 to 54 n cse where regulr books of ccounts re mntned, otherwse fll tem 55) [pplcble for compny whose fnncl sttements re drwn up n complnce to the Indn Accountng Stndrds specfed n Annexure to the compnes (Indn Accountng Stndrds) Rules, 2015] A Sles/ Gross recepts of busness (net of returns nd refunds nd duty or tx, f ny) Sle of products/goods Sle of servces Other opertng revenues (specfy nture nd mount) b c Totl ( + b) v Interest (n cse of fnnce compny) v Other fnncl servces (n cse of fnnce compny v Totl ( + + c + v + v) B Dutes, txes nd cess receved or recevble n respect of goods nd servces sold or suppled Unon Excse dutes Servce tx VAT/ Sles tx v Centrl Goods & Servce Tx (CGST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) v Unon Terrtory Goods & Servces Tx (UTGST) v Any other duty, tx nd cess x Totl ( v + v + v + v + v) C Totl Revenue from opertons (Av + Bx) 2 Other ncome Interest ncome (n cse of compny, other thn fnnce compny) Dvdend ncome Proft on sle of fxed ssets v Proft on sle of nvestment beng securtes chrgeble to Securtes Trnscton Tx (STT) v Proft on sle of other nvestment v Rent v Commsson v Proft on ccount of currency fluctuton x Agrculturl ncome x Any other ncome (specfy nture nd mount) b c Totl (x + xb) x Totl of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Rw mterl 3 Work-n-progress Fnshed goods Totl ( ) 4 Totl of credts to proft nd loss ccount (1C + 2x + 3v) 4 5 Openng Stock Rw mterl 5 Work-n-progress Fnshed goods b c v v v v v v v v v v v v x x xb xc Av Bx 1C 2x 3v

122 300 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Totl ( ) 6 Purchses (net of refunds nd duty or tx, f ny) 6 7 Dutes nd txes, pd or pyble, n respect of goods nd servces purchsed Custom duty 7 Counter velng duty Specl ddtonl duty v Unon excse duty v Servce tx v VAT/ Sles tx v Centrl Goods & Servce Tx (GST) v Stte Goods & Servces Tx (SGST) x Integrted Goods & Servces Tx (IGST) x Unon Terrtory Goods & Servces Tx (UTGST) x Any other tx, pd or pyble x Totl ( v + 7v + 7v + 7v+7v + 7x + 7x + 7x) 8 Freght 8 9 Consumpton of stores nd spre prts 9 10 Power nd fuel Rents Reprs to buldng Reprs to plnt, mchnery or furnture Compenston to employees 7 7 7v 7v 7v 7v 7v Slres nd wges 14 Bonus Rembursement of medcl expenses v Leve encshment v Leve trvel benefts v Contrbuton to pproved supernnuton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed grtuty fund x Contrbuton to ny other fund 7x 7x 7x v 14v 14v 14v 14v Any other beneft to employees n respect of whch n x 14x expendture hs been ncurred Totl compenston to employees ( v + 14v + 14v + 14v + 14v + 14x + x 14x) Whether ny compenston, ncluded n 14x, pd to nonresdent x x Yes / No 15 Insurnce If Yes, mount pd to non-resdents Medcl Insurnce 15 Lfe Insurnce Keymn s Insurnce v Other Insurnce ncludng fctory, offce, cr, goods, etc. v Totl expendture on nsurnce ( v) 16 Workmen nd stff welfre expenses Entertnment Hosptlty Conference Sles promoton ncludng publcty (other thn dvertsement) Advertsement Commsson Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny 14x xb v 5v 7x 14x 15v

123 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 301 To others Totl ( + ) 23 Roylty Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 24 Professonl / Consultncy fees / Fee for techncl servces Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 25 Hotel, bordng nd Lodgng Trvelng expenses other thn on foregn trvelng Foregn trvelng expenses Conveynce expenses Telephone expenses Guest House expenses Club expenses Festvl celebrton expenses Scholrshp Gft Donton Rtes nd txes, pd or pyble to Government or ny locl body (excludng txes on ncome) Unon excse duty Servce tx VAT/ Sles tx v Cess v Goods & Servce Tx (GST) v Stte Goods & Servces Tx (SGST) v Integrted Goods & Servces Tx (IGST) v 36v 36v 36v v Unon Terrtory Goods & Servces Tx (UTGST) 36v x Any other rte, tx, duty or cess ncl. STT nd CTT 36x x Totl rtes nd txes pd or pyble ( v + 36v + 36v + 36v + 36v + 36x) 36x 37 Audt fee Other expenses (specfy nture nd mount) 39 Totl ( + ) Bd debts wrtten off (specfy PAN of the person, f t s vlble, for whom Bd Debt for mount of Rs. 1 lkh or more s clmed nd mount) v Others (more thn Rs. 1 lkh) where PAN s not vlble v Others (mounts less thn Rs. 1 lkh) v Totl Bd Debt ( v + 39v) 39 39v 39v 39v 40 Provson for bd nd doubtful debts Other provsons Proft before nterest, deprecton nd txes [4 (5v x + 8 to x + 15v + 16 to to x v )] 43 Interest 42

124 302 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PROVISIONS FOR TAX AND APPROPRIATIONS NO ACCOUNT CASE Pd outsde Ind, or pd n Ind to non-resdent other thn compny or foregn compny To others Totl ( + ) 44 Deprecton nd mortzton Proft before txes ( ) Provson for current tx Provson for Deferred Tx nd deferred lblty Proft fter tx ( ) Blnce brought forwrd from prevous yer Amount vlble for pproprton ( ) Approprtons Trnsfer to reserves nd surplus 51 Proposed dvdend/ Interm dvdend Tx on dvdend/ Tx on dvdend for erler yers v Approprton towrds Corporte Socl Responsblty (CSR) ctvtes (n cse of compnes covered under secton 135 of Compnes Act, 2013) v Any other pproprton v Totl ( v+51v) 52 Blnce crred to blnce sheet (50 51v) Other Comprehensve Income A Items tht wll not be reclssfed to P&L Chnges n revluton surplus Re-mesurements of the defned beneft plns Equty nstruments through OCI Fr vlue Chnges reltng to own credt rsk of fnncl v lbltes desgnted t FVTPL Shre of Other comprehensve ncome n ssoctes nd jont v ventures, to the extent not to be clssfed to P&L v Others (Specfy nture) v Income tx reltng to tems tht wll not be reclssfed to P&L v Totl B Items tht wll be reclssfed to P&L Exchnge dfferences n trnsltng the fnncl sttements of foregn operton Debt nstruments through OCI The effectve porton of gns nd loss on hedgng nstruments n csh flow hedge Shre of OCI n ssoctes nd jont ventures to the extent to be v clssfed nto P&L v Others (Specfy nture) v Income tx reltng to tems tht wll be reclssfed to P&L v Totl 54 Totl Comprehensve Income ( A + 53B) In cse where regulr books of ccount of busness or professon re not mntned, furnsh the followng nformton for prevous yer n respect of busness or professon Gross recepts b Gross proft c Expenses d Net proft v 51v v v v v v v v 43 51v 53A 53B 55 55b 55c 55d Prt A- OI OTHE R Other Informton (optonl n cse not lble for udt under secton 44AB) 1 Method of ccountng employed n the prevous yer (Tck) mercntle csh 2 Is there ny chnge n method of ccountng (Tck) Yes No

125 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 303 Increse n the proft or decrese n loss becuse of devton, f ny, s per Income Computton Dsclosure 3 Stndrds notfed under secton 145(2) [column 11() of Schedule ICDS] Decrese n the proft or ncrese n loss becuse of devton, f ny, s per Income Computton Dsclosure 3b Stndrds notfed under secton 145(2) [column 11b() of Schedule ICDS] 4 Method of vluton of closng stock employed n the prevous yer Rw Mterl (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) b Fnshed goods (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) c Is there ny chnge n stock vluton method (Tck) Yes No d Increse n the proft or decrese n loss becuse of devton, f ny, from the method of vluton specfed under secton 145A e Decrese n the proft or ncrese n loss becuse of devton, f ny, from the method of vluton specfed under secton 145A 5 Amounts not credted to the proft nd loss ccount, beng - the tems fllng wthn the scope of secton 28 b the proform credts, drwbcks, refund of duty of customs or excse or servce tx, or refund of sles tx or vlue dded tx, or refund of GST, where such credts, drwbcks or refunds re dmtted s due by the uthortes concerned c esclton clms ccepted durng the prevous yer d ny other tem of ncome e cptl recept, f ny f Totl of mounts not credted to proft nd loss ccount (5+5b+5c+5d+5e) 6 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 36 due to nonfulflment of condton specfed n relevnt cluses- Premum pd for nsurnce gnst rsk of dmge or destructon 6 of stocks or store [36(1)()] b Premum pd for nsurnce on the helth of employees [36(1)(b)] c d Any sum pd to n employee s bonus or commsson for servces rendered, where such sum ws otherwse pyble to hm s profts or dvdend [36(1)()] Any mount of nterest pd n respect of borrowed cptl [36(1)()] e Amount of dscount on zero-coupon bond [36(1)()] f Amount of contrbutons to recognsed provdent fund [36(1)(v)] Amount of contrbutons to n pproved supernnuton fund g [36(1)(v)] Amount of contrbuton to penson scheme referred to n secton h 80CCD [36(1)(v)] Amount of contrbutons to n pproved grtuty fund [36(1)(v)] 6 j Amount of contrbutons to ny other fund k Any sum receved from employees s contrbuton to ny provdent fund or supernnuton fund or ny fund set up under ESI Act or ny other fund for the welfre of employees to the extent not credted to the employees ccount on or before the due dte [36(1)(v)] l Amount of bd nd doubtful debts [36(1)(v)] 6l m Provson for bd nd doubtful debts [36(1)(v)] n Amount trnsferred to ny specl reserve [36(1)(v)] Expendture for the purposes of promotng fmly plnnng o mongst employees [36(1)(x)] Amount of securtes trnscton pd n respect of trnscton n p securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] q Any other dsllownce r Totl mount dsllowble under secton 36 (totl of 6 to 6q) s Totl number of employees employed by the compny (mndtory n cse compny hs recognzed Provdent Fund) deployed n Ind deployed outsde Ind Totl 7 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 37 Expendture of cptl nture [37(1)] b Expendture of personl nture [37(1)] 5 5b 5c 5d 5e 6b 6c 6d 6e 6f 6g 6h 6j 6k 6m 6n 6o 6p 6q 7 7b 3 3b 4d 4e 5f 6r

126 304 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Expendture ld out or expended wholly nd exclusvely NOT for the c purpose of busness or professon [37(1)] Expendture on dvertsement n ny souvenr, brochure, trct, d pmphlet or the lke, publshed by poltcl prty [37(2B)] Expendture by wy of penlty or fne for volton of ny lw for the e tme beng n force f Any other penlty or fne g Expendture ncurred for ny purpose whch s n offence or whch s prohbted by lw h Expendture ncurred on corporte socl responsblty (CSR) Amount of ny lblty of contngent nture 7 j Any other mount not llowble under secton 37 k Totl mount dsllowble under secton 37 (totl of 7 to 7j) 8 A. Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40 B. Amount dsllowble under secton 40 ()(), on ccount of non-complnce wth the provsons of Chpter XVII-B Amount dsllowble under secton 40()() on ccount of b non-complnce wth the provsons of Chpter XVII-B Amount dsllowble under secton 40()(b) on ccount of c non-complnce wth the provsons of Chpter VIII of the Fnnce Act, 2016 Amount dsllowble under secton 40()() on ccount of d non-complnce wth the provsons of Chpter XVII-B e Amount of tx or rte leved or ssessed on the bss of profts [40()()] f Amount pd s welth tx [40()()] g Amount pd by wy of roylty, lcense fee, servce fee etc. s per secton 40()(b) h Amount of nterest, slry, bonus, commsson or remunerton pd to ny prtner or member [40(b)] Any other dsllownce j Totl mount dsllowble under secton 40(totl of A to A ) Any mount dsllowed under secton 40 n ny precedng prevous yer but llowble durng the prevous yer 9 Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 40A 10 Amounts pd to persons specfed n secton 40A(2)(b) b Amount pd otherwse thn by ccount pyee cheque or ccount pyee bnk drft or use of electronc clerng system through bnk ccount, dsllowble under secton 40A(3) c Provson for pyment of grtuty [40A(7)] d ny sum pd by the ssessee s n employer for settng up or s contrbuton to ny fund, trust, compny, AOP, or BOI or socety or ny other nsttuton [40A(9)] e Any other dsllownce f Totl mount dsllowble under secton 40A Any mount dsllowed under secton 43B n ny precedng prevous yer but llowble durng the prevous yer Any sum n the nture of tx, duty, cess or fee under ny lw b c d e Any sum pyble by wy of contrbuton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the welfre of employees Any sum pyble to n employee s bonus or commsson for servces rendered Any sum pyble s nterest on ny lon or borrowng from ny publc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton Any sum pyble s nterest on ny lon or borrowng from ny scheduled bnk or co-opertve bnk other thn prmry grculturl credt socety or prmry co-opertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment g Any sum pyble to the Indn Rlwys for the use of rlwy ssets h Totl mount llowble under secton 43B (totl of 10 to 10g ) 11 Any mount debted to proft nd loss ccount of the prevous yer but dsllowble under secton 43B Any sum n the nture of tx, duty, cess or fee under ny lw A Ab Ac Ad Ae Af Ag Ah A 9 9b 9c 9d 9e 10 10b 10c 10d 10e 10f 10g 11 7c 7d 7e 7f 7g 7h 7j 7k Aj 8B 9f 10h

127 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 305 b Any sum pyble by wy of contrbuton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the welfre of employees c Any sum pyble to n employee s bonus or commsson for servces rendered d Any sum pyble s nterest on ny lon or borrowng from ny publc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton e Any sum pyble s nterest on ny lon or borrowng from ny scheduled bnk or co-opertve bnk other thn prmry grculturl credt socety or prmry co-opertve grculturl nd rurl development bnk f Any sum pyble towrds leve encshment Any sum pyble to the Indn Rlwys for the use of rlwy g ssets h Totl mount dsllowble under Secton 43B(totl of 11 to 11g) 12 Amount of credt outstndng n the ccounts n respect of Unon Excse Duty b Servce tx c VAT/sles tx d Centrl Goods & Servce Tx (CGST) e Stte Goods & Servces Tx (SGST) f Integrted Goods & Servces Tx (IGST) g Unon Terrtory Goods & Servces Tx (UTGST) h Any other tx Totl mount outstndng (totl of 12 to 12h) Amounts deemed to be profts nd gns under secton 33AB or 33ABA or 33AC Any mount of proft chrgeble to tx under secton Amount of ncome or expendture of pror perod credted or debted to the proft nd loss ccount (net) 15 Prt A QD QUANTITATIVE DETAILS Quntttve detls (optonl n cse not lble for udt under secton 44AB) () In the cse of trdng concern 1 Openng stock 1 2 Purchse durng the prevous yer 2 3 Sles durng the prevous yer 3 4 Closng stock 4 5 Shortge/ excess, f ny 5 (b) In the cse of mnufcturng concern 6 Rw mterls b c d Openng stock 6 Purchses durng the prevous yer 6b Consumpton durng the prevous yer 6c Sles durng the prevous yer 6d e Closng stock f Yeld fnshed products 6f g Percentge of yeld 6g h Shortge/ excess, f ny 7 Fnshed products/ By-products b c d e f openng stock 7 purchse durng the prevous yer 7b quntty mnufctured durng the prevous yer 7c sles durng the prevous yer 7d closng stock 7e shortge/ excess, f ny 7f 11b 11c 11d 11e 11f 11g 12 12b 12c 12d 12e 12f 12g 12h 11h 6e 6h

128 306 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Prt A OL Recept nd pyment ccount of compny under lqudton 1 Openng blnce Csh n hnd 1 Bnk 1 Totl openng blnce 1 2 Recepts Interest 2 Dvdend 2 Sle of ssets (pls. specfy nture nd mount) 2 b 2b Recept nd pyment ccount of compny under lqudton c 2c d Totl ( + b + c) 2d v Relston of dues/debtors 2v v Others (pls. specfy nture nd mount) 2v b 2vb c Totl of other recepts (v + vb) 2vc v Totl recepts ( d+ 2v + 2vc) 2v 3 Totl of openng blnce nd recepts 3 4 Pyments Repyment of secured lon 4 Repyment of unsecured lon 4 Repyment to credtors 4 v Commsson 4v v Others (pls. specfy) 4v b 4vb c Totl of other pyments (4v + 4vb) 4vc v Totl pyments ( v + 4vc) 4v 5 Closng blnce Csh n hnd 5 Bnk 5 Totl of closng blnce (5 + 5) 5 6 Totl of closng blnce nd pyments (4v + 5) 6 TOTAL INCOME Prt B - TI Computton of totl ncome 1 Income from house property (3b of Schedule-HP) (enter nl f loss) 1 2 Profts nd gns from busness or professon Profts nd gns from busness other thn specultve busness nd specfed busness (A39 of Schedule BP) (enter nl f loss) Profts nd gns from specultve busness (B43 of Schedule BP) (enter nl f loss nd tke the fgure to schedule CFL) Profts nd gns from specfed busness ( C49 of Schedule BP)(enter nl f loss nd tke the fgure to schedule CFL) v Income from ptent u/s 115BBF (3d of Schedule BP) v Income from trnsfer of crbon credts u/s 115BBG (3e of Schedule BP) 2v v Totl ( v + 2v) 2v 3 Cptl gns Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) v

129 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 307 Short-term chrgeble t pplcble rte (7v of tem E of schedule CG) v Totl Short-term ( + + ) b Long-term Long-term 10% (7v of tem E of schedule CG) b Long-term 20% (7v of tem E of schedule CG) b Totl Long-term (b + b) (enter nl f loss) c Totl cptl gns (3v + 3b) (enter nl f loss) 4 Income from other sources from sources other thn from ownng nd mntnng rce horses nd ncome chrgeble to tx t specl rte (1k of Schedule OS) (enter nl f loss) b Income chrgeble to tx t specl rte (1fv of Schedule OS) c from ownng nd mntnng rce horses (3e of Schedule OS) (enter nl f loss) d Totl (4 + 4b + 4c) 5 Totl (1 + 2v + 3c + 4d) 5 6 Losses of current yer to be set off gnst 5 (totl of 2x, 3x nd 4x of Schedule CYLA) 6 7 Blnce fter set off current yer losses (5 6) (totl of column 5 of schedule CYLA + 4b) 7 8 Brought forwrd losses to be set off gnst 7 (totl of 2x, 3x nd 4x of Schedule BFLA) 8 9 Gross Totl ncome (7 8) (5x of Schedule BFLA + 4b) 9 10 Income chrgeble to tx t specl rte under secton 111A, 112 etc. ncluded n Deducton u/s 10AA (e of Sch. 10AA) Deductons under Chpter VI-A Prt-B of Chpter VI-A [1 of Schedule VI-A nd lmted upto (9-10)] b Prt-C of Chpter VI-A [2 of Schedule VI-A nd lmted upto (9-10-2)] c Totl ( b) [lmted upto (9-10)] 13 Totl ncome ( c) Income chrgeble to tx t specl rtes (totl of () of schedule SI) Income chrgeble to tx t norml rtes (13-14) Net grculturl ncome(4 of Schedule EI) Losses of current yer to be crred forwrd (totl of x of Schedule CFL) Deemed totl ncome under secton 115JB (9 of Schedule MAT) b 4c 3v b 3c 4d 12 12b 12c Prt B - TTI Computton of tx lblty on totl ncome 1 Tx Pyble on deemed totl Income under secton 115JB (10 of Schedule MAT) 1 COMPUTATION OF TAX LIABILITY b Surchrge on () bove c Educton cess, ncludng secondry nd hgher educton cess on (1+1b) bove d Totl Tx Pyble u/s 115JB (1+1b+1c) 2 Tx pyble on totl ncome Tx t norml rtes on 15 of Prt B-TI b Tx t specl rtes (totl of col. () of Schedule-SI) c Tx Pyble on Totl Income (2 + 2b) d Surchrge 25% of 12() of Schedule SI On [(2d) (12() of Schedule SI)] Totl ( + ) e Educton cess, ncludng secondry nd hgher educton cess on (2c+2d) f Gross tx lblty (2c+2d+2e) 2f 3 Gross tx pyble (hgher of 1d nd 2f) 3 4 Credt under secton 115JAA of tx pd n erler yers (f 2f s more thn 1d) ( 5 of Schedule MATC) 5 Tx pyble fter credt under secton 115JAA [ (3-4)] 5 6 Tx relef 2 2b 2d 2d 1b 1c 1d 2c 2d 2e 4

130 308 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TAXES PAID BANK ACCOUNT Secton 90/90A(2 of Schedule TR) b Secton 91(3 of Schedule TR) c Totl (6 + 6b) 7 Net tx lblty (5 6c) (enter zero f negtve) 7 8 Interest nd fee pyble Interest for defult n furnshng the return (secton 234A) b Interest for defult n pyment of dvnce tx (secton 234B) c Interest for deferment of dvnce tx (secton 234C) d Fee for defult n furnshng return of ncome (secton 234F) e Totl Interest nd Fee Pyble (8+8b+8c+8d) 9 Aggregte lblty (7 + 8e) 9 10 Txes Pd Advnce Tx (from column 5 of 16A) b TDS (totl of column 9 of 16B) c TCS (totl of column 7 of 16C) d Self-Assessment Tx (from column 5 of 16A) e Totl Txes Pd (10+10b+10c + 10d) 11 Amount pyble (9-10e) (Enter f 9 s greter thn 10e, else enter 0) Refund (If 10e s greter thn 9) (Refund, f ny, wll be drectly credted nto the bnk ccount) b 8 8b 8c 8d 10 10b 10c 10d Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of non-resdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Accounts held n Ind (SWIFT Code n cse of foregn Bnk Account) Nme of the Bnk Account Number (IBAN n cse of foregn Bnk Accounts) Indcte the ccount n whch you prefer to get your refund credted, f ny (tck one ccount ) 6c 8e 10e 14 Do you t ny tme durng the prevous yer,- () hold, s benefcl owner, benefcry or otherwse, ny sset (ncludng fnncl nterest n ny entty) locted outsde Ind; or () hve sgnng uthorty n ny ccount locted outsde Ind; or () hve ncome from ny source outsde Ind? [pplcble only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] Yes No VERIFICATION I, son/ dughter of, solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return nd the schedules thereto s correct nd complete s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng ths return n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon). I further declre tht the crtcl ssumptons specfed n the greement hve been stsfed nd ll the terms nd condtons of the greement hve been compled wth. (Applcble, n cse where return s furnshed under secton 92CD) Plce Dte Sgn here A 15 TAX PAYMENTS ADVANCE/ SELF ASSESSMENT TAX Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Amount (Rs) No (1) (2) (3) (4) (5) NOTE Enter the totls of Advnce tx nd Self-Assessment tx n Sl No. 10 & 10d of Prt B-TTI B TDS ON INCOME Detls of Tx Deducted t Source (TDS) on Income [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s)] Sl No TAN of the Deductor/ PAN of the Buyer/ Tennt Nme of the Deductor/Buyer/ Tennt Unque TDS Certfcte Number Unclmed TDS brought forwrd (b/f) TDS of the current fn. yer TDS credt out of (7) or (8) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) TDS credt out of (7) or (8) beng crred forwrd

131 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 309 Fn. Yer n whch deducted Amount b/f Deducted n own hnds Deducted n the hnds of ny other person s per rule 37BA(2) (f pplcble) Clmed n own hnds Clmed n the hnds of ny other person s per rule 37BA(2) (f pplcble) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Income TDS PAN of other person Income TDS PAN of other person C TCS ON INCOME NOTE Plese enter totl of column (8) n 10b of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tx Deducton nd Tx Collecton Account Number of the Collector Nme of the Collector Unclmed TCS brought forwrd (b/f) Fn. Yer n whch collected Amount b/f TCS of the current fn. yer Amount out of (5) or (6) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) Amount out of (5) or (6) beng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) NOTE Plese enter totl of column (7) n 10c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1- S21) AS APPLICABLE

132 310 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule HP Detls of Income from House Property (Plese refer nstructons) Address of property 1 Town/ Cty Stte PIN Code 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Assessee s percentge of shre n the property Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property I II HOUSE PROPERTY 2 [Tck the pplcble opton] Let out Deemed let out Nme(s) of Tennt (f let out) Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two f let out for prt of the yer) b The mount of rent whch cnnot be relzed 1b c Tx pd to locl uthortes 1c d Totl (1b + 1c) 1d e Annul vlue (1 1d) 1e f Annul vlue of the property owned (own percentge shre x 1e) 1f g 30% of 1f 1g h Interest pyble on borrowed cptl 1h Totl (1g + 1h) 1 PAN of Tennt(s) (f vlble) j Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty Stte PIN Code Is the property co-owned? Yes No (f YES plese enter followng detls) Assessee s percentge of shre n the property 1 Nme of Co-owner(s) PAN of Co-owner (s) Percentge Shre n Property I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out Deemed let out I II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two, f let out for prt of the yer) 2 b The mount of rent whch cnnot be relzed 2b c Tx pd to locl uthortes 2c d Totl (2b + 2c) 2d e Annul vlue (2 2d) 2e f Annul vlue of the property owned (own percentge shre x 2e) 2f g 30% of 2f 2g h Interest pyble on borrowed cptl 2h Totl (2g + 2h) 2 j Income from house property 2 (2e 2h) 2j 3 Income under the hed Income from house property Unrelzed rent nd Arrers of rent receved durng the yer under secton 25A fter deductng 30% b Totl (1j + 2j + 3) 3b 3 Schedule BP Computton of ncome from busness or professon A From busness or professon other thn specultve busness nd specfed busness Proft before tx s per proft nd loss ccount (tem 45 or 53 of Prt A-P&L) / (tem 45 or 55 of Prt A- 1 P&L Ind AS) (s pplcble) Net proft or loss from specultve busness ncluded n 1 (enter ve sgn n 2 cse of loss) 2 INCOME FROM BUSINESS OR 2b Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n cse of loss) 3 Income/ recepts credted to proft nd loss ccount House property 3 2b 1

133 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k consdered under other heds of ncome/chrgeble u/s 115BBF/ chrgeble u/s 115BBG Proft or loss ncluded n 1, whch s referred to n secton 44AE/44B/44BB/44BBA/44BBB/ 44D/44DA/ Chpter-XII-G/ Frst Schedule of Income-tx Act b Cptl gns c Other sources d u/s 115BBF e u/s 115BBG u/s 115B b Other 5 Income credted to Proft nd Loss ccount (ncluded n 1) whch s exempt Shre of ncome from frm(s) 5 b Shre of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nture nd mount) Totl (c + c) d Totl exempt ncome (5 + 5b + 5c) c c 5c 6 Blnce (1 2 2b 3-3b 3c 3d 3e 4 5d) 6 7 Expenses debted to proft nd loss ccount consdered under other heds of ncome/relted to ncome chrgeble u/s 115BBF or u/s 115BBG House property b Cptl gns c Other sources d u/s 115BBF e u/s 115BBG 8 Expenses debted to proft nd loss ccount whch relte to exempt ncome 8 9 Totl (7 + 7b + 7c + 7d + 7e + 8) 9 10 Adjusted proft or loss (6+9) Deprecton nd mortston debted to proft nd loss ccount Deprecton llowble under Income-tx Act Deprecton llowble under secton 32(1)() nd 32(1)() (tem 6 of Schedule-DEP) Deprecton llowble under secton 32(1)() (Mke your own computton refer Appendx-IA of IT Rules) Totl ( ) 13 Proft or loss fter djustment for deprecton ( ) 13 Amounts debted to the proft nd loss ccount, to the extent dsllowble 14 under secton 36 (6r of Prt A-OI) Amounts debted to the proft nd loss ccount, to the extent dsllowble under secton 37 (7k of Prt A-OI) 15 Amounts debted to the proft nd loss ccount, to the extent dsllowble 16 under secton 40 (8Aj of Prt A-OI) 16 Amounts debted to the proft nd loss ccount, to the extent dsllowble 17 under secton 40A (9f of Prt A-OI) 17 Any mount debted to proft nd loss ccount of the prevous yer but 18 dsllowble under secton 43B (11h of Prt A-OI) 18 Interest dsllowble under secton 23 of the Mcro, Smll nd Medum 19 Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AC/ 32AD/ 33AB/ 33ABA/35ABA/ 35ABB/ 21 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ 80-IA Deemed ncome under secton 43CA Any other tem of ddton under secton 28 to 44DA 23 Any other ncome not ncluded n proft nd loss ccount/ny other expense 24 not llowble (ncludng ncome from slry, commsson, bonus nd nterest 24 from frms n whch compny s prtner) Increse n proft or decrese n loss on ccount of ICDS djustments nd devton n method of vluton of stock (Column 3 + 4d of Prt A- OI) 26 Totl ( ) Deducton llowble under secton 32(1)() Deducton llowble under secton 32AD Amount llowble s deducton under secton 32AC Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the mount debted to proft nd loss ccount (tem x(4) of Schedule ESR) (f mount deductble under secton 35 or 35CCC or 35CCD s lower thn mount debted to P&L ccount, t wll go to tem 24) Any mount dsllowed under secton 40 n ny precedng prevous yer but llowble durng the prevous yer(8b of Prt A-OI) 3b 3c 3d 3e 4 4b 5d 7 7b 7c 7d 7e

134 312 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Any mount dsllowed under secton 43B n ny precedng prevous yer but 32 llowble durng the prevous yer (10g of Prt A-OI) 33 Any other mount llowble s deducton 33 Decrese n proft or ncrese n loss on ccount of ICDS djustments nd devton n method of vluton of stock (Column 3b + 4e of Prt A- OI) 35 Totl ( ) Income ( ) Profts nd gns of busness or professon deemed to be under - Secton 44AE 37 Secton 44B Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v Secton 44DA 37v (tem 4 of Form 3CE) v Chpter-XII-G (tonnge) 37v (totl of col. 7 of tem 10 of Form 66) x Frst Schedule of Income-tx Act 37x u/s 115B b Other x Totl (37 to 37x) 38 Net proft or loss from busness or professon other thn specultve nd specfed busness (34+37x) 38 Net Proft or loss from busness or professon other thn specultve busness nd specfed busness fter 39 pplyng rule 7A, 7B or 8, f pplcble (If rule 7A, 7B or 8 s not pplcble, enter sme fgure s n 38) (If loss tke the fgure to 2 of tem E) B Computton of ncome from specultve busness 40 Net proft or loss from specultve busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA Deductons n ccordnce wth secton 28 to 44DA Income from specultve busness ( ) (f loss, tke the fgure to 6x of schedule CFL) B43 C Computton of ncome from specfed busness under secton 35AD D 44 Net proft or loss from specfed busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA Deductons n ccordnce wth secton 28 to 44DA (other thn deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clmed) 47 Proft or loss from specfed busness ( ) Deductons n ccordnce wth secton 35AD(1) Income from Specfed Busness (47-48) (f loss, tke the fgure to 7x of schedule CFL) C49 Relevnt cluse of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from 50 drop down menu) C50 Income chrgeble under the hed Profts nd gns from busness or professon (A38+B43+C49) E Intr hed set off of busness loss of current yer Sl. Type of Busness ncome Loss to be set off (Fll ths row only f fgure s negtve) Income from specultve busness Income from specfed busness v Totl loss set off ( + ) v Loss remnng fter set off ( v) v 37v 37v Income of current yer (Fll ths column only f fgure s zero or postve) 32 Busness loss set off 37x A39 46 D Busness ncome remnng fter set off (1) (2) (3) = (1) (2) (B43) (C49) (A39) Deprecton on Plnt nd Mchnery (Other thn ssets on whch full cptl expendture s llowble s deducton under ny other Schedule DPM secton) 1 Block of ssets Plnt nd mchnery DEPRECIATIO N ON PLANT 2 Rte (%) () Wrtten down vlue on the frst dy of prevous yer () () ()

135 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 313 DEPRECIATION ON OTHER ASSETS 3(b) Wrtten down vlue on the frst dy of prevous yer, of those block of ssets whch were elgble for 50%, 60% or 80% s per the old Tble 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed (3() + 3(b) + 4-5) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 9 Amount on whch deprecton t hlf rte to be llowed (7 8) (enter 0, f result s negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Addtonl deprecton, f ny, on 4 13 Addtonl deprecton, f ny, on 7 14 Addtonl deprecton reltng to mmedtely precedng yer on sset put to use for less thn 180 dys 15 Totl deprecton ( ) 16 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net ggregte deprecton (15-16) 18 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth trnsfer of sset/ ssets 20 Cptl gns/ loss under secton 50 ( () 3(b) ) (enter negtve only, f block ceses to exst) 21 Wrtten down vlue on the lst dy of prevous yer* ( ) (enter 0, f result s negtve) Schedule DOA Deprecton on other ssets (Other thn ssets on whch full cptl expendture s llowble s deducton) 1 Block of ssets Lnd Buldng (not ncludng lnd) Furnture nd fttngs Intngble ssets Shps 2 Rte (%) Nl Wrtten down vlue on the frst dy of prevous yer 4 Addtons for perod of 180 dys or more n the prevous yer 5 Consderton or other relzton durng the prevous yer out of 3 or 4 6 Amount on whch deprecton t full rte to be llowed ( ) (enter 0, f result s negtve) 7 Addtons for perod of less thn 180 dys n the prevous yer 8 Consderton or other relztons durng the yer out of 7 9 Amount on whch deprecton t hlf rte to be llowed (7-8) (enter 0, f result s negtve) 10 Deprecton on 6 t full rte 11 Deprecton on 9 t hlf rte 12 Totl deprecton (10+11) 13 Deprecton dsllowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net ggregte deprecton (12-13) 15 Proportonte ggregte deprecton llowble n the event of successon, mlgmton, demerger etc. (out of column 14) () () () (v) (v) (v) (v)

136 314 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SUMMARY OF DEPRECIATION ON ASSETS 16 Expendture ncurred n connecton wth trnsfer of sset/ ssets 17 Cptl gns/ loss under secton 50* ( ) (enter negtve only f block ceses to exst) 18 Wrtten down vlue on the lst dy of prevous yer* ( ) (enter 0 f result s negtve) Schedule DEP 1 Plnt nd mchnery Summry of deprecton on ssets (Other thn on ssets on whch full cptl expendture s llowble s deducton under ny other secton) Block enttled for 15 per cent ( Schedule DPM - 17 or 18 s pplcble) Block enttled for 30 per cent b ( Schedule DPM - 17 or 18 s pplcble) Block enttled for 40 per cent c ( Schedule DPM - 17 or 18 s pplcble) d Totl deprecton on plnt nd mchnery ( 1 + 1b + 1c) 2 Buldng (not ncludng lnd) Block enttled for 5 per cent (Schedule DOA- 14 or 15 s pplcble) b Block enttled for 10 per cent (Schedule DOA- 14 or 15 s pplcble) c Block enttled for 40 per cent (Schedule DOA- 14v or 15v s pplcble) d Totl deprecton on buldng (2+2b+2c) 3 Furnture nd fttngs(schedule DOA- 12v) 3 4 Intngble ssets (Schedule DOA- 12v) 4 5 Shps (Schedule DOA- 12v) 5 6 Totl deprecton ( 1d+2d+3+4+5) 6 1 1b 1c 2 2b 2c 1d 2d Schedule DCG Deemed Cptl Gns on sle of deprecble ssets 1 Plnt nd mchnery Block enttled for 15 per cent 1 (Schedule DPM - 20) b Block enttled for 30 per cent 1b (Schedule DPM 20) c Block enttled for 40 per cent 1c (Schedule DPM - 20) d Totl ( 1 +1b + 1c) 1d 2 Buldng (not ncludng lnd) Block enttled for 5 per cent 2 (Schedule DOA- 17) b Block enttled for 10 per cent 2b (Schedule DOA- 17) c Block enttled for 40 per cent 2c (Schedule DOA- 17v) d Totl ( 2 + 2b + 2c) 2d 3 Furnture nd fttngs ( Schedule DOA- 17v) 3 4 Intngble ssets (Schedule DOA- 17v) 4 5 Shps (Schedule DOA- 17v) 5 6 Totl ( 1d+2d+3+4+5) 6 Schedule ESR Sl No v v v Deducton under secton 35 or 35CCC or 35CCD Expendture of the nture referred to n secton (1) 35(1)() 35(1)() 35(1)() 35(1)() 35(1)(v) 35(2AA) Amount, f ny, debted to proft nd loss ccount (2) Amount of deducton llowble (3) Amount of deducton n excess of the mount debted to proft nd loss ccount (4) = (3) - (2)

137 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 315 v v x x 35(2AB) 35CCC 35CCD Totl

138 316 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule CG Cptl Gns A Short-term Cptl Gns (STCG) (Sub-tems 4 & 5 re not pplcble for resdents) Short-term Cptl Gns 1 From sle of lnd or buldng or both Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b + b) bv c Blnce ( bv) 1c d Deducton under secton 54D/ 54G/54GA (Specfy detls n tem D below) e Short-term Cptl Gns on Immovble property (1c - 1d) A1e 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) 3 4 b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Short term cptl gns from slump sle (2-2b) From sle of equty shre or unt of equty orented Mutul Fund (MF) or unt of busness trust on whch STT s pd under secton 111A or 115AD(1)() provso (for FII) Full vlue of consderton 3 b Deductons under secton 48 Cost of cquston wthout ndexton Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (3 bv) 3c d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) e Short-term cptl gn on equty shre or equty orented MF (STT pd) (3c +3d) A3e For NON-RESIDENT, not beng n FII- from sle of shres or debentures of n Indn compny (to be computed wth foregn exchnge djustment under frst provso to secton 48) STCG on trnsctons on whch securtes trnscton tx (STT) s pd A4 b STCG on trnsctons on whch securtes trnscton tx (STT) s not pd 5 For NON-RESIDENTS- from sle of securtes (other thn those t A3 bove) by n FII s per secton 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s c per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl ( + + ) bv c Blnce (5 bv) 5c d Loss to be dsllowed u/s 94(7) or 94(8)- for exmple f securty bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such securty to be gnored (Enter postve vlue only) e Short-term cptl gn on securtes (other thn those t A3 bove) by n FII (5c +5d) A5e 6 From sle of ssets other thn t A1 or A2 or A3 or A4 or A5 bove In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres 5d b b 1d b b b bv 3d A2c A4b

139 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 317 b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce (6 bv) 6c d In cse of sset (securty/unt) loss to be dsllowed u/s 94(7) or 94(8)- for exmple f sset bought/cqured wthn 3 months pror to record dte nd dvdend/ncome/bonus unts re receved, then loss rsng out of sle of such sset to be gnored (Enter postve vlue only) 6d e Deemed short term cptl gns on deprecble ssets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on ssets other thn t A1 or A2 or A3 or A4 or A5 bove (6c + 6d + 6e 6f) A6g 7 Amount deemed to be short-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yers shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer Secton under whch n whch sset deducton clmed n trnsferred tht yer D/54G/54GA New sset cqured/constructed c b b bv Yer n whch sset Amount utlsed out of cqured/constructed Cptl Gns ccount b Amount deemed to be short-term cptl gns u/s 54D/54G/54GA, other thn t Totl Amount deemed to be short-term cptl gns u/s 54D/54G/54GA (X + b) Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) 8 Amount of STCG ncluded n A1-A7 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA A7 Sl. Amount of No. ncome Item No. A1 to A7 bove n Country nme whch & Code ncluded Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of STCG not chrgeble to tx n Ind s per DTAA b Totl mount of STCG chrgeble t specl rtes n Ind s per DTAA 9 Totl Short-term Cptl Gn (A1e+ A2c+ A3e+ A4+ A4b+ A5e+ A6g+A7-A8) A9 B Long-term cptl gn (LTCG) (Sub-tems 5& 6 re not pplcble for resdents) Long-term Cptl Gns 1 From sle of lnd or buldng or both Full vlue of consderton receved/recevble Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) b Deductons under secton 48 Cost of cquston wth ndexton b Cost of Improvement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b + b) c Blnce ( bv) Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n tem D d below) e Long-term Cptl Gns on Immovble property (1c - 1d) 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) b Net worth of the under tkng or dvson 2b (6(e) of Form 3CEA) c Blnce (2 2b) d Deducton u/s 54EC/54EE 2c 2d b b bv 1c 1d A8 A8b B1e

140 318 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e Long term cptl gns from slump sle (2c-2d) 3 From sle of bonds or debenture (other thn cptl ndexed bonds ssued by Government) 4 Full vlue of consderton b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (3 bv) d Deducton under sectons 54EC /54EE (Specfy detls n tem D below) e LTCG on bonds or debenture (3c 3d) From sle of lsted securtes (other thn unt) or zero coupon bonds where provso under secton 112(1) s pplcble Full vlue of consderton 4 b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (4 bv) 4c d Deducton under sectons 54EC /54EE (Specfy detls n tem D below) 4d e Long-term Cptl Gns on ssets t B4 bove (4c 4d) B4e For NON-RESIDENTS- from sle of shres or debenture of Indn compny (to be computed wth foregn 5 exchnge djustment under frst provso to secton 48) LTCG computed wthout ndexton beneft 5 6 b Deducton under sectons 54EC /54EE (Specfy detls n tem D below) 5b c LTCG on shre or debenture (5-5b) B5c For NON-RESIDENTS- from sle of, () unlsted securtes s per sec. 112(1)(c), () unts referred n sec. 115AB, () bonds or GDR s referred n sec. 115AC, (v) securtes by FII s referred to n sec. 115AD In cse securtes sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) c Full vlue of consderton n respect of securtes other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl (b + b +b) c Blnce (6 bv) 6c d Deducton under sectons 54EC/54EE (Specfy detls n tem D below) 6d e Long-term Cptl Gns on ssets t 6 bove n cse of NON-REESIDENT (6c 6d) B6e 7 From sle of ssets where B1 to B6 bove re not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or b) Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) 3 b b b bv 3c 3d b b b bv c B2e B3e b Deductons under secton 48 Cost of cquston wth ndexton b Cost of mprovement wth ndexton b Expendture wholly nd exclusvely n connecton wth trnsfer b v Totl (b + b +b) bv c Blnce (7 bv) d Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n tem D below) e Long-term Cptl Gns on ssets t B7 bove (7c-7d) 7c 7d B7e

141 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Amount deemed to be long-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yer shown below ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcble. If yes, then provde the detls below Sl. Prevous yer n whch sset trnsferred Secton under whch deducton clmed n tht yer /54D/54F/54G/54GA b Amount deemed to be long-term cptl gns, other thn t 9 10 Totl mount deemed to be long-term cptl gns (X + b) New sset cqured/constructed Amount 319tlzed Yer n whch sset out of Cptl cqured/constructed Gns ccount Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) Amount of LTCG ncluded n tems B1 to B8 but not chrgeble to tx or chrgeble t specl rtes n Ind s per DTAA Sl. Amount Item No. B1 to B8 bove n whch No. of ncome ncluded Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Totl mount of LTCG not chrgeble to tx n Ind s per DTAA b Totl mount of LTCG chrgeble t specl rtes n Ind s per DTAA Totl long term cptl gn [B1e +B2e+ B3e +B4e + B5c + B6e + B7e+ B8-B9] (In cse of loss tke the fgure to 9x of schedule CFL) C Income chrgeble under the hed CAPITAL GAINS (A9 + B10) (tke B10 s nl, f loss) D Informton bout deducton clmed gnst Cptl Gns 1 In cse of deducton u/s 54B/54D/54EC/54EE /54G/54GA gve followng detls b c d e f Deducton clmed u/s 54B Dte of trnsfer of orgnl sset dd/mm/yyyy Cost of new grculturl lnd Dte of purchse of new grculturl lnd dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54D Dte of cquston of orgnl sset b dd/mm/yyyy Cost of purchse/ constructon of new lnd or buldng for ndustrl b undertkng Dte of purchse of new lnd or buldng b dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54EC Dte of trnsfer of orgnl sset c dd/mm/yyyy Amount nvested n specfed/notfed bonds Dte of nvestment c dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54EE Dte of trnsfer of orgnl sset d dd/mm/yyyy Amount nvested n specfed sset Dte of nvestment d dd/mm/yyyy v Amount of deducton clmed Deducton clmed u/s 54G Dte of trnsfer of orgnl sset from urbn re e dd/mm/yyyy Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n n re other thn urbn re v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed Deducton clmed u/s 54GA v v bv bv c cv d dv e e dd/mm/yyyy Dte of trnsfer of orgnl sset from urbn re f dd/mm/yyyy ev ev B8 B9 B9b B10 C

142 320 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Cost nd expenses ncurred for purchse or constructon of new sset Dte of purchse/constructon of new sset n SEZ f dd/mm/yyyy v Amount deposted n Cptl Gns Accounts Scheme before due dte v Amount of deducton clmed g Totl deducton clmed (1 + 1b + 1c + 1d + 1e + 1f) E Set-off of current yer cptl losses wth current yer cptl gns (excludng mounts ncluded n A7 & B9 whch s chrgeble under DTAA) Sl. Type of Cptl Gn Gn of current yer (Fll ths column only f computed fgure s postve) Short term cptl loss set off f fv fv 1g Long term cptl loss set off 15% 30% pplcble rte 10% 20% Current yer s cptl gns remnng fter set off (7= ) Loss to be set off (Fll ths row f fgure computed s negtve) (A3e+A4) A5e (A1e+A2c+A4b +A6g +A7) (B4e+ + B6e) (B1e+B2e+B3e+ B5c+ B7e+B8) 15% (A3e+A4) Short term 30% A5e cptl gn pplcble (A1e+A2c+A4b+A6g v rte +A7) v 10% (B4e+ + B6e) Long term cptl gn (B1e+B2e+B3e+ v 20% B5c+ B7e+B8) v Totl loss set off ( + + v + v + v) v Loss remnng fter set off ( v) F Informton bout ccrul/recept of cptl gn Type of Cptl gn / Dte Upto 15/6 () 16/6 to 15/9 () 16/9 to 15/12 () 16/12 to 15/3 (v) 16/3 to 31/3 (v) Short-term cptl gns txble t the rte of 15% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t the rte of 30% Enter vlue from tem 5v of schedule BFLA, f ny. Short-term cptl gns txble t pplcble rtes Enter vlue from tem 5v of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 10% Enter vlue from tem 5v of schedule BFLA, f ny. Long- term cptl gns txble t the rte of 20% Enter vlue from tem 5x of schedule BFLA, f ny. Schedule OS OTHER SOURCES 1 Income Dvdends, Gross b Interest, Gross Income from other sources c Rentl ncome from mchnery, plnts, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng rce horses) Menton the nture Income by wy of wnnngs from lotteres, crossword puzzles etc. Csh credts u/s 68 b Unexplned nvestments u/s 69 c Unexplned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B e Unexplned expendture etc. u/s 69C f Amount borrowed or repd on hund u/s 69D Totl ( + b + c + d + e + f) Income of the nture referred to n secton 56(2)(x) whch s chrgeble to tx Aggregte vlue of sum of money receved wthout consderton In cse mmovble property s receved wthout b consderton, stmp duty vlue of property In cse mmovble property s receved for ndequte c consderton, stmp duty vlue of property n excess of such consderton In cse ny other property s receved wthout d consderton, fr mrket vlue of property 1 1b 1c 1d 1d

143 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k v v e In cse ny other property s receved for ndequte consderton, fr mrket vlue of property n excess of such consderton Totl (+ b + c +d + e) v Totl (1d + 1d+ 1d+ 1dv+1dv) e Totl (1 + 1b + 1c + 1dv) f Income ncluded n 1e chrgeble to tx t specl rte (to be tken to schedule SI) Income by wy of wnnngs from lotteres, crossword puzzles, rces, gmes, gmblng, bettng etc (u/s 115BB) Deemed Income chrgeble to tx u/s 115BBE Income from ptent chrgeble u/s 115BBF v Income from trnsfer of crbon credts u/s 115BBG v Any other ncome chrgeble to tx t the rte specfed under chpter XII/XII-A v Income chrgeble t specl rtes under DTAA Sl. Amount of No. ncome Nture of ncome Country nme & Code Artcle of DTAA Rte s per Trety (enter NIL, f not chrgeble) Whether TRC obtned (Y/N) Secton of I.T. Act 1d 1dv 1dv 1dv Rte s per I.T. Act Applcble rte [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II III Totl mount of ncome chrgeble t specl rtes under DTAA v Income ncluded n 1e chrgeble to tx t specl rte (1f +1f + 1f+1fv+1fv + 1fv) g Gross mount chrgeble to tx t norml pplcble rtes (1e 1fv) h Deductons under secton 57 (other thn those reltng to ncome under 1f, 1f, 1f, 1fv, 1fv & 1fv ) Expenses / Deductons h Deprecton Totl Amounts not deductble u/s 58 j Profts chrgeble to tx u/s 59 k Income from other sources (other thn from ownng rce horses nd mount chrgeble to tx t specl rte) (1g h j) (If negtve tke the fgure to 4 of schedule CYLA) Income from other sources (other thn from ownng nd mntnng rce horses) (1fv + 1k) (enter1k s nl, f negtve) 3 Income from the ctvty of ownng rce horses Recepts b Deductons under secton 57 n relton to (4) c Amounts not deductble u/s 58 d Profts chrgeble to tx u/s 59 e Blnce (3 3b + 3c + 3d) (f negtve tke the fgure to 10x of Schedule CFL) 4 Income under the hed Income from other sources (2 + 3e) (tke 3e s nl f negtve) 4 3 3b 3c 3d h h 1e 1f 1f 1f 1fv 1fv 1fv 1fv 1g 1 1j 1k 2 3e Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Sl.No Hed/ Source of Income Loss to be set off Detls of Income fter Set off of current yer losses Income of current yer (Fll ths column only f ncome s zero or postve) House property (3b of Schedule HP) Busness (excludng speculton ncome nd ncome from specfed busness) House property loss of the current yer set off Busness Loss (other thn speculton or specfed busness loss) of the current yer set off Other sources loss Current (other thn loss from yer s rce horses nd mount Income chrgeble to specl remnng rte of tx) of the fter set off current yer set off = (A39 of Schedule BP) v Speculton ncome (3 of tem E of Sch. BP) v Specfed busness ncome u/s 35AD (3 of tem E of Sch. BP) v Short-term cptl gn 15% (7 of tem E of schedule CG) (3b of Schedule HP) (2v of tem E of Schedule BP) (1k of Schedule-OS)

144 322 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Short-term cptl gn (7 of tem E of schedule 30% CG) v Short-term cptl gn txble t (7v of tem E of schedule pplcble rtes CG) x Long term cptl gn (7v of tem E of schedule 10% CG) x Long term cptl gn (7v of tem E of schedule 20% CG) x Other sources (excludng proft from ownng rce horses nd mount (1k of schedule OS) chrgeble to specl rte of tx) x Proft from ownng nd mntnng rce horses (3e of schedule OS) x Totl loss set off (+ + v+ v+ v+ v+ v+ x+ x+ x+ x) xv Loss remnng fter set-off ( - x) Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT Sl. No. Detls of Income fter Set off of Brought Forwrd Losses of erler yers Hed/ Source of Income Income fter set off, f ny, of current yer s losses s per 5 of Schedule CYLA) Brought forwrd loss set off House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculton ncome nd ncome from specfed busness) Speculton Income v Specfed Busness Income Brought forwrd deprecton set off Brought forwrd llownce under secton 35(4) set off Current yer s ncome remnng fter set off (5 of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) (B/f busness loss, other thn speculton or specfed busness loss) (B/f norml busness or speculton loss) (B/f norml busness or specfed busness loss) (B/f short-term cptl loss) (B/f short-term cptl loss) (B/f short-term cptl loss) (B/f short-term or longterm cptl loss) (B/f short-term or longterm cptl loss) v Short-term cptl gn 15% (5v of schedule CYLA) v Short-term cptl gn (5v of schedule CYLA) 30% v Short-term cptl gn txble t (5v of schedule CYLA) pplcble rtes Long-term cptl gn v 10% (5x of schedule CYLA) x Long term cptl gn 20% (5x of schedule CYLA) Other sources ncome (excludng x proft from ownng nd mntnng rce horses nd mount chrgeble (5x of schedule CYLA) to specl rte of tx) x Proft from ownng nd mntnng rce horses (5x of schedule CYLA) (B/f loss from horse rces) x Totl of brought forwrd loss set off x Current yer s ncome remnng fter set off Totl ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5) Schedule CFL CARRY FORWARD OF LOSS Sl. No. Assessment Yer Detls of Losses to be crred forwrd to future yers Dte of Flng (DD/MM/ YYYY) House property loss Loss from busness other thn loss from specultve busness nd specfed busness Loss from specultve busness Loss from specfed busness Short-term cptl loss Long-term Cptl loss Loss from ownng nd mntnng rce horses v v v

145 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 323 v v x x x x Totl of erler yer losses b/f Adjustment of bove losses n Schedule BFLA (Current yer losses) Totl loss Crred forwrd to future yers (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2 of schedule BFLA) (B43 of schedule BP, f ve) (2v of schedule BFLA) (C49 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) (2x of schedule BFLA) (3e of schedule OS, f ve)

146 324 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule UD Unbsorbed deprecton nd llownce under secton 35(4) Sl No Assessment Yer Amount of brought forwrd unbsorbed deprecton Deprecton Allownce under secton 35(4) Amount of deprecton set-off gnst the current yer ncome Blnce crred forwrd to the next yer Amount of brought forwrd unbsorbed llownce Amount of llownce set-off gnst the current yer ncome Blnce Crred forwrd to the next yer (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Yer v Totl (3x of BFLA) (4x of BFLA) Schedule ICDS Effect of Income Computton Dsclosure Stndrds on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X Accountng Polces Vluton of Inventores (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Constructon Contrcts Revenue Recognton Tngble Fxed Assets Chnges n Foregn Exchnge Rtes Government Grnts Securtes (other thn the effect of chnge n method of vluton u/s 145A, f the sme s seprtely reported t col. 4d or 4e of Prt A-OI) Borrowng Costs Provsons, Contngent Lbltes nd Contngent Assets 11. Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) 11b. Totl effect of ICDS djustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negtve) Schedule 10AA Deducton under secton 10AA Deductons n respect of unts locted n Specl Economc Zone DEDUCTION U/S 10AA Sl Undertkng Undertkng No.1 b Undertkng No.2 c Totl deducton under secton 10AA ( + b) Assessment yer n whch unt begns to mnufcture/produce/provde servces Sl b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertkng 1) (tem 17 of Annexure A of Form 56F for Undertkng 2) c Schedule 80G DETAILS OF DONATIONS A B Detls of dontons enttled for deducton under secton 80G Dontons enttled for 100% deducton wthout qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton v Totl Dontons enttled for 50% deducton wthout qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton

147 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 325 DEDUCTION U/S 80-IA v Totl C Dontons enttled for 100% deducton subject to qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton v Totl D Dontons enttled for 50% deducton subject to qulfyng lmt Nme nd ddress of donee PAN of Donee Amount of donton Elgble Amount of donton v Totl E Totl dontons (Av + Bv + Cv + Dv) Schedule 80-IA b c d e Deductons under secton 80-IA Deducton n respect of profts of n enterprse referred to n secton 80-IA(4)() [Infrstructure fclty] Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)() [Telecommuncton servces] Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)() [Industrl prk nd SEZs] Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Power] Deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Revvl of power genertng plnt] nd deducton n respect of profts of n undertkng referred to n secton 80-IA(4)(v) [Crosscountry nturl gs dstrbuton network] f Totl deductons under secton 80-IA ( b1 + b2 + c1 + c2+ d1 + d2+ e1 + e2) 1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) 2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) b1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) b2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) c1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) c2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) d1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) d2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) e1 Undertkng no. 1 (tem 30 of Form 10CCB of the undertkng) e2 Undertkng no. 2 (tem 30 of Form 10CCB of the undertkng) f Schedule 80-IB b c Deductons under secton 80-IB Deducton n respect of ndustrl undertkng locted n Jmmu & Kshmr [Secton 80-IB(4)] Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd sttes specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustrl undertkng locted n ndustrlly bckwrd dstrcts [Secton 80-IB(5)] d Deducton n the cse of multplex thetre [Secton 80-IB(7A)] e Deducton n the cse of conventon centre [Secton 80-IB(7B)] f g h j k Deducton n the cse of compny crryng on scentfc reserch [Secton 80-IB(8A)] Deducton n the cse of undertkng whch begns commercl producton or refnng of mnerl ol [Secton 80-IB(9)] Deducton n the cse of n undertkng developng nd buldng housng projects [Secton 80-IB(10)] Deducton n the cse of n undertkng opertng cold chn fclty [Secton 80-IB(11)] Deducton n the cse of n undertkng engged n processng, preservton nd pckgng of fruts, vegetbles, met, met products, poultry, mrne or dry products [Secton 80-IB(11A)] Deducton n the cse of n undertkng engged n ntegrted busness of hndlng, storge nd trnsportton of food grns [Secton 80-IB(11A)] 1 2 b1 b2 Undertkng no. 1 (30 of Form 10CCB of the undertkng) Undertkng no. 2 (30 of Form 10CCB of the undertkng) Undertkng no. 1 (30 of Form 10CCB of the undertkng) Undertkng no. 2 (30 of Form 10CCB of the undertkng) c1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) c2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) d1 Undertkng no. 1 (10(v) of Form 10CCBA of the undertkng) d2 Undertkng no. 2 (10(v) of Form 10CCBA of the undertkng) e1 Undertkng no. 1 (10(v) of Form 10CCBB of the undertkng) e2 Undertkng no. 2 (10(v) of Form 10CCBB of the undertkng) f1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) f2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) g1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) g2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) h1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) h2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) 1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) 2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) j1 j2 k1 k2 Undertkng no. 1 (30 of Form 10CCB of the undertkng) Undertkng no. 2 (30 of Form 10CCB of the undertkng) Undertkng no. 1 (30 of Form 10CCB of the undertkng) Undertkng no. 2 (30 of Form 10CCB of the undertkng)

148 326 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] l m Deducton n the cse of n undertkng engged n opertng nd mntnng rurl hosptl [Secton 80-IB(11B)] Deducton n the cse of n undertkng engged n opertng nd mntnng hosptl n ny re, other thn excluded re [Secton 80-IB(11C) n Totl deducton under secton 80-IB (Totl of 1 to m2) l1 Undertkng no. 1 (11(v) of From 10CCBC) l2 Undertkng no. 2 (11(v) of From 10CCBC) m1 Undertkng no. 1 (11(d) of From 10CCBD) m2 Undertkng no. 2 (11(d) of From 10CCBD) n DEDUCTION U/S 80-IC Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE Deducton n respect of undertkng locted n Skkm b Deducton n respect of undertkng locted n Hmchl Prdesh c Deducton n respect of undertkng locted n Uttrnchl d Deducton n respect of undertkng locted n North-Est d Assm db Arunchl Prdesh dc Mnpur dd Mzorm de Meghly df Nglnd dg Trpur d1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) d2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) db1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) db2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dc1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dc2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dd1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dd2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) de1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) de2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) df1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) df2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dg1 Undertkng no. 1 (30 of Form 10CCB of the undertkng) dg2 Undertkng no. 2 (30 of Form 10CCB of the undertkng) dh Totl deducton for undertkngs locted n North-est (totl of d1 to dg2) e Totl deducton under secton 80-IC or 80-IE ( + d + c + dh) 1 Undertkng no. 1 2 Undertkng no. 2 b1 Undertkng no. 1 b2 Undertkng no. 2 c1 Undertkng no. 1 c1 Undertkng no. 2 dh e (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) (30 of Form 10CCB of the undertkng) Schedule VI-A Deductons under Chpter VI-A 1 Prt B- Deducton n respect of certn pyments 80G c 80GGA b 80GGB d 80GGC Totl Deducton under Prt B ( + b + c +d) 1 TOTAL DEDUCTIONS 2 Prt C- Deducton n respect of certn ncomes e 80-IA (f of Schedule 80-IA) f 80-IAB g 80-IAC h 80-IB (n of Schedule 80-IB) 80-IBA j 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) k 80JJA l 80JJAA (10 of Annexure to Form 10DA) m 80LA (9 of Annexure to Form 10CCF) Totl Deducton under Prt C (totl of e to m) 2 3 Totl deductons under Chpter VI-A (1 + 2) 3 Schedule SI I A L Sl No Income chrgeble to tx t specl rtes [Plese see nstructon Number-7() for secton nd rte of tx] Secton/Descrpton Specl rte (%) Income () Tx thereon ()

149 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k A (STCG on shres/equty orented MF on whch STT pd) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pd) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexton) 10 (prt of 5v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (prt of 5v of schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (prt of 5v of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (prt of 5v of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (prt of 5v of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) 9 115B (Profts nd gns of lfe nsurnce busness) (prt of 37x of schedule BP) AC (Income of non-resdent from bonds or GDR purchsed n foregn currency) 10 (prt of 1f of schedule OS) BB (Wnnngs from lotteres, puzzles, rces, gmes etc.) 30 (1f of schedule OS) BBD (Dvdend receved from specfed foregn compny) 15 (prt of 1fv of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (1f of schedule OS) A(b) (Income of foregn compny from Roylty) 25 (prt of 1fv of schedule OS) 15 Chrgeble under DTAA rte (prt of 1fv of schedule OS + A8b nd B9b of schedule CG) BBF (Tx on ncome from ptent) Income under hed busness or professon 10 (3d of schedule BP) b Income under hed other sources 10 (1f of schedule OS) BBG (Tx on ncome from trnsfer of crbon credts) Income under hed busness or professon 10 (3e of schedule BP) b Income under hed other sources 10 (1fv of schedule OS) 18 Totl Schedule EI EXEMPT INCOME Detls of Exempt Income (Income not to be ncluded n Totl Income) 1 Interest ncome 1 2 Dvdend ncome 2 3 Long-term cptl gns from trnsctons on whch Securtes Trnscton Tx s pd 3 4 Gross Agrculturl recepts (other thn ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on grculture Unbsorbed grculturl loss of prevous eght ssessment yers v Net Agrculturl ncome for the yer ( ) (enter nl f loss) 4 5 Others, ncludng exempt ncome of mnor chld (plese specfy) 5 6 Totl ( ) 6 Schedule PTI Pss Through Income detls from busness trust or nvestment fund s per secton 115UA, 115UB Sl. Nme of busness trust/ PAN of the busness Sl. Hed of ncome Amount of ncome TDS on such nvestment fund trust/ nvestment fund mount, f ny 1. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s 2. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s NOTE Plese refer to the nstructons for fllng out ths schedule. PASS THROUGH INCOME

150 328 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule MAT Computton of Mnmum Alternte Tx pyble under secton 115JB Whether the Proft nd Loss Account s prepred n ccordnce wth the provsons of Prts II of Schedule III to the Compnes Act, (If yes, wrte Y, f no wrte N ) If 1 s no, whether proft nd loss ccount s prepred n ccordnce wth the provsons of the Act governng such compny (If yes, wrte Y, 2 f no wrte N ) Whether, for the Proft nd Loss Account referred to n tem 1 bove, the sme ccountng polces, ccountng stndrds nd sme method 3 nd rtes for clcultng deprecton hve been followed s hve been dopted for preprng ccounts ld before the compny t ts nnul generl body meetng? (If yes, wrte Y, f no wrte N ) MINIMUM ALTERNATE TAX 4 Proft fter tx s shown n the Proft nd Loss Account (enter tem 48 of Prt A-P&L) 4 5 Addtons (f debted n proft nd loss ccount) Income-tx pd or pyble or ts provson ncludng the mount of deferred tx nd the provson thereof b Reserve (except reserve under secton 33AC) c Provsons for unscertned lblty d Provsons for losses of subsdry compnes e Dvdend pd or proposed f Expendture relted to exempt ncome under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] g Expendture relted to shre n ncome of AOP/ BOI on whch no ncome-tx s pyble s per secton 86 h Expendture n cse of foregn compny referred to n cluse (fb) of explnton 1 to secton 115JB Notonl loss on trnsfer of certn cptl ssets or unts referred to n cluse (fc) of explnton 1 to secton 115JB j Expendture reltble to ncome by wy of roylty n respect of ptent chrgeble to tx u/s 115BBF k Deprecton ttrbutble to revluton of ssets Gn on trnsfer of unts referred to n cluse (k) of l explnton 1 to secton 115JB Others (ncludng resdul undjusted tems nd provson for m dmnuton n the vlue of ny sset) n Totl ddtons (5+5b+5c+5d+5e+5f+5g+5h+5+5j+5k+5l+5m) 6 Deductons Amount wthdrwn from reserve or provsons f credted to Proft nd Loss ccount b Income exempt under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] c Amount wthdrwn from revluton reserve nd credted to proft nd loss ccount to the extent t does not exceed the mount of deprecton ttrbutble to revluton of sset d Shre n ncome of AOP/ BOI on whch no ncome-tx s pyble s per secton 86 credted to Proft nd Loss ccount e Income n cse of foregn compny referred to n cluse (d) of explnton 1 to secton 115JB f Notonl gn on trnsfer of certn cptl ssets or unts referred to n cluse (e) of explnton 1 to secton 115JB g Loss on trnsfer of unts referred to n cluse (f) of explnton 1 to secton 115JB h Income by wy of roylty referred to n cluse (g) of explnton 1 to secton 115JB Loss brought forwrd or unbsorbed deprecton whchever s less j Proft of sck ndustrl compny tll net worth s equl to or exceeds ccumulted losses k Others (ncludng resdul undjusted tems nd the mount of deferred tx credted to P&L A/c) 5 5b 5c 5d 5e 5f 5g 5h 5 5j 5k 5l 5m 6 6b 6c 6d 6e 6f 6g 6h 6 6j 6k 5n l Totl deductons (6+6b+6c+6d+6e+6f+6g+6h+6+6j+6k) 6l 7 Book proft under secton 115JB (4+ 5n 6l) 7 Whether the fnncl sttements of the compny re drwn up n complnce to the Indn Accountng 8 Stndrds (Ind-AS) specfed n Annexure to the compnes (Indn Accountng Stndrds) Rules, If yes, furnsh the detls below:- A. Addtons to book proft under sub-sectons (2A) to (2C) of secton 115JB Amounts credted to other comprehensve ncome n sttement of proft & loss under the hed tems tht wll not be reclssfed to proft & loss Amounts debted to the sttement of proft & loss on dstrbuton of non-csh ssets to shreholders n b demerger c One ffth of the trnston mount s referred to n secton 115JB (2C) (f pplcble) 8 8b 8c Yes No

151 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 329 d Others (ncludng resdul djustment) e Totl ddtons (8 + 8b + 8c + 8d) B. Deductons from book proft under sub-sectons (2A) to (2C) of secton 115JB Amounts debted to other comprehensve ncome n sttement of proft & loss under the hed tems f tht wll not be reclssfed to proft & loss Amounts credted to the sttement of proft & loss on dstrbuton of non-csh ssets to shreholders n g demerger h One ffth of the trnston mount s referred to n secton 115JB (2C) (f pplcble) Others (ncludng resdul djustment) j Totl deductons (8f + 8g + 8h + 8) 9 Deemed totl ncome under secton 115JB (7 + 8e 8j) 9 10 Tx pyble under secton 115JB 10 8d 8e 8f 8g 8h 8 8j Schedule MATC Computton of tx credt under secton 115JAA 1 Tx under secton 115JB n ssessment yer (1d of Prt-B-TTI) 1 2 Tx under other provsons of the Act n ssessment yer (2f of Prt-B-TTI) 2 MAT CREDIT 3 Amount of tx gnst whch credt s vlble [enter (2 1) f 2 s greter thn 1, otherwse enter 0] 3 4 Utlston of MAT credt Avlble [Sum of MAT credt utlsed durng the current yer s subject to mxmum of mount mentoned n 3 bove nd cnnot exceed the sum of MAT Credt Brought Forwrd ] S.No Assessment Yer MAT Credt (A) v v v v v x x x x (enter 1-2, f 1>2 else enter 0) Totl Gross (B1) Set-off n erler yers (B2) Blnce Brought forwrd (B3)=(B2)-(B1) MAT Credt Utlsed durng the Current Yer (C) 5 Amount of tx credt under secton 115JAA utlsed durng the yer [enter 4(C)x] 5 6 Amount of MAT lblty vlble for credt n subsequent ssessment yers [enter 4(D)x] 6 Blnce MAT Credt Crred Forwrd (D)= (B3) (C) Schedule- DDT DIVIDEND DISTRIBUTION TAX Detls of tx on dstrbuted profts of domestc compnes nd ts pyment Sl Descrpton Detls of 1 st dvdend Detls of 2 nd dvdend Detls of 3 rd dvdend () () () (v) (v) 1 Dte of declrton or dstrbuton or pyment, whchever s erlest, of dvdend by domestc compny 2 Rte of dvdend, declred, dstrbuted or pd 3 Amount of dvdend declred, dstrbuted or pd 4 Amount of reducton s per secton 115-O(1A) 5 Tx pyble on dvdend declred, dstrbuted or pd b c d Addtonl pyble under secton 115-O on (3-4) Surchrge on Educton cess on (+b) Totl tx pyble (+b+c) 6 Interest pyble under secton 115P 7 Addtonl ncome-tx nd nterest pyble (5d + 6) 8 Tx nd nterest pd 9 Net pyble/refundble (7-8) 10 Dte(s) of depost of dvdend dstrbuton tx (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) Dte 1 Dte 2 Dte 1 Dte 2 Dte 1 Dte 2 (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ YYYY) YYYY) YYYY) YYYY) YYYY) YYYY)

152 330 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 11 Nme of Bnk nd Brnch 12 BSR Code 13 Serl number of chlln 14 Amount deposted

153 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 331 Schedule- BBS TAX ON BUY BACK OF SHARES Detls of tx on dstrbuted ncome of domestc compny on buy bck of shres, not lsted on stock exchnge Sl Descrpton Detls of 1 st buy-bck Detls of 2 nd buybck Detls of 3 rd buybck () () () (v) (v) Dte of pyments of ny consderton to the shreholder on 1 buy bck of shre Amount of consderton pd by the compny on buy-bck of 2 shres 3 Amount receved by the compny for ssue of such shres 4 Dstrbuted Income of the compny (2 3) 5 Tx pyble on dstrbuted ncome b c d Addtonl pyble under secton 115QA on 4 Surchrge on Educton cess on (+b) Totl tx pyble (+b+c) 6 Interest pyble under secton 115QB 7 Addtonl ncome-tx nd nterest pyble (5d + 6) 8 Tx nd nterest pd 9 Net pyble/refundble (7-8) 10 Dte(s) of depost of tx on dstrbuton ncome 11 Nme of Bnk nd Brnch 12 BSR Code 13 Serl number of chlln 14 Amount deposted (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) Dte 1 Dte 2 Dte 1 Dte 2 Dte 1 Dte 2 (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ YYYY) YYYY) YYYY) YYYY) YYYY) YYYY) Schedule FSI INCOME FROM OUTSIDE INDIA AND TAX RELIEF Sl. Country Code 1 2 NOTE Txpyer Identfcton Number Detls of Income from outsde Ind nd tx relef Sl. Hed of ncome Income from outsde Ind (ncluded n PART B- TI) House Property Busness or Professon Cptl Gns v Other sources House Property Busness or Professon Cptl Gns v Other sources Tx pd outsde Ind Tx pyble on such ncome under norml provsons n Ind Tx relef vlble n Ind (e)= (c) or (d) whchever s lower Relevnt rtcle of DTAA f relef clmed u/s 90 or 90A () (b) (c) (d) (e) (f) Totl Totl Plese refer to the nstructons for fllng out ths schedule. Schedule TR TAX RELIEF FOR TAX PAID OUTSIDE INDIA Summry of tx relef clmed for txes pd outsde Ind 1 Detls of Tx relef clmed Country Code Txpyer Identfcton Number Totl txes pd outsde Ind (totl of (c) of Schedule FSI n respect of ech country) Totl tx relef vlble (totl of (e) of Schedule FSI n respect of ech country) Secton under whch relef clmed (specfy 90, 90A or 91) () (b) (c) (d) (e) Totl 2 Totl Tx relef vlble n respect of country where DTAA s pplcble (secton 90/90A) (Prt of totl of 1(d)) 2

154 332 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 3 Totl Tx relef vlble n respect of country where DTAA s not pplcble (secton 91) (Prt of totl of 1(d)) 3 4 Whether ny tx pd outsde Ind, on whch tx relef ws llowed n Ind, hs been refunded/credted by the foregn tx uthorty durng the yer? If yes, provde the detls below NOTE Schedule FA A Sl No Amount of tx refunded Plese refer to the nstructons for fllng out ths schedule. Detls of Foregn Assets nd Income from ny source outsde Ind b Assessment yer n whch tx relef llowed n Ind Detls of Foregn Bnk Accounts held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Country Nme nd Code Nme nd Address of the Bnk Account holder nme Sttus- Owner/ Benefcl owner/ Benefcry Account Number Account openng dte Pek Blnce Durng the Yer (n rupees) Interest ccrued n the ccount 4 Yes/No Interest txble nd offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detls of Fnncl Interest n ny Entty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Country Nture of Nme nd Dte Nture of Nme nd entty Address of snce held Income Amount code the Entty Sl No Nture of Interest- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income ccrued from such Interest Income txble nd offered n ths return Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () DETAILS OF FOREIGN ASSETS C Detls of Immovble Property held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Address of the Property Dte of cquston Nture of Income Income txble nd offered n ths return Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income derved from the property Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detls of ny other Cptl Asset held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Nture of Asset Dte of cquston Nture of Income Income txble nd offered n ths return Amount Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry (1) (2) (3) (4) Totl Investment (t cost) (n rupees) Income derved from the sset Schedule where offered Item number of schedule (5) (6) (7) (8) (9) (10) (11) () () E Detls of ccount(s) n whch you hve sgnng uthorty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer nd whch hs not been ncluded n A to D bove. Sl No Account Number If (7) s yes, Income offered n ths return Nme of the Insttuton n whch the ccount s held Address of the Insttuton Nme of the ccount holder Pek Blnce/ Investment durng the yer (n rupees) Whether ncome ccrued s txble n your hnds? If (7) s yes, Income ccrued n the ccount Amount Schedule Item number of where offered schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detls of trusts, creted under the lws of country outsde Ind, n whch you re trustee, benefcry or settlor Sl Country Nme nd Nme nd Nme nd Nme nd Dte Whether If (8) s yes, If (8) s yes, Income offered n ths return No Nme nd ddress of ddress of ddress of ddress of snce ncome derved Income Amount Schedule Item number code the trust trustees Settlor Benefcres poston s txble n derved from where offered of schedule held your hnds? the trust (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detls of ny other ncome derved from ny source outsde Ind whch s not ncluded n,- () tems A to F bove nd, () ncome under the hed busness or professon If (6) s yes, Income offered n ths return Country Nme Nme nd ddress of the Whether txble Income derved Nture of ncome nd code person from whom derved n your hnds? Amount Schedule Item number where offered of schedule

155 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 333 (1) (2) (3) (4) (5) (6) (7) (8) (9) () NOTE Plese refer to nstructons for fllng out ths schedule Brek-up of totl expendture wth enttes regstered or not regstered under the GST (Detls n respect of expendture on or Schedule GST fter 01 st July, 2017 to be flled up by the ssessee who s not lble to get ccounts udted u/s 44AB) Sl. Expendture n respect of enttes regstered under GST No. DETAILS OF GST Totl mount of Expendture durng the yer (ggregte of expendture reported t tems 6, 8 to 35, 37 & 38 of Prt-A-P&L / P&L Ind AS) Reltng to goods or servces exempt from GST Reltng to enttes fllng under composton scheme Reltng to other regstered enttes Totl pyment to regstered enttes Expendture reltng to enttes not regstered under GST (1) (2) (3) (4) (5) (6) (7) NOTE Plese refer to nstructons for fllng out ths schedule. Brek-up of pyments/recepts n Foregn currency (to be flled up by the ssessee who s not lble to get ccounts udted u/s Schedule FD 44AB) S. Amount (n Rs.) No. Pyments mde durng the yer on cptl ccount Foregn Currency Trnscton Pyments mde durng the yer on revenue ccount Recepts durng the yer on cptl ccount v Recepts durng the yer on revenue ccount NOTE Plese refer to nstructons for fllng out ths schedule.

156 334 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR- 7 INDIAN INCOME TAX RETURN [For persons ncludng compnes requred to furnsh return under sectons 139(4A) or 139(4B) or 139(4C) or 139(4D) or 139(4E) or 139(4F)] (Plese see rule 12 of the Income-tx Rules, 1962) (Also see ttched nstructons for gudnce) Assessment Yer Prt A-GEN Nme (s mentoned n deed of creton/ estblshng/ ncorporton/ formton) PAN Flt/Door/Block No Nme Of Premses/Buldng/Vllge Dte of formton/ncorporton (DD/MM/YYYY) / / Rod/Street/Post Offce Are/Loclty Sttus Town/Cty/Dstrct Stte Pn code/zp code (see nstructons pr 11b) Offce Phone Number wth STD code/moble No. 1 Fx Number/Moble No. 2 Income Tx Wrd/Crcle PERSONAL INFORMATION Eml Address 1 Eml Address 2 Detls of the projects/nsttutons run by you Sl. Nme of the project/nsttuton (see nstructon pr 11c) Nture of ctvty (see nstructon pr 11d) 1 2 Clssfcton (see nstructons pr 11d) Aggregte nnul recepts 3 4 Detls of regstrton or pprovl Sl. Dte of regstrton or pprovl Secton under whch regstered or pproved Approvl/ Notfcton/ Regstrton No. Approvng/ regsterng Authorty FILING STATUS (c) (d) 4 () (b) Return fled[plese see nstructon No.-6] On or before due dte-139(1), After due dte-139(4), Revsed Return-139(5) Modfed return-92cd under secton 119(2)(b), OR In response to notce u/s 139(9)- defectve, 142(1), 148, 153A, 153C Return furnshed under secton 139(4A) 139(4B) 139(4C) 139(4D) 139(4E) 139(4F) If revsed/n response to defectve/modfed, then enter Recept No. nd Dte of flng orgnl return (DD/MM/YYYY) If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C enter dte of such notce, or u/s 92CD enter dte of dvnce prcng greement (e) Resdentl sttus? (Tck) Resdent Non-resdent (f) (g) / / / / Whether ny ncome ncluded n totl ncome for whch for whch clm under secton 90/90A/91 hs been mde? Yes No [pplcble n the cse of resdent] [f yes, ensure to fll Schedule FSI nd Schedule TR] Whether ny trnscton hs been mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No

157 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 335 For Offce Use Only For Offce Use Only Recept No. Dte Sel nd Sgnture of recevng offcl OTHER DETAILS (h) In the cse of non-resdent, s there permnent estblshment (PE) n Ind (Tck) Yes No () A Whether ths return s beng fled by representtve ssessee? (Tck) Yes No If yes, plese furnsh followng nformton - (1) Nme of the representtve (2) Address of the representtve (3) Permnent Account Number (PAN) of the representtve Where, n ny of the projects/nsttutons run by you, one of the chrtble purposes s dvncement of ny other object of generl publc utlty then,- b whether there s ny ctvty n the nture of trde, commerce or busness referred to n provso to secton 2(15)? Yes No If yes, then percentge of recept from such ctvty vs-à-vs totl recepts % whether there s ny ctvty of renderng ny servce n relton to ny trde, commerce or busness for ny consderton s referred to n provso to Yes secton 2(15)? If yes, then percentge of recept from such ctvty vs-à-vs totl recepts % If or b s YES, the ggregte nnul recepts from such ctvtes n respect of tht nsttuton Sl. Nme of the project/insttuton Amount of ggregte nnul recepts from such ctvtes No B C b Whether pprovl obtned u/s 80G? Yes No If yes, then enter Approvl No. Dte of Approvl (DD/MM/YYYY) / / Is there ny chnge n the objects/ctvtes durng the Yer on the bss of whch pprovl/regstrton ws grnted? Yes No If yes, plese furnsh followng nformton:- dte of such chnge (DD/MM/YYYY) / / b whether n pplcton for fresh regstrton hs been mde n the prescrbed form nd mnner wthn the stpulted perod of thrty dys s per Cluse (b) of sub-secton (1) of secton 12A Yes No c whether fresh regstrton hs been grnted under secton 12AA Yes No d dte of such fresh regstrton (DD/MM/YYYY) / / D Whether poltcl prty s per secton 13A? (f yes, plese fll schedule LA) Yes No If yes, then whether regstered? Yes No If yes, then enter regstrton number under secton 29A of the Representton of People Act, 1951 E Whether n Electorl Trust? (f yes, plese fll schedule ET) Yes No If yes, then enter pprovl number? Dte of Approvl (DD/MM/YYYY) / / F Whether regstered under Foregn Contrbuton (Regulton) Act, 2010 (FCRA)? Yes No If yes, then enter Regstrton No.

158 336 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Dte of Regstrton (DD/MM/YYYY) / / v Totl mount of foregn contrbuton receved durng the yer, f ny Rs. b Specfy the purpose for whch the bove contrbuton s receved G Whether busness trust regstered wth SEBI? Yes No If yes, then enter Regstrton No. Dte of Regstrton (DD/MM/YYYY) / / H Whether lble to tx t mxmum mrgnl rte under secton 164? Yes No I Is ths your frst return? Yes No Are you lble for udt under the Income-tx Act?(Tck) Yes No, If yes, furnsh followng J nformton- Secton under whch you re lble for udt (specfy secton). Plese menton dte of udt report. (DD/MM/YY) (see Instructon 6()) AUDIT INFORMATION MEMBER S INFORMATION K L 12A b c d e Nme of the udtor sgnng the tx udt report Membershp No. of the udtor Nme of the udtor (propretorshp/ frm) Permnent Account Number (PAN) of the propretorshp/ frm Dte of udt report f Dte of furnshng of the udt report / / (DD/MM/YYYY). If lble to udt under ny Act other thn the Income-tx Act, menton the Act, secton nd dte of furnshng the udt report? Act nd secton (DD/MM/YY) Act nd secton (DD/MM/YY) Prtculrs of persons who were members n the AOP on 31 st dy of Mrch, 2018 (to be flled by venture cptl fund/nvestment fund) Percentge of Adhr Number/ Sttus S.No Nme nd Address shre (f PAN Enrolment Id (f elgble for (see determnte) Adhr) nstructon) (1) (2) (3) (4) (5) (6) Prt B STATEMENT OF INCOME FOR THE PERIOD ENDED ON 31 ST MARCH, 2018 TI If regstered under secton 12A/12AA or pproved under secton 10(23C)(v)/10(23C)(v)/ 10(23C)(v)/10(23C)(v), fll out tems 1 to 7 (s pplcble) 1 Voluntry contrbuton formng prt of corpus s per secton 11(1)(d) [(A + B) of schedule VC] 1 2 Voluntry Contrbutons other thn corpus(c (A+B) of schedule VC) 2 3 Aggregte of ncome referred to n sectons 11, 12 nd sectons 10(23C)(v),10(23C)(v),10(23C)(v) 3 nd 10(23C)(v) derved durng the prevous yer excludng Voluntry contrbuton ncluded n 1 nd 2 bove (9 of Schedule AI) 4 Applcton of ncome for chrtble or relgous purposes or for the stted objects of the trust/nsttuton:- Amount ppled durng the prevous yer - Revenue Account [24(A) of Schedule ER] 4 Amount ppled durng the prevous yer Cptl Account [Excludng pplcton from Borrowed Funds] [8(A) of Schedule EC] 4

159 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 337 Amount ppled durng the prevous yer - Cptl Account (Repyment of Lon) 4 v v v v Amount ppled durng the prevous yer - Utlston of surplus ccumulted durng n erler yer [tem No. 24(B) of Schedule ER + tem No.8(B) of Schedule EC] Amount deemed to hve been ppled durng the prevous yer s per cluse (2) of Explnton to secton 11(1) If (v) bove pplcble, whether opton Form No. 9A hs 4v been furnshed to the Assessng Offcer b If yes, dte of furnshng Form No. 9A (DD/MM/YYYY) 4vb Amount ccumulted or set prt for pplcton to chrtble or relgous purposes or for the stted objects of the trust/nsttuton to the extent t does not exceed 15 per cent of ncome derved from property held n trust/ nsttuton under secton 11(1)()/11(1)(b) or n terms of thrd provso to secton 10(23C) [restrcted to the mxmum of 15% of (2 + 3) bove] Amount n ddton to mount referred to n(v) bove, ccumulted or set prt for specfed purposes f ll the condtons n secton 11(2) nd 11(5) or thrd provso to secton 10(23C) re fulflled (fll out schedule I) v Amount elgble for exempton under secton 11(1)(c) 4v Approvl number gven by the Bord 4v b Dte of pprovl by bord 4vb x Totl [ v+4v+4v+4v] (excludng the tem 4v - Utlston of deemed ncome of n erler yer) 4x 5 Addtons Corpus donton to other trust or nsttuton chrgeble s per Explnton 2 to secton 11(1) 5 [tem No. 15() of Schedule ER] Income chrgeble under secton 11(1B) 5 Income chrgeble under secton 11(3) 5 v Income n respect of whch exempton under secton 11 s not vlble by vrtue of provsons of secton 13 Beng nonymous donton t D of schedule VC to the 5v extent ppled for chrtble purpose b Other thn () bove 5vb v Income chrgeble under secton 12(2) 5v v Totl [ v+5vb+5v] 5v 6 Income chrgeble u/s 11(4) [s per tem No. E36 of Schedule BP] 6 7 Totl (2+3-4x+5v+6) 7 8 Amount elgble for exempton under secton 10(21), 10(22B), 10(23A), 10(23B) 8 9 Amount elgble for exempton under secton 10(23C)(b), 10(23C)(c), 10(23C)(d), 9 10(23C)(e), 10(23D), 10(23DA), 10(23FB), 10(24), 10(46), 10(47) 10 Amount elgble for exempton under ny other cluse of secton 10 (other thn those t 8 nd 9) Income chrgeble under secton 11(3) red wth secton 10(21) Income clmed/ exempt under secton 13A or 13B n cse of Poltcl Prty or Electorl Trust (tem 12 No. 11 of Schedule LA or tem No. 6v of Schedule ET) 13 Income not formng prt of tem No. 7 & 11 bove Income from house property [3b of Schedule HP] (enter nl f loss) 13 Profts nd gns of busness or professon [s per tem No. E 35 of schedule BP] 13 Income under the hed Cptl Gns Short term (A5 of schedule CG) 13 b Long term (B3 of schedule CG) (enter nl f loss ) 13b c Totl cptl gns (13 +13b) (enter nl f loss ) 13c v Income from other sources [s per tem No. 4 of Schedule OS] 13v v Totl ( c + 13v) 13v 14 Gross ncome [ v] Losses of current yer to be set off gnst 13v (totl of 2x, 3x nd 4x of Schedule CYLA) Gross Totl Income (14-15) Income chrgeble to tx t specl rte under secton 111A, 112 etc. ncluded n Deducton u/s 10AA Deductons under chpter VIA [lmted to (16-17)] Totl Income [ ] Income whch s ncluded n 20 nd chrgeble to tx t specl rtes (totl of col. () of schedule SI) Net Agrculturl ncome for rte purpose Aggregte Income ( ) [pplcble f (20-21) exceeds mxmum mount not chrgeble to tx] 23 4v 4v 4v 4v

160 338 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 24 Anonymous dontons, ncluded n 23, to be txed under secton 30% (D of schedule VC) Income chrgeble t mxmum mrgnl rtes (23-24) 25 Prt B - TTI Computton of tx lblty on totl ncome 1 Tx Pyble on deemed totl Income under secton 115JB or 115JC s pplcble (7 1 of Schedule MAT/ 4 of Schedule AMT) 1b Surchrge on () bove TAX LIABILITY TAXES PAID BANK ACCOUNT 1c Educton Cess on (1+1b) bove 1d Totl Tx Pyble u/s 115JB or 115JC s pplcble (1+1b+1c) 2 Tx pyble on totl ncome Tx t norml rtes on ( ) of Prt B-TI b Tx t specl rtes (totl of col. () of Schedule-SI) Tx on nonymous donton u/s on 24 of c Prt B-TI d Tx t mxmum mrgnl rte on 25 of Prt B-TI e Rebte on grculturl ncome [pplcble f (20-21) of Prt B- TI exceeds mxmum mount not chrgeble to tx] f Tx Pyble on Totl Income (2 + 2b+2c+2d 2e) 3 Surchrge 25% of 5() of Schedule SI On [(2f) (5() of Schedule SI)] Totl ( + ) 4 Educton cess, ncludng secondry nd hgher educton cess on (2f+3) 4 5 Gross tx lblty (2f+3+4) 5 6 Gross tx pyble (hgher of 5 nd 1d) 6 7 Credt under secton 115JAA/115JD of tx pd n erler yers (f 5 s more thn 1d) (5 of Schedule MATC/AMTC) 8 Tx pyble fter credt under secton 115JAA/115JD [ (6 7)] 8 9 Tx relef Secton 90/90A (2 of Schedule TR) b Secton 91 (3 of Schedule TR) c Totl (9 + 9b) 10 Net tx lblty (8 9c) Interest nd fee pyble Interest for defult n furnshng the return (secton 234A) b Interest for defult n pyment of dvnce tx (secton 234B) c Interest for deferment of dvnce tx (secton 234C) d Fee for defult n furnshng return of ncome (secton 234F) e Totl Interest nd Fee Pyble (11+11b+11c+11d) 12 Aggregte lblty ( e) Txes Pd Advnce Tx (from column 5 of19a) b TDS (totl of column 9of 19B) c TCS (totl of column 7 of 19C) d Self-Assessment Tx (from column 5 of 19A) e Totl Txes Pd (13+13b+13c + 13d) 14 Amount pyble (Enter f 12 s greter thn 13e, else enter 0) Refund(If 13e s greter thn 12) (refund, f ny, wll be drectly credted nto the bnk ccount) b 13 13b 13c 13d Detls of ll Bnk Accounts held n Ind t ny tme durng the prevous yer (excludng dormnt ccounts) (In cse of non-resdents, detls of ny one foregn Bnk Account my be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bnk n cse of Bnk Accounts held n Ind (SWIFT Code n cse of foregn Bnk Account) Nme of the Bnk b 2c 2d 2e 11b 11c 11d 3 3 Account Number ( (IBAN n cse of foregn Bnk Accounts) 1 1b 1c 1d 2f 3 7 9c 11e 13e Indcte the ccount n whch you prefer to get your refund credted, f ny (tck one ccount )

161 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Do you t ny tme durng the prevous yer,- () hold, s benefcl owner, benefcry or otherwse, ny sset (ncludng fnncl nterest n ny entty) locted outsde Ind; or () hve sgnng uthorty n ny ccount locted outsde Ind; or Yes () hve ncome from ny source outsde Ind? [pplcble only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] VERIFICATION I, son/ dughter of, solemnly declre tht to the best of my knowledge nd belef, the nformton gven n the return nd the schedules, sttements, etc. ccompnyng t s correct nd complete s n ccordnce wth the provsons of the Income-tx Act, I further declre tht I m mkng ths return n my cpcty s nd I m lso competent to mke ths return nd verfy t. I m holdng permnent ccount number (f llotted) (Plese see nstructon). I further declre tht the crtcl ssumptons specfed n the greement hve been stsfed nd ll the terms nd condtons of the greement hve been compled wth. (Applcble, n cse where return s furnshed under secton 92CD) Plce Dte Sgn here 18 TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON INCOME Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl BSR Code Dte of Depost (DD/MM/YYYY) Serl Number of Chlln Amount (Rs) No (1) (2) (3) (4) (5) v NOTE Enter the totls of Advnce tx nd Self-Assessment tx n Sl No. 13 & 13d of Prt B-TTI Detls of Tx Deducted t Source (TDS) on Income [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s)] Sl No TAN of the Deductor/ PAN of the Buyer/ Tennt Nme of the Deductor/ Buyer/Tennt Unque TDS Certfcte Number Unclmed TDS brought forwrd (b/f) Fn. Amount Yer n b/f whch deducted TDS of the current fn. yer Amount out of (6) or (7) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) Deducted n own hnds Deducted n the hnds of ny other person s per rule 37BA(2) (f pplcble) Clmed n own hnds Clmed n the hnds of ny other person s per rule 37BA(2) (f pplcble) No Amount out of (6) or (7) beng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Income TDS PAN of other person Income TDS PAN of other person C TCS ON INCOME NOTE Plese enter totl of column (8) n 13b of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tx Deducton nd Tx Collecton Account Number of the Collector Nme of the Collector Unclmed TCS brought forwrd (b/f) Fn. Yer n whch collected Amount b/f TCS of the current fn. yer Amount out of (5) or (6) beng clmed ths Yer (only f correspondng ncome s beng offered for tx ths yer) Amount out of (5) or (6) beng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) NOTE Plese enter totl of column (7) n 13c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (S1 - S15) AS APPLICABLE

162 340 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule I Yer of ccumulton (F.Yr.) Detls of mounts ccumulted / set prt wthn the menng of secton 11(2)) or n terms of thrd provso to secton 10(23C) Amount Purpose of ccumulted ccumulton n the yer of ccumulton Amount ppled for chrtble/ relgous purposes upto the begnnng of the prevous yer Amount nvested or deposted n the modes specfed n secton 11(5) Amounts ppled for chrtble or relgous purpose durng the prevous yer Blnce mount vlble for pplcton (7) = (2) - (4) (6) (1) (2) (3) (4) (5) (6) (7) (8) Totl Amount deemed to be ncome wthn menng of sub-secton (3) of secton 11 Sttement showng the funds nd nvestments s on the lst dy of the prevous yer [to be flled f Schedule J regstered under secton 12A/12AA or pproved under secton 10(23C)(v)/10(23C)(v)/ 10(23C)(v)/10(23C)(v)/10(21)] A Blnce n the corpus fund s on the lst dy of the prevous yer Rs. Blnce n the non-corpus fund s on the lst dy of the prevous yer B Detls of nvestment/deposts mde under secton 11(5) Sl No Mode of nvestment s per secton 11(5) Dte of nvestment Dte of mturty Rs. Amount of nvestment Mturty mount DETAILS OF INVESTMENT OF FUNDS (1) (2) (3) (4) (5) (6) Investment n Government Svng Scheme Post Offce Svng Bnk Depost n Schedule Bnk or co-opertve socetes s per secton 11(5)() v Investment n UTI v Any Other v TOTAL C Investment held t ny tme durng the prevous yer (s) n concern (s) n whch persons referred to n secton 13(3) hve substntl nterest Sl No Nme nd ddress Where the Number of Clss of Nomnl Income from Whether the mount n col of the concern concern s shres held shres vlue of the (6) exceeds 5 percent of the compny held the nvestment cptl of the concern (tck s pplcble nvestment durng the prevous yer (tck s pplcble ) (1) (2) (3) (4) (5) (6) (7) (8) Yes No Yes No Yes No Yes No Yes No Yes No

163 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 341 v Yes No Yes No v Yes No Yes No TOTAL D Other nvestments s on the lst dy of the prevous yer Sl No Nme nd ddress of the concern Whether the concern s compny (tck s pplcble ) Clss of shres held Number of shres held Nomnl vlue of nvestment (1) (2) (3) (4) (5) (6) Yes No Yes No Yes No v Yes No v TOTAL E Voluntry contrbutons/dontons receved n knd but not converted nto nvestments n the specfed modes u/s 11(5) wthn the tme provded Sl.No Nme nd ddress of the donor Vlue of contrbuton/donton Amount out of (3) nvested n modes prescrbed under secton 11(5) Blnce to be treted s ncome under secton 11(3) (1) (2) (3) (4) (5) v TOTAL Schedule K Sttement of prtculrs regrdng the Author(s) / Founder(s) / Trustee(s) / Mnger(s), etc., of the Trust or Insttuton (to be mndtorly flled n by ll persons flng ITR-7) A Nme(s) of uthor(s) / founder(s) / Settlor(s) nd ddress(es), f lve Sl. Nme nd ddress PAN Adhr Number/ Enrolment Id (f vlble) B Nme(s) of the person(s) who ws / were trustee(s) / mnger(s) durng the prevous yer(s) Sl. Nme nd ddress PAN Adhr Number/ Enrolment Id (f elgble for Adhr) C Nme(s) of the person(s) who hs / hve mde substntl contrbuton to the trust / nsttuton n terms of secton 13(3)(b) Sl. Nme nd ddress PAN Adhr Number/ Enrolment Id (f vlble) D Nme(s) of reltve(s) of uthor(s), founder(s), trustee(s), mnger(s), nd substntl contrbutor(s) nd where ny such uthor, founder, trustee, mnger or substntl contrbutor s Hndu undvded fmly, lso the nmes of the members of the fmly nd ther reltves

164 342 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Sl. Nme nd ddress PAN Adhr Number/ Enrolment Id (f vlble) Schedule Poltcl Prty LA 1 Whether books of ccount were mntned? (tck s pplcble ) Yes No 2 Whether ny voluntry contrbuton from ny person n excess of twenty thousnd rupees ws receved durng the yer? (tck s pplcble ) Yes No If yes, whether record of ech voluntry contrbuton (other thn contrbutons b by wy of electorl bonds) n excess of twenty thousnd rupees (ncludng nme nd ddress of the person who hs mde such contrbuton) were mntned? Yes No (tck s pplcble ) 3 Whether the ccounts hve been udted? (tck s pplcble ) Yes No POLITICAL PARTY If yes, furnsh the followng nformton:- Dte of furnshng of the udt report (DD/MM/YYYY) / / b c d e f Nme of the udtor sgnng the udt report Membershp No. of the udtor Nme of the udtor (propretorshp/ frm) Propretorshp/frm regstrton No. Permnent Account Number (PAN) of the udtor (propretorshp/ frm) g Dte of udt report 4 Whether ny donton exceedng two thousnd rupees ws receved otherwse thn by n ccount pyee cheque or ccount pyee bnk drft or use of electronc Yes No clerng system through bnk ccount or through electorl bond? (tck s pplcble ) 5 Whether the report under sub-secton (3) of secton 29C of the Representton of the People Act, 1951 for the fnncl yer hs been submtted?(tck s pplcble ) Yes No 6 If yes, then dte of submsson of the report (DD/MM/YYYY) / / 7 Whether the return of ncome for the prevous yer s per provsons of secton 139(4B) ws furnshed wthn the due dte under secton 139? (tck s pplcble ) Yes No Schedule ET ELECTORAL TRUST Electorl Trust 1 Whether books of ccount were mntned? (tck s pplcble ) Yes No 2 Whether record of ech voluntry contrbuton (ncludng nme, ddress nd PAN of the person who hs mde such contrbuton long wth the mode of contrbuton) were mntned? (tck s pplcble ) 3 Whether record of ech elgble poltcl prty to whom the dstrbutble contrbutons hve been dstrbuted (ncludng nme, ddress, PAN nd regstrton number of elgble poltcl prty) ws mntned? (tck s pplcble ) 4 Whether the ccounts hve been udted s per rule 17CA(12)? (tck s pplcble ) If yes, dte of udt report n Form No.10BC (DD/MM/YYYY ) 5 Whether the report s per rule 17CA(14) furnshed to the Commssoner of Incometx or Drector of Income-tx?(tck s pplcble ) 6 Detls of voluntry contrbutons receved nd mounts dstrbuted durng the yer Openng blnce s on 1 st Aprl Voluntry contrbuton receved durng the yer Totl ( + ) v Amount dstrbuted to Poltcl prtes v v Amount spent on dmnstrtve nd mngement functons of the Trust v v Totl (v + v) v v Totl mount elgble for exempton under secton 13B v Yes Yes Yes No No No / / Yes No

165 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 343 v Closng blnce s on 31 st Mrch ( v) v Schedule AI Aggregte of ncome derved durng the prevous yer excludng Voluntry contrbutons [to be mndtorly flled n by ll persons flng ITR-7 (except Poltcl Prty or Electorl Trust)] 1 Recepts from mn objects 1 2 Recepts from ncdentl objects 2 3 Rent 3 4 Commsson 4 5 Dvdend ncome 5 6 Interest ncome 6 7 Agrculture ncome 7 AGGREGATE OF INCOME 8 Any other ncome (specfy nture nd mount) Nture Amount b b c c d d e Totl (8+8b+8c+8d) e 8 9 Totl 9 Schedule ER Amount ppled to chrtble or relgous purposes n Ind or for the stted objects of the trust/nsttuton durng the prevous yer - Revenue Account [to be mndtorly flled n by ll persons flng ITR-7 (except Poltcl Prty or Electorl Trust)] 1 Rents 1 2 Reprs 2 3 Compenston to employees 3 4 Insurnce 4 5 Workmen nd stff welfre expenses 5 6 Entertnment nd Hosptlty 6 7 Advertsement 7 8 Commsson 8 9 Roylty 9 10 Professonl / Consultncy fees / Fee for techncl servces Conveynce nd Trvelng expenses other thn on foregn trvel Foregn trvel expenses Scholrshp Gft Donton 15 Corpus 15 Other thn corpus Rtes nd txes, pd or pyble to Government or ny locl 16 body (excludng txes on ncome) 17 Audt fee Other expenses (Specfy nture nd mount) Out of ncome derved durng the prevous yer (A) Utlston of surplus ccumulte d durng erler yers (B) Nture Amount

166 344 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b c d e Totl (v + vb + vc + vd) e Totl Bd debts Provsons Interest Deprecton nd mortzton Totl revenue expenses 24 b c d 1 2 Schedule EC Amount ppled to chrtble or relgous purposes n Ind or for the stted objects of the trust/nsttuton durng the prevous yer Cptl Account [excludng pplcton from borrowed funds nd mount exempt u/s 11(1A)] [[to be mndtorly flled n by ll persons flng ITR-7 (except Poltcl Prty or Electorl Trust)] Addton to Cptl work n progress (for whch exempton u/s 11(1A) hs not been clmed) 1 Acquston of cptl sset (not clmed erler s pplcton of ncome nd for whch exempton u/s 11(1A) hs not been clmed) 2 3 Totl (1 + 2) 3 4 Net consderton on trnsfer of cptl sset 4 5 Exempton u/s 11(1A) 5 Net consderton on trnsfer of cptl sset excludng mount exempt u/s 11(1A) 6 (4-5) (tke 6 s nl, f negtve) 6 7 Other cptl expenses v Totl expenses (7 +7+7) 7 v 8 Totl cptl expenses ( ) 8 Out of ncome derved durng the prevous yer (A) Schedule HP Detls of Income from House Property (Plese refer to nstructons) Address of property 1 Town/ Cty Stte PIN Code 1 Is the property co-owned? Yes No (f YES plese enter followng detls) Utlsto n of surplus ccumul ted durng erler yers (B) Your percentge of shre n the property HOUSE PROPERTY Nme of Co-owner(s) PAN of Co-owner(s) (optonl) Percentge Shre n Property I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out I Deemed let out II Annul letble vlue or rent receved or recevble (hgher of the two, f let out for whole of the yer, lower of the two f let out for prt of the yer) 1 b The mount of rent whch cnnot be relzed 1b c Tx pd to locl uthortes 1c

167 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k d Totl (1b + 1c) 1d e Annul vlue (1 1d) (nl, f self -occuped etc. s per secton 23(2)of the Act) 1e f 30% of 1e 1f g Interest pyble on borrowed cptl 1g h Totl (1f + 1g) 1h Income from house property 1 (1f 1) 1 Address of property 2 Town/ Cty Stte PIN Code Is the property co-owned? Yes No (f YES plese enter followng detls) Your percentge of shre n the property. Nme of Co-owner(s) PAN of Co-owner(s) (optonl) Percentge Shre n Property I II [Tck the pplcble opton] Nme(s) of Tennt (f let out) PAN of Tennt(s) (f vlble) Let out I Deemed let out II Annul letble vlue or rent receved/ recevble (hgher of the two, f let out for whole of the yer, lower of the two, f let out for prt of the yer) 2 b The mount of rent whch cnnot be relzed 2b c Tx pd to locl uthortes 2c d Totl (2b + 2c) 2d e Annul vlue (2 2d) 2e f 30% of 2f 2f g Interest pyble on borrowed cptl 2g h Totl (2f + 2g) 2h Income from house property 2 (2e 2h) 2 3 Income under the hed Income from house property Unrelzed rent nd Arrers of rent receved durng the yer under secton 25A fter deductng 30% 3 b Totl ( ) (f negtve tke the fgure to 2 of schedule CYLA) 3b Schedule CG Cptl Gns A Short-term cptl gn 1 From ssets (shres/unts) where secton 111A s pplcble (STT pd) Full vlue of consderton 1 b Deductons under secton 48 Cost of cquston b Cost of Improvement b Expendture on trnsfer b v Totl ( + + ) bv c Blnce (1 bv) 1c d Loss, f ny, to be gnored under secton 94(7) 1d or e Short-term 94(8) (Enter cptl postve gn vlue (1c only) +1d) CAPITAL GAINS 2 From ssets where secton 111A s not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of Full or vlue b) of consderton n respect of ssets other thn unquoted shres c A1e

168 346 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Totl (c + ) b Deductons under secton 48 Cost of cquston b Cost of Improvement b Expendture on trnsfer b v Totl ( + + ) bv c Blnce (2 bv) 2c d Loss, f ny, to be gnored under secton 94(7) 2d or 94(8) (Enter postve vlue only) e Short-term cptl gn (2c + 2d) 2e 3 Deemed short term cptl gn on deprecble ssets A3 4 Exempton other thn u/s 11(1A), f ny (pls. specfy secton) A4 5 Totl short term cptl gn (A1e + 2e + A3 - A4) A5 B Long term cptl gn 1 From sset where provso under secton 112(1) s not pplcble In cse ssets sold nclude shres of compny other thn quoted shres, enter the followng detls Full vlue of consderton receved/recevble n respect of unquoted shres b Fr mrket vlue of unquoted shres determned n the prescrbed mnner c Full vlue of consderton n respect of c unquoted shres dopted s per secton 50CA for the purpose of Cptl Gns (hgher of or Full vlue of consderton n respect of ssets other thn unquoted shres Totl (c + ) b Deductons under secton 48 Cost of cquston fter ndexton b Cost of mprovement fter ndexton b Expendture on trnsfer b v Totl (b + b +b) bv c Blnce (1 bv) 1c d Exempton u/s 11(1A) 1d e Long-term cptl gns where provso under secton 112(1) s not pplcble (1c B1e 2 From sset where provso under secton 112(1) s pplcble (wthout ndexton) Full vlue of consderton b Deductons under secton 48 Cost of cquston wthout ndexton b Cost of mprovement wthout b Expendture on trnsfer b v Totl (b + b +b) bv c Blnce (2 bv) 2c d Exempton other thn u/s 11(1A), f ny (pls. specfy secton) 2d e Long-term cptl gns where provso under secton 112(1) s pplcble (2c B2e 3 Totl long term cptl gn (B1e + B2e) B3 C Income chrgeble under the hed CAPITAL GAINS (A5 + B3) (enter B3 s nl, f C 2 Schedule OS Income from other sources OTHER SOURCES 1 Income Dvdends, Gross b Interest, Gross c Rentl ncome from mchnery, plnts, buldngs, etc., Gross Others, Gross (excludng ncome from ownng rce horses)menton d the source Income from wnnngs from lotteres, crossword puzzles etc. Csh credts u/s 68 b Unexplned nvestments u/s 69 c Unexplned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B 1 1b 1c 1d

169 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 347 e Unexplned expendture etc. u/s 69C f Amount borrowed or repd on hund u/s 69D Totl ( + b + c + d + e + f) Income of the nture referred to n secton 56(2)(x) whch s chrgeble to tx Aggregte vlue of sum of money receved wthout consderton In cse mmovble property s receved b wthout consderton, stmp duty vlue of In cse mmovble property s receved for c ndequte consderton, stmp duty vlue of property n excess of such consderton In cse ny other property s receved d wthout consderton, fr mrket vlue of In cse ny other property s receved for e ndequte consderton, fr mrket vlue of property n excess of such consderton Totl (+ b + c +d + e) v v 1dv v Totl (1d + 1d+ 1d+ 1dv+1dv) 1dv e Totl (1 + 1b + 1c + 1dv) f Income ncluded n 1e chrgeble to tx t specl rte (to be tken to schedule SI) Income from wnnngs from lotteres, crossword puzzles, rces, gmes, gmblng, bettng etc. (u/s 115BB) Dvdend Income from domestc compny tht exceeds Rs.10 Lkh (u/s 115BBDA Deemed Income chrgeble to tx u/s 115BBE v Income from ptent chrgeble u/s 11BBF v Income from trnsfer of credts u/s 115BBG v Any other ncome under chpter XII/XII-A v Income ncluded n 1e chrgeble to tx t specl rte (1f +1f+1f+1fv + 1fv + g Gross 1fv) mount chrgeble to tx t norml pplcble rtes (1e 1fv) Deductons under secton 57(other thn those reltng to ncome under 1f,1f, 1f, 1fv, 1fv, h 1fv & 1fv) Expenses / Deductons Deprecton Totl Amounts not deductble u/s 58 j Profts chrgeble to tx u/s 59 k Income from other sources (other thn from ownng rce horses nd mount chrgeble to tx t specl rte) (1g h j) (If negtve tke the fgure to 4 of schedule CYLA) 2 Income from other sources (other thn from ownng rce horses) (1fv + 1k) (enter 1k s nl, f 2 3 Income from the ctvty of ownng nd mntnng rce horses Recepts 3 b Deductons under secton 57 n relton to (3) 3b c Amounts not deductble u/s 58 3c d Profts chrgeble to tx u/s 59 3d e Blnce (3 3b + 3c + 3d) 4 Income under the hed Income from other sources (2 + 3e) (tke 3e s nl f negtve) 4 h h h 1d 1d 1dv 1e 1f 1f 1f 1fv 1fv 1fv 1fv 1g 1 1j 1k 3ex Schedule- VC A Locl Voluntry Contrbutons (to be mndtorly flled n by ll persons flng ITR-7) Corpus fund donton A Other thn corpus fund donton () (b) (c) Grnts Receved from Government Grnts Receved from Compnes under Corporte Socl Responsblty Other specfc grnts

170 348 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule OA B (d) Other Dontons (e) Totl Ae Voluntry contrbuton locl (A + Ae) A Foregn contrbuton Corpus fund donton B Other thn corpus fund donton B Foregn contrbuton (B + B) B C Totl Contrbutons (A + B) C D Anonymous dontons, ncluded n C, chrgeble u/s 115BBC Aggregte of such nonymous dontons receved 5% of totl dontons receved t C or 1,00,000 whchever s hgher Anonymous dontons chrgeble u/s 30% ( ) Generl Do you hve ny ncome under the hed busness nd professon? Yes No (f yes plese enter followng 1 Nture of Busness or professon (refer to the nstructons) 1 2 Number of brnches 2 3 Method of ccountng employed n the prevous yer (Tck) mercntle 3 4 Is there ny chnge n method of ccountng (Tck) Yes 4 5 Effect on the proft becuse of devton, f ny, n the method of ccountng employed n the prevous yer from ccountng stndrds prescrbed under secton 5 145A 6 Method of vluton of closng stock employed n the prevous yer 6 b Rw Mterl (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) Fnshed goods (f t cost or mrket rtes whchever s less wrte 1, f t cost wrte 2, f t mrket rte wrte 3) c Is there ny chnge n stock vluton method (Tck) Yes No d Effect on the proft or loss becuse of devton, f ny, from the method of vluton prescrbed under secton 145A 6d Schedule BP Computton of ncome from busness or professon A From busness or professon other thn specultve busness nd specfed busness [ncludng busness ncome s referred to n secton 11(4A)] INCOME FROM BUSINESS OR PROFESSION 1 Proft before tx s per proft nd loss ccount 1 2 Net proft or loss from specultve busness ncluded n 1 (enter ve sgn n cse of loss) Net proft or loss from Specfed Busness u/s 3 35AD ncluded n 1 (enter ve sgn n cse of loss) 3 Proft or loss ncluded n 1, whch s referred to 4 n secton 44AD/44AE 4 5 Income credted to Proft nd Loss ccount (ncluded n 1) whch s exempt shre of ncome from frm(s) 5 b Shre of ncome from AOP/ BOI 5b c Any other exempt ncome 5c d Totl exempt ncome 6 Blnce ( d) 6 Expenses debted to proft nd loss ccount 7 7 consdered under other heds of ncome 8 Expenses debted to proft nd loss ccount whch relte to exempt ncome 9 Totl (7 + 8) 9 10 Adjusted proft or loss (6+9) 10 Deemed ncome under secton AB/33ABA/35ABB 2 5d 8

171 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 349 Any other tem or tems of ddton under secton to 44DA 13 Any other ncome not ncluded n proft nd loss 13 ccount/ny other expense not llowble (ncludng ncome from slry, commsson, bonus nd nterest from frms n whch 14 Totl ( ) Deducton llowble under secton 32(1)() Any other mount llowble s deducton Totl ( ) Income (14 17) Profts nd gns of busness or professon deemed to be under - Secton 44AD Secton 44ADA Secton 44AE v Totl (19 to 19) 20 Net proft or loss from busness or professon other thn specultve nd specfed busness ( v) 21 Net Proft or loss from busness or professon other thn specultve busness nd specfed busness fter pplyng rule 7A, 7B or 7C, f pplcble (If rule 7A, 7B or 7C s not pplcble, enter sme fgure s n 20) B Computton of ncome from specultve busness 24 Net proft or loss from specultve busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA Deductons n ccordnce wth secton 28 to 44DA Proft or loss from specultve busness ( ) (enter nl f loss) B27 C Computton of ncome from specfed busness under secton 35AD C 28 Net proft or loss from specfed busness s per proft or loss ccount Addtons n ccordnce wth secton 28 to 44DA 29 Deductons n ccordnce wth secton 28 to 44DA (other thn deducton under secton, () 35AD, () 32 or 35 on whch deducton u/s 35AD s clmed) 31 Proft or loss from specfed busness ( ) Deductons n ccordnce wth secton 35AD(1) Proft or loss from specfed busness (31-32) (enter nl f loss) 33 Relevnt cluse of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from drop down menu) D Income chrgeble under the hed Profts nd gns (A21+B27+C33) D E Computton of ncome chrgeble to tx under secton 11(4) 35 Income s shown n the ccounts of busness under tkng [refer secton 11(4)] E35 36 Income chrgeble to tx under secton 11(4) [D34-E35] E36 19v 20 A21 Schedule CYLA Detls of Income fter set-off of current yers losses Sl.No Hed/ Source of House property loss of Income the current yer set off CURRENT YEAR LOSS ADJUSTMENT v Loss to be djusted -> House property Busness (excludng speculton ncome nd ncome from specfed busness) Speculton ncome Specfed busness ncome Income of current yer (Fll ths column only f ncome s zero or postve) Busness Loss (other thn speculton or specfed busness loss) of the current yer set off Other sources loss (other thn loss from rce horses) of the current yer set off Current yer s Income remnng fter set off Totl loss Totl loss Totl loss (3b of Schedule HP) (A21 of Schedule-BP) (1k of Schedule-OS) =

172 350 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Short-term cptl gn v Long term cptl gn v Other sources (excludng proft from ownng rce horses nd wnnngs from lottery) v Proft from ownng nd mntnng rce horses x Totl loss set-off x Loss remnng fter set-off Schedule Computton of Mnmum Alternte Tx pyble under secton 115JB MAT Whether the Proft nd Loss Account s prepred n ccordnce wth the provsons of Prts II of Schedule III to the 1 Compnes Act, 2013 (If yes, wrte Y, f no wrte N ) Whether, for the Proft nd Loss Account referred to n tem 1 bove, the sme ccountng polces, ccountng stndrds 2 nd sme method nd rtes for clcultng deprecton hve been followed s hve been dopted for preprng ccounts ld before the compny t ts nnul generl body meetng? (If yes, wrte Y, f no wrte N MINIMUM ALTERNATE TAX 3 Proft fter tx s shown n the Proft nd Loss Account 3 4 Addtons (f debted n proft nd loss ccount) Income Tx pd or pyble or ts provson ncludng the mount of deferred tx nd the provson therefor b Reserve (except reserve under secton 33AC) c Provsons for unscertned lblty d Provsons for losses of subsdry compnes e Dvdend pd or proposed Expendture relted to exempt ncome under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt f under secton 10(38)] g Expendture relted to shre n ncome of AOP/ BOI on whch no ncome-tx s pyble s per secton 86 h Expendture n cse of foregn compny referred to n cluse (fb) of Explnton 1 to secton 115JB 4h Notonl loss on trnsfer of certn cptl ssets or unts referred to n cluse (fc) of Explnton 1 to secton 115JB 4 j Expendture reltble to ncome by wy of roylty n respect of ptent chrgeble to tx u/s 115BBF 4j k Deprecton ttrbutble to revluton of ssets l Gn on trnsfer of unts referred to n cluse (k) of explnton 1 to secton 115JB 4l m Others (ncludng resdul undjusted tems nd provson for dmnuton n the vlue of ny sset) n Totl ddtons (4+4b+4c+4d+4e+4f+4g+4h+4+4j+4k+4l+4m) 5 Deductons Amount wthdrwn from reserve or provsons f credted to Proft nd Loss ccount 5 b Income exempt under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] 5b c Amount wthdrwn from revluton reserve nd credted to proft nd loss ccount to the extent t does not 5c exceed the mount of deprecton ttrbutble to revluton of sset d Shre n ncome of AOP/ BOI on whch no ncome-tx s pyble s per secton 86 credted to Proft nd Loss 5d ccount e Income n cse of foregn compny referred to n cluse (d) of explnton 1 to secton 115JB 5e f Notonl gn on trnsfer of certn cptl ssets or unts referred to n cluse (e) of Explnton 1 to secton 115JB 5f g Loss on trnsfer of unts referred to n cluse (f) of Explnton 1 to secton 115JB 5g h Income by wy of roylty referred to n cluse (g) of explnton 1 to secton 115JB 5h Loss brought forwrd or unbsorbed deprecton whchever s less 5 j Proft of sck ndustrl compny tll net worth s equl to or exceeds ccumulted losses 5j k Others (ncludng resdul undjusted tems nd the mount of deferred tx credted to P&L A/c) l Totl deductons (5+5b+5c+5d+5e+5f+5g+5h+5+5j+5k) 5l 6 Book proft under secton 115JB (3+ 4n 5l) 6 4 4b 4c 4d 4e 4f 4g 4k 4m 5k 4n

173 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Tx pyble under secton 115JB 7 Schedule MATC Computton of tx credt under secton 115JAA 1 Tx under secton 115JB n ssessment yer (1d of Prt-B-TTI) 1 2 Tx under other provsons of the Act n ssessment yer (5 of Prt-B-TTI) 2 3 Amount of tx gnst whch credt s vlble [enter (2 1) f 2 s greter thn 1, otherwse 3 enter 0] 4 Utlston of MAT credt Avlble [Sum of MAT credt utlzed durng the current yer s subject to mxmum of mount mentoned n 3 bove nd cnnot exceed the sum of MAT Credt Brought Forwrd ] S.No Assessment Yer (A) MAT Credt MAT Credt Utlsed durng the Current Yer (C) Blnce MAT Credt Crred Forwrd (D)= (B3) (C) MAT CREDIT v v v v v x x x (enter 1-2, f 1>2 else enter 0) x Totl Gross (B1) Set-off n erler yers (B2) Blnce Brought forwrd (B3)=(B2)-(B1) 5 Amount of tx credt under secton 115JAA utlsed durng the yer [enter 4(C)x] 5 6 Amount of MAT lblty vlble for credt n subsequent ssessment yers [enter 4(D)x] 6 Schedule AMT Computton of Alternte Mnmum Tx pyble under secton 115JC 1 Totl Income s per tem 25 of PART-B-TI 1 2 Adjustment s per secton 115JC(2) Deducton Clmed under ny secton ncluded n Chpter VI-A under the 2 hedng C. Deductons n respect of certn ncomes b Deducton Clmed u/s 10AA 2b c Deducton clmed u/s 35AD s reduced by the mount of deprecton on 2c ssets on whch such deducton s clmed d Totl Adjustment (2+ 2b+2c) 2d 3 Adjusted Totl Income under secton 115JC(1) (1+2d) 3 4 Tx pyble under secton 115JC [18.5% of (3)] (In the cse of AOP, BOI, AJP ths s pplcble f 3 s greter thn Rs. 20 lkhs) 4 Schedule AMTC Computton of tx credt under secton 115JD 1 Tx under secton 115JC n ssessment yer (1d of Prt-B-TTI) 1 2 Tx under other provsons of the Act n ssessment yer (5 of Prt-B-TTI) 2 3 Amount of tx gnst whch credt s vlble [enter (2 1) f 2 s greter thn 1, otherwse 3 enter 0] 4 Utlston of AMT credt Avlble (Sum of AMT credt utlzed durng the current yer s subject to mxmum of mount mentoned n 3 bove nd cnnot exceed the sum of AMT Credt Brought Forwrd)

174 352 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] S.No Assessment Yer (AY) (A) Gross (B1) AMT Credt Set-off n erler yers (B2) Blnce brought forwrd (B3) = (B1) (B2) AMT Credt Blnce Utlsed durng the AMT Credt Current Yer Crred (C) Forwrd (D)= (B3) (C) v v v v v Current AY (enter 1-2, f 1>2 else enter 0) Totl 5 Amount of tx credt under secton 115JD utlsed durng the yer [totl of tem no 4C] 5 6 Amount of AMT lblty vlble for credt n subsequent ssessment yers [totl of 4D] 6 Schedule PTI Sl. PASS THROUGH INCOME Nme of busness trust/ nvestment fund Pss Through Income detls from busness trust or nvestment fund s per secton 115UA, 115UB PAN of the busness trust/ Sl. Hed of ncome Amount of nvestment fund ncome 1. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s 2. House property Cptl Gns Short term b Long term Other Sources v Income clmed to be exempt u/s 10(23FBB) b u/s.. c u/s NOTE Plese refer to the nstructons for fllng out ths schedule. TDS on such mount, f ny Schedule SI Income chrgeble to tx t specl rtes [Plese see nstructon] Sl No Secton Specl rte (%) Income () 1 111A (STCG on shres where STT pd) 15 SPECI AL RATE Tx thereon ()

175 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k provso (LTCG on lsted securtes/ unts wthout ndexton) (LTCG on others) B (Profts nd gns of lfe nsurnce busness) BB (Wnnngs from lotteres, puzzles, rces, gmes etc.) BBDA (Dvdend Income from domestc compny tht 10 exceeds Rs.10 Lkh) 7 115BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) BBF (Tx on ncome from ptent) BBG (Tx on ncome from trnsfer of crbon credts) Totl Schedule 115TD Accreted ncome under secton 115TD 1 Aggregte Fr Mrket Vlue (FMV) of totl ssets of trust/nsttuton 1 2 Less: Totl lblty of trust/nsttuton 2 3 Net vlue of ssets (1 2) 3 4 () FMV of ssets drectly cqured out of ncome referred to n secton 4 10(1) () FMV of ssets cqured durng the perod from the dte of creton 4 or estblshment to the effectve dte of regstrton u/s 12AA, f beneft u/s 11 nd 12 not clmed durng the sd perod () FMV of ssets trnsferred n ccordnce wth thrd provso to secton 115TD(2) 4 (v) Totl ( ) 4v 5 Lblty n respect of ssets t 4 bove 5 6 Accreted ncome s per secton 115TD [3 (4 5)] 6 7 Addtonl ncome-tx pyble u/s 115TD t mxmum mrgnl rte 7 8 Interest pyble u/s 115TE 8 9 Addtonl ncome-tx nd nterest pyble 9 10 Tx nd nterest pd Net pyble/refundble (9 10) Dte(s) of depost of tx on ccreted ncome Dte 1 DD/MM/YYYY Dte 2 DD/MM/YYYY 13 Nme of Bnk nd Brnch 14 BSR Code 15 Serl number of chlln 16 Amount deposted Dte 3 DD/MM/YYYY Schedule FSI Detls of Income from outsde Ind nd tx relef Sl. Country Txpyer Sl. Hed of Code Identfcton ncome Number INCOME FROM OUTSIDE INDIA AND TAX RELIEF 1 2 House Property Busness or Professon Cptl Gns v Other sources Income from outsde Ind (ncluded n PART B-TI) Tx pd outsde Ind Tx pyble on such ncome under norml provsons n Ind Tx relef vlble n Ind (e)= (c) or (d) whchever s lower Relevnt rtcle of DTAA f relef clmed u/s 90 or 90A () (b) (c) (d) (e) (f) Totl House Property Busness or Professon Cptl Gns

176 354 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NOTE v Other sources Totl Plese refer to the nstructons for fllng out ths schedule. Schedule TR Summry of tx relef clmed for txes pd outsde Ind 1Detls of Tx relef clmed Country Code Txpyer Identfcton Totl txes pd outsde Ind Number (totl of (c) of Schedule FSI n respect of ech country) TAX RELIEF FOR TAX PAID OUTSIDE INDIA Totl tx relef vlble (totl of (e) of Schedule FSI n respect of ech country) Secton under whch relef clmed (specfy 90, 90A or 91) () (b) (c) (d) (e) Totl Totl Tx relef vlble n respect of country where DTAA s pplcble (secton 2 90/90A) (Prt of totl of 1(d)) Totl Tx relef vlble n respect of country where DTAA s not pplcble (secton 3 91) (Prt of totl of 1(d)) Whether ny tx pd outsde Ind, on whch tx relef ws llowed n Ind, hs been 4refunded/credted by the foregn tx uthorty durng the yer? If yes, provde the detls below NOTE Schedule FA Amount of tx refunded b Plese refer to the nstructons for fllng out ths schedule. Detls of Foregn Assets nd Income from ny source outsde Ind Yes/No Assessment yer n whch tx relef llowed n Ind A Detls of Foregn Bnk Accounts held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Country Nme nd Code Nme nd Address of the Bnk Account holder nme Sttus- Owner/ Benefcl owner/ Benefcry Account Number Account openng dte Pek Blnce Durng the Yer (n rupees) Interest ccrued n the ccount Interest txble nd offered n ths return Amount Schedule where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () Item number of schedule DETAILS OF FOREIGN ASSETS () B Detls of Fnncl Interest n ny Entty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Nture of entty Dte snce held Nture of Income Income txble nd offered n Country Nme nd code Nme nd Address of the Entty Nture of Interest- Drect/ Benefcl owner/ Benefcry Totl Investment (t cost) (n rupees) Income ccrued from such Interest ths return Amount Schedule where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () Item number of schedule C Detls of Immovble Property held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Address of the Property Dte of cquston Totl Investment (t cost) (n rupees) Income Nture of Income Income txble nd offered n ths return Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry derved from the property Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () ()

177 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 355 D Detls of ny other Cptl Asset held (ncludng ny benefcl nterest) t ny tme durng the prevous yer Sl No Nture of Asset Dte of cquston Totl Investment (t cost) (n rupees) Nture of Income Income txble nd offered n ths return Country Nme nd code Ownershp- Drect/ Benefcl owner/ Benefcry Income derved from the sset Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detls of ccount(s) n whch you hve sgnng uthorty held (ncludng ny benefcl nterest) t ny tme durng the prevous yer nd whch hs not been ncluded n A to D bove. Sl No Nme of the ccount holder Account Number If (7) s yes, Income offered n ths return Nme of the Insttuton n whch the ccount s held Address of the Insttuton Pek Blnce/ Investment durng the yer (n rupees) Whether ncome ccrued s txble n your hnds? If (7) s yes, Income ccrued n the ccount Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detls of trusts, creted under the lws of country outsde Ind, n whch you re trustee, benefcry or settlor Sl No Nme nd ddress of Benefcres If (8) s yes, Income offered n Country Nme nd code Nme nd ddress of the trust Nme nd ddress of trustees Nme nd ddress of Settlor Dte snce poston held Whether ncome derved s txble n your hnds? If (8) s yes, Income derved from the trust ths return Amount Schedule where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Item number of schedule Detls of ny other ncome derved from ny source outsde Ind whch s not ncluded n,- () tems A to F bove nd, () ncome under the hed busness or professon If (6) s yes, Income offered n ths return Country Nme Nme nd ddress of the Whether txble Amount Schedule Income derved Nture of ncome nd code person from whom derved n your hnds? where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Plese refer to nstructons for fllng out ths schedule. Item number of schedule

178 356 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] ITR- V ACKNOWLEDGEMENT AY Receved wth thnks from return of ncome n ITR No. 1(SAHAJ) O 2 O 3 O 4(SUGAM) O 5 O 7 O for ssessment yer , hvng the followng prtculrs (A1) Frst nme (A2) Mddle nme (A3) Lst nme (A4) Permnent Account Number (A5) Dte of Brth(DD/MM/YYYY) (A6) Income Tx Wrd/Crcle (A7) Flt/Door/Buldng D D M M Y Y Y Y (A8) Nme of Premses/ Buldng/ Vllge (A9) Rod/ Street (A10) Are/ loclty (A11) Town/ Cty/ Dstrct (A12) Stte Country (A13) Pn code (A14) Fll only one: Fled- On or before due dte -139(1), After due dte -139(4), Revsed Return- 139(5) OR In response to notce under secton 139(9)-Defectve 142(1) A/153C OR Under Sec. 119(2)(b) COMPUTATION OF INCOME AND TAX RETURN Whole Rupee ( ) only. B1 Gross Totl Income B1 ( ) B2 Deductons under Chpter-VI-A B2 B3 Totl Income B3 ( ) B4 Current loss, f ny B4 ( ) B5 Net Tx Pyble B5 B6 Interest Pyble B6 B7 Totl Tx nd Interest Pyble B7 B8 Totl Advnce Tx Pd B8 B9 Totl Self Assessment Tx Pd B9 B10 Totl TDS deducted B10 B11 Totl TCS collected B11 B12 Totl Prepd Txes (B8 + B9 + B10+ B11) B12 B13 Tx Pyble (B7-B12, If B7>B12) B13 B14 Refund (B12-B7, If B12>B7) B14 B15 Exempt Income Agrculture Others B15 SIGN HERE FOR OFFICIAL USE ONLY STAMP RECEIPT NO. HERE SEAL, DATE AND SIGNATRUE OF RECEIVING OFFICIAL.