Is there any change in the company s name? If yes, please furnish the old name issued by MCA

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1 AUDIT INFORMATION FILING STATUS PERSONAL INFORMATION 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 Numer (CIN) ssued y MCA 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 If pulc compny wrte 6, nd f prvte compny wrte 7 (s defned n secton 3 of The Compny Act) Offce Phone Numer wth STD code/ Mole No. 1 Mole No. 2 Income Tx Wrd/Crcle Eml Address-1 Eml Address-2 () () (c) Return fled(tck)[plese see nstructon numer-5] On or efore due dte-139(1), After due dte-139(4), Revsed Return-139(5) Modfed return-92cd, under secton 119(2)(),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) (pplcle on Domestc Compny) (f) (g) Whether totl turnover/ gross recepts n the prevous yer exceeds 5 crore rupees? (Yes/No) (pplcle 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 estlshment (PE) n Ind (Tck) Yes No () (j) Whether ssessee s requred to seek regstrton under ny lw for the tme eng n force reltng to compnes? Whether ssessee s locted n n Interntonl Fnncl Servces Centre nd derves ncome solely n convertle foregn exchnge? (Tck) Yes No (k) Whether the ssessee compny s under lqudton (Tck) Yes No (l) Whether you re n FII / FPI? Yes/No If yes, plese provde SEBI Regn. No. (m) (n) Whether ny trnscton hs een mde wth person locted n jursdcton notfed u/s 94A of the Act? Yes No Whether ths return s eng fled y 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 Numer (PAN) of the representtve ssessee () Whether lle to mntn ccounts s per secton 44AA? (Tck) Yes No () Whether lle for udt under secton 44AB? (Tck) Yes No (c) If () s Yes, whether the ccounts hve een udted y n ccountnt? (Tck) Yes No If Yes, furnsh the followng nformton elow (1) Menton the dte of furnshng of udt report (DD/MM/YYYY) (2) Nme of the udtor sgnng the tx udt report (3) Memershp no. of the udtor (4) Nme of the udtor (propretorshp/ frm) Pge 1

2 NATURE OF COMPANY AND ITS BUSINESS SHAREHOLDERS INFORMATION KEY PERSONS BUSINESS ORGANISATION HOLDING STATUS (d) (e) (5) Propretorshp/frm regstrton numer (6) Permnent Account Numer (PAN) of the udtor (propretorshp/ frm) (7) Dte of udt report If lle 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 susdry compny, wrte 3 f oth, wrte 4 f ny other) () If susdry compny, menton the detls of the Holdng Compny PAN Nme of Holdng Compny Address of Holdng Compny Percentge of Shres held (c) If holdng compny, menton the detls of the susdry compnes PAN Nme of Susdry Compny Address of Susdry 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 () In cse of mlgmted compny, menton the detls of mlgmtng compny PAN Nme of Amlgmtng Compny Address of Amlgmtng Compny (c) In cse of demerged compny, menton the detls of resultng compny PAN Nme of Resultng Compny Address of Resultng Compny (d) In cse of resultng compny, menton the detls of demerged compny PAN Nme of Demerged Compny Address of Demerged Compny 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 Numer (DIN) ssued y MCA, n cse of Drector Prtculrs of persons who were enefcl 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 Nture of compny (Tck) 1 Whether pulc sector compny s defned n secton 2(36A) of the Income-tx Act Yes No 2 Whether compny owned y 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) y the Government or the Reserve Bnk of Ind or corporton owned y tht Bnk Yes No 4 Whether nkng compny s defned n cluse (c) of secton 5 of the Bnkng Regulton Act,1949 Yes No 5 6 Whether scheduled Bnk eng nk ncluded n the Second Schedule to the Reserve Bnk of Ind Act Whether compny regstered wth Insurnce Regultory nd Development Authorty (estlshed under su-secton (1) of secton 3 of the Insurnce Regultory nd Development Authorty Act, 1999) 7 Whether compny eng non-nkng Fnncl Insttuton Yes No Nture of usness or professon, f more thn one usness or professon ndcte the three mn ctvtes/ products Yes Yes No No Pge 2

3 EQUITY AND LIABILITIES S.No. Code [Plese see nstructon No.7()] Descrpton () () () Prt A-BS BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2017 OR AS ON THE DATE OF AMALGAMATION I Equty nd Lltes 1 Shreholder s fund A Shre cptl Authorsed A Issued, Suscred nd fully Pd up A Suscred ut not fully pd A v Totl (A + A) Av B Reserves nd Surplus Cptl Reserve B Cptl Redempton Reserve B Securtes Premum Reserve B v Deenture Redempton Reserve Bv v Revluton Reserve Bv v Shre optons outstndng mount Bv Other reserve (specfy nture nd mount) v v v c Totl (v + v) Bv v Surplus.e. Blnce n proft nd loss ccount (Det lnce Bv to e shown s ve fgure) x Totl (B + B + B + Bv + Bv + Bv + Bv + Bv) (Det lnce to e shown s ve fgure) Bx C Money receved gnst shre wrrnts 1C D Totl Shreholder s fund (Av + Bx + 1C) 1D 2 Shre pplcton money pendng llotment Pendng for less thn one yer Pendng for more thn one yer Totl ( + ) 2 3 Non-current lltes A Long-term orrowngs Bonds/ deentures Foregn currency Rupee c Totl ( + ) c Term lons Foregn currency Rupee lons 1 From Bnks 1 2 From others 2 3 Totl (1 + 2) 3 c Totl Term lons ( + 3) c Deferred pyment lltes 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 Pge 3

4 v Long term mturtes of fnnce lese olgtons x Totl Long term orrowngs (c + c + + v + v + v + v + v) B Deferred tx lltes (net) C Other long-term lltes Trde pyles Others Totl Other long-term lltes ( + ) D Long-term provsons Provson for employee enefts Others Totl ( + ) E Totl Non-current lltes (3A + 3B + 3C + 3D) 4 Current lltes A Short-term orrowngs v 3A 3B 3C 3D 3E Lons repyle on demnd From Bnks From Non-Bnkng Fnnce Compnes c From other fnncl nsttutons d From others e Totl Lons repyle on demnd ( + + 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 orrowngs (e v + v) B Trde pyles Outstndng for more thn 1 yer Others Totl Trde pyles ( + ) c d e v v 4A 4B C D Other current lltes Current mturtes of long-term det Current mturtes of fnnce lese olgtons Interest ccrued ut not due on orrowngs v Interest ccrued nd due on orrowngs 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 deentures nd nterest ccrued thereon x Other pyles x Totl Other current lltes ( v + v + v + v + v + x + x) Short-term provsons Provson for employee eneft Provson for Income-tx v v v v v x x 4C Proposed Dvdend v Tx on dvdend v Other v Totl Short-term provsons ( v + v) E Totl Current lltes (4A + 4B + 4C + 4D) v v 4D 4E Pge 4

5 Totl Equty nd lltes (1D E + 4E) I II ASSETS 1 Non-current ssets A Fxed ssets Tngle ssets Gross lock Deprecton c Imprment losses c d Net lock ( - c) d Intngle ssets Gross lock Amortzton c Imprment losses c d Net lock ( - c) d Cptl work-n-progress v Intngle 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 Unlsted equtes c Totl ( + ) c Investments n Preference shres v Investments n Government or trust securtes v v Investments n Deenture or onds 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 c for the purpose of usness or professon not for the purpose of usness or professon gven to shreholder, eng the enefcl owner of shre, or to ny concern or on ehlf/ eneft of such shreholder s per secton 2(22)(e) of I.T. Act E Other non-current ssets Long-term trde recevles Others Secured, consdered good Unsecured, consdered good c Doutful d Totl Other non-current ssets ( + + c) Totl (d + ) v v vc c d E Pge 5

6 v Non-current ssets ncluded n E whch s due from shreholder, eng the enefcl owner of shre, or from ny concern or on ehlf/ eneft 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 Unlsted equtes c Totl ( + ) Investment n Preference shres Investment n government or trust securtes v Investment n deentures or onds 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 recevles Outstndng for more thn 6 months Others Totl Trde recevles ( + + ) 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 Totl Short-term lons nd dvnces ( + ) v Short-term lons nd dvnces ncluded n E whch s for the purpose of usness or professon not for the purpose of usness or professon v c v v v v v v v 1F Av Bv C E c gven to shreholder, eng the enefcl owner of shre, or to ny concern or on ehlf/ eneft 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) Totl Assets (1F + 2G) 2G II Pge 6

7 DEBITS TO PROFIT AND LOSS ACCOUNT CREDITS TO PROFIT AND LOSS ACCOUNT Prt A-P& L 1 Revenue from opertons Proft nd Loss Account for the fnncl yer (fll tems 1 to 52 n cse where regulr ooks of ccounts re mntned, otherwse fll tem 53) A Sles/ Gross recepts of usness (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) c Totl ( + ) 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 recevle n respect of goods nd servces sold or suppled Unon Excse dutes Servce tx VAT/ Sles tx v Any other duty, tx nd cess v Totl ( v) C Totl Revenue from opertons (Av + Bv) 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 eng securtes chrgele 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) c Totl (x + x) 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 pyle, n respect of goods nd servces purchsed Custom duty 7 Counter velng duty Specl ddtonl duty I I I I Ic Iv V I I I Iv I I v v v v v x x x xc Av Bv 1C 2x 3v 5v Pge 7

8 v Unon excse duty v Servce tx v VAT/ Sles tx v Any other tx, pd or pyle v Totl ( v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores nd spre prts 9 10 Power nd fuel Rents Reprs to uldng Reprs to plnt, mchnery or furnture Compenston to employees 7v 7v 7v 7v Slres nd wges 14 Bonus Remursement of medcl expenses v Leve encshment v Leve trvel enefts v Contruton to pproved supernnuton fund v Contruton to recognsed provdent fund v Contruton to recognsed grtuty fund x Contruton to ny other fund v 14v 14v 14v 14v x Any other eneft to employees n respect of whch n 14x expendture hs een ncurred x Totl compenston to employees ( v + 14v + 14v + 14v + 14v + 14x + 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 pulcty (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 ( + ) 14x x v 7v 14x 15v Pge 8

9 PROVISIONS FOR TAX AND APPROPRIATIONS 25 Hotel, ordng nd Lodgng Trvelng expenses other thn on foregn trvelng Foregn trvelng expenses Conveynce expenses Telephone expenses Guest House expenses Clu expenses Festvl celerton expenses Scholrshp Gft Donton Rtes nd txes, pd or pyle to Government or ny locl ody (excludng txes on ncome) Unon excse duty 36 Servce tx VAT/ Sles tx v Cess 36v v Any other rte, tx, duty or cess ncl. STT nd CTT 36v v Totl rtes nd txes pd or pyle ( v + 36v) 36v 37 Audt fee Other expenses (specfy nture nd mount) 39 Totl ( + ) Bd dets wrtten off (specfy PAN of the person, f t s vlle, for whom Bd Det for mount of Rs. 1 lkh or more s clmed nd mount) v Others (more thn Rs. 1 lkh) where PAN s not vlle v Others (mounts less thn Rs. 1 lkh) v 39v v Totl Bd Det ( v + 39v) 40 Provson for d nd doutful dets Other provsons Proft efore nterest, deprecton nd txes [4 (5v v + 8 to x + 15v + 16 to to v 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 mortzton Proft efore txes ( ) Provson for current tx Provson for Deferred Tx nd deferred llty 47 39v Proft fter tx ( ) Blnce rought forwrd from prevous yer Amount vlle for pproprton ( ) Approprtons Trnsfer to reserves nd surplus 51 Proposed dvdend/ Interm dvdend Tx on dvdend/ Tx on dvdend for erler yers v Any other pproprton v Totl ( v) v 51v Pge 9

10 OTHER INFORMATION NO ACCOUNT CASE 52 Blnce crred to lnce sheet (50 51v) In cse where regulr ooks of ccount of usness or professon re not mntned, furnsh the followng nformton for prevous yer n respect of usness or professon Gross recepts Gross proft c Expenses d Net proft c 53d Prt A- OI Other Informton (optonl n cse not lle 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 3 Effect on the proft ecuse of devton, f ny, s per Income Computton Dsclosure Stndrds notfed under secton 145(2) [column 11() 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) 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 ecuse of devton, f ny, from the method of vluton prescred under secton 145A 5 Amounts not credted to the proft nd loss ccount, eng - the tems fllng wthn the scope of secton 28 the proform credts, drwcks, refund of duty of customs or excse or servce tx, or refund of sles tx or vlue dded tx, where such credts, drwcks or refunds re dmtted s due y 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+5+5c+5d+5e) 6 Amounts deted to the proft nd loss ccount, to the extent dsllowle under secton 36 due to nonfulflment 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 [36(1)()] 6 c Any sum pd to n employee s onus or commsson for servces rendered, where such sum ws otherwse pyle to hm s 6c profts or dvdend [36(1)()] d Any mount of nterest pd n respect of orrowed cptl [36(1)()] 6d e Amount of dscount on zero-coupon ond [36(1)()] f Amount of contrutons to recognsed provdent fund [36(1)(v)] 6f g Amount of contrutons to n pproved supernnuton fund [36(1)(v)] 6g h Amount of contruton to penson scheme referred to n secton 80CCD [36(1)(v)] 6h Amount of contrutons to n pproved grtuty fund [36(1)(v)] j Amount of contrutons to ny other fund k Any sum receved from employees s contruton 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 efore the due dte [36(1)(v)] l Amount of d nd doutful dets [36(1)(v)] m Provson for d nd doutful dets [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 usness ncome [36(1)(xv)] q Any other dsllownce r Totl mount dsllowle under secton 36 (totl of 6 to 6q) s Totl numer of employees employed y the compny (mndtory n cse compny hs recognzed Provdent Fund) 5 5 5c 5d 5e 6e 6 6j 6k 6l 6m 6n 6o 6p 6q 3 4d 5f 6r Pge 10

11 deployed n Ind deployed outsde Ind Totl 7 Amounts deted to the proft nd loss ccount, to the extent dsllowle under secton 37 Expendture of cptl nture [37(1)] Expendture of personl nture [37(1)] c d e Expendture ld out or expended wholly nd exclusvely NOT for the purpose of usness or professon [37(1)] Expendture on dvertsement n ny souvenr, rochure, trct, pmphlet or the lke, pulshed y poltcl prty [37(2B)] Expendture y wy of penlty or fne for volton of ny lw for the tme eng n force f Any other penlty or fne g Expendture ncurred for ny purpose whch s n offence or whch s prohted y lw h Expendture ncurred on corporte socl responslty (CSR) Amount of ny llty of contngent nture j Any other mount not llowle under secton 37 k Totl mount dsllowle under secton 37 (totl of 7 to 7j) 8 A. Amounts deted to the proft nd loss ccount, to the extent dsllowle under secton 40 B. Amount dsllowle under secton 40 ()(), on ccount of non-complnce wth the provsons of Chpter XVII-B Amount dsllowle under secton 40()() on ccount of non-complnce wth the provsons of Chpter XVII-B Amount dsllowle under secton 40()() on ccount of c non-complnce wth the provsons of Chpter VIII of the Fnnce Act, 2016 Amount dsllowle 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 ss of profts [40()()] f Amount pd s welth tx [40()()] g Amount pd y wy of roylty, lcense fee, servce fee etc. s per secton 40()() h Amount of nterest, slry, onus, commsson or remunerton pd to ny prtner or memer [40()] Any other dsllownce j Totl mount dsllowle under secton 40(totl of A to A ) Any mount dsllowed under secton 40 n ny precedng prevous yer ut llowle durng the prevous yer 9 Amounts deted to the proft nd loss ccount, to the extent dsllowle under secton 40A 10 Amounts pd to persons specfed n secton 40A(2)() Amount pd otherwse thn y ccount pyee cheque or ccount pyee nk drft under secton 40A(3) 100% dsllowle c Provson for pyment of grtuty [40A(7)] d ny sum pd y the ssessee s n employer for settng up or s contruton to ny fund, trust, compny, AOP, or BOI or socety or ny other nsttuton [40A(9)] e Any other dsllownce f Totl mount dsllowle under secton 40A Any mount dsllowed under secton 43B n ny precedng prevous yer ut llowle durng the prevous yer Any sum n the nture of tx, duty, cess or fee under ny lw c d e Any sum pyle y wy of contruton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the welfre of employees Any sum pyle to n employee s onus or commsson for servces rendered Any sum pyle s nterest on ny lon or orrowng from ny pulc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton Any sum pyle s nterest on ny lon or orrowng from ny scheduled nk f Any sum pyle towrds leve encshment g Totl mount llowle under secton 43B (totl of 10 to 10f ) 11 Any mount deted to proft nd loss ccount of the prevous yer ut dsllowle under secton 43B A A Ac Ad Ae Af Ag Ah A 9 9 9c 9d 9e c 10d 10e 10f 7 7 7c 7d 7e 7f 7g 7h 7 7j 7k Aj 8B 9f 10g Pge 11

12 Recept nd pyment ccount of compny under lqudton QUANTITATIVE DETAILS Any sum n the nture of tx, duty, cess or fee under ny lw Any sum pyle y wy of contruton to ny provdent fund or supernnuton fund or grtuty fund or ny other fund for the welfre of employees c Any sum pyle to n employee s onus or commsson for servces rendered d Any sum pyle s nterest on ny lon or orrowng from ny pulc fnncl nsttuton or Stte fnncl corporton or Stte Industrl nvestment corporton e Any sum pyle s nterest on ny lon or orrowng from ny scheduled nk f Any sum pyle towrds leve encshment Any sum pyle to the Indn Rlwys for the use of rlwy g ssets h Totl mount dsllowle under Secton 43B(totl of 11 to 11g) 12 Amount of credt outstndng n the ccounts n respect of Unon Excse Duty Servce tx c VAT/sles tx d Any other tx e Totl mount outstndng (totl of 12 to 12d) 13 Amounts deemed to e profts nd gns under secton 33AB or 33ABA or 33AC Any mount of proft chrgele to tx under secton Amount of ncome or expendture of pror perod credted or deted to the proft nd loss ccount (net) 15 Prt A QD Quntttve detls (optonl n cse not lle 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 () In the cse of mnufcturng concern 6 Rw mterls c d Openng stock 6 Purchses durng the prevous yer 6 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 c d e f openng stock 7 purchse durng the prevous yer 7 quntty mnufctured durng the prevous yer 7c sles durng the prevous yer 7d closng stock 7e shortge/ excess, f ny 7f c 11d 11e 11f 11g c 12d 11h 12e 6e 6h Prt A OL Recept nd pyment ccount of compny under lqudton 1 Openng lnce Csh n hnd 1 Bnk 1 Totl openng lnce 1 2 Recepts Pge 12

13 TOTAL INCOME Interest 2 Dvdend 2 Sle of ssets (pls. specfy nture nd mount) 2 2 c 2c d Totl ( + + c) 2d v Relston of dues/detors 2v v Others (pls. specfy nture nd mount) 2v 2v c Totl of other recepts (v + v) 2vc v Totl recepts ( d+ 2v + 2vc) 2v 3 Totl of openng lnce 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 4v c Totl of other pyments (4v + 4v) 4vc v Totl pyments ( v + 4vc) 4v 5 Closng lnce Csh n hnd 5 Bnk 5 Totl of closng lnce (5 + 5) 5 6 Totl of closng lnce nd pyments (4v + 5) 6 Prt B - TI Computton of totl ncome 1 Income from house property (3 of Schedule-HP) (enter nl f loss) 1 2 Profts nd gns from usness or professon Profts nd gns from usness other thn specultve usness nd 2 specfed usness (A37 of Schedule-BP) (enter nl f loss) Profts nd gns from specultve usness (B42 of Schedule-BP) (enter 2 nl f loss nd tke the fgure to schedule CFL) Profts nd gns from specfed usness (C48 of Schedule BP)(enter nl 2 f loss nd tke the fgure to schedule CFL) v Income from ptent u/s 115BBF (3d of Schedule BP) 2v v Totl ( v) 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 chrgele t pplcle rte (7v of tem E of schedule CG) v Totl Short-term ( + + ) Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) Totl Long-term ( + ) (enter nl f loss) c Totl cptl gns (3v + 3) (enter nl f loss) 4 Income from other sources 3v 2v 3c Pge 13

14 COMPUTATION OF TAX LIABILITY from sources other thn from ownng nd mntnng rce horses nd ncome chrgele to tx t specl rte (1 of Schedule OS) (enter nl f loss) Income chrgele to tx t specl rte (1fv of Schedule OS) c from ownng nd mntnng rce horses (3c of Schedule OS) (enter nl f loss) d Totl ( c) 5 Totl (1 + 2v + 3c + 4d) 5 6 Losses of current yer to e 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 + 4) 7 8 Brought forwrd losses to e set off gnst 7 (totl of 2x, 3x nd 4x of Schedule BFLA) 8 9 Gross Totl ncome (7 8) (5x of Schedule BFLA + 4) 9 10 Income chrgele to tx t specl rte under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA (e of Sch. 10A + 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)] Prt-C of Chpter VI-A [2 of Schedule VI-A nd lmted upto (9-10-2)] c Totl ( ) [lmted upto (9-10)] 13 Totl ncome ( c) Income chrgele to tx t specl rtes (totl of () of schedule SI) Income chrgele to tx t norml rtes (13-14) Net grculturl ncome(4 of Schedule EI) Losses of current yer to e crred forwrd (totl of x of Schedule CFL) Deemed totl ncome under secton 115JB (7 of Schedule MAT) c 4d c Prt B - TTI Computton of tx llty on totl ncome 1 Tx Pyle on deemed totl Income under secton 115JB (8 of Schedule MAT) 1 Surchrge on () ove c Educton cess, ncludng secondry nd hgher educton cess on (1+1) ove d Totl Tx Pyle u/s 115JB (1+1+1c) 2 Tx pyle on totl ncome Tx t norml rtes on 15 of Prt B-TI Tx t specl rtes (totl of col. () of Schedule-SI) c 1d c Tx Pyle on Totl Income (2 + 2) 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) 2d 2d 2g( ) f Gross tx llty (2c+2d+2e) 2f 3 Gross tx pyle (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 pyle fter credt under secton 115JAA [ (3-4)] 5 6 Tx relef Secton 90/90A(2 of Schedule TR) Secton 91(3 of Schedule TR) c Totl (6 + 6) 7 Net tx llty (5 6c) (enter zero f negtve) 7 8 Interest pyle For defult n furnshng the return (secton 234A) For defult n pyment of dvnce tx (secton 234B) c For deferment of dvnce tx (secton 234C) d Totl Interest Pyle (8+8+8c) c 2c 2d 2e 4 6c 8d Pge 14

15 TDS ON INCOME ADVANCE/ SELF ASSESSMENT TAX BANK ACCOUNT TAXES PAID 9 Aggregte llty (7 + 8d) 9 10 Txes Pd Advnce Tx (from column 5 of 15A) 10 TDS (totl of column 8 of 15B) 10 c TCS (totl of column 7 of 15C) 10c d Self-Assessment Tx (from column 5 of 15A) 10d e Totl Txes Pd ( c + 10d) 10e 11 Amount pyle (9-10e) (Enter f 9 s greter thn 10e, else enter 0) Refund (If 10e s greter thn 9) (Refund, f ny, wll e drectly credted nto the nk ccount) 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 Numer (the numer should e 9 dgts or more s per CBS system of the nk ) Indcte the ccount n whch you prefer to get your refund credted, f ny (tck one ccount ) Csh deposted durng to (f ggregte csh deposts durng the perod Rs.2 lkh) 14 Do you t ny tme durng the prevous yer,- () hold, s enefcl owner, enefcry 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? [pplcle only n cse of resdent] [Ensure Schedule FA s flled up f the nswer s Yes ] Yes No VERIFICATION I, son/ dughter of, holdng permnent ccount numer solemnly declre tht to the est of my knowledge nd elef, the nformton gven n the return nd the schedules thereto s correct nd complete nd tht the mount of totl ncome nd other prtculrs shown theren re truly stted nd re n ccordnce wth the provsons of the Income-tx Act, 1961, n respect of ncome chrgele to ncome-tx for the prevous yer relevnt to the ssessment yer 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 further declre tht the crtcl ssumptons specfed n the greement hve een stsfed nd ll the terms nd condtons of the greement hve een compled wth. (Applcle, n cse where return s furnshed under secton 92CD) Plce Dte Sgn here 15 TAX PAYMENTS A B Detls of pyments of Advnce Tx nd Self-Assessment Tx Sl BSR Code Dte of Depost (DD/MM/YYYY) Serl Numer 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 or Form 26QB ssued y Deductor(s)] Sl No TAN of the Deductor/ PAN of the Buyer Nme of the Deductor Unque TDS Certfcte Numer Unclmed TDS rought forwrd (/f) Fn. Yer n whch deducted Amount /f TDS of the current fn. yer Amount out of (6) or (7) eng clmed ths Yer (only f correspondng ncome s eng offered for tx ths yer) Amount out of (6) or (7) eng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) (9) C Sl TCS ON INCOME NOTE Plese enter totl of column (8) of Schedule-TDS n 10 of Prt B-TTI Detls of Tx Collected t Source (TCS) [As per Form 27D ssued y the Collector(s)] No Tx Deducton nd Tx Collecton Account Numer of the Collector Nme of the Collector Unclmed TCS rought forwrd (/f) Fn. Yer n whch collected Amount /f TCS of the current fn. yer Amount out of (5) or (6) eng clmed ths Yer (only f correspondng ncome s eng offered for tx ths yer) Amount out of (5) or (6) eng crred forwrd (1) (2) (3) (4) (5) (6) (7) (8) Pge 15

16 NOTE Plese enter totl of column (7) of Schedule-TCS n 10c of Prt B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1- S19) AS APPLICABLE Pge 16

17 INCOME FROM BUSINESS OR PROFESSION HOUSE PROPERTY 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 (Tck) f let out deemed let out Nme(s) of Tennt (f let out) PAN of Tennt(s) (optonl) 2 Annul letle vlue or rent receved or recevle (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 The mount of rent whch cnnot e relzed 1 c Tx pd to locl uthortes 1c d Totl (1 + 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 pyle on orrowed 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) f let out deemed let out Nme(s) of Tennt (f let out) PAN of Tennt(s) (optonl) I II Annul letle vlue or rent receved or recevle (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 The mount of rent whch cnnot e relzed 2 c Tx pd to locl uthortes 2c d Totl (2 + 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 pyle on orrowed 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% Totl (1j + 2j + 3) 3 3 Schedule BP Computton of ncome from usness or professon A From usness or professon other thn specultve usness nd specfed usness 1 Proft efore tx s per proft nd loss ccount (tem 45 nd 53 of Prt A-P&L ) 1 Net proft or loss from specultve usness ncluded n 1 (enter ve sgn n 2 cse of loss) Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n cse of loss) Income/ recepts credted to proft nd loss ccount consdered under other heds of ncome/chrgele u/s 115BBF House property Cptl gns c Other sources c Pge S1

18 4 d u/s 115BBF 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 5 Income credted to Proft nd Loss ccount (ncluded n 1) whch s exempt Shre of ncome from frm(s) 5 Shre of ncome from AOP/ BOI 5 c Any other exempt ncome (specfy nture nd mount) Totl (c + c) d Totl exempt ncome ( c) c c 5c 6 Blnce ( c 3d 4 5d) 6 7 Expenses deted to proft nd loss ccount consdered under other heds of ncome/relted to ncome chrgele u/s 115BBF House property Cptl gns c Other sources d u/s 115BBF 8 Expenses deted to proft nd loss ccount whch relte to exempt ncome 8 9 Totl ( c + 7d + 8) 9 10 Adjusted proft or loss (6+9) Deprecton nd mortston deted to proft nd loss ccount Deprecton llowle under Income-tx Act Deprecton llowle under secton 32(1)() nd 32(1)() (tem 6 of Schedule-DEP) Deprecton llowle 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 deted to the proft nd loss ccount, to the extent dsllowle 14 under secton 36 (6r of Prt A-OI) Amounts deted to the proft nd loss ccount, to the extent dsllowle under secton 37 (7k of Prt A-OI) 15 Amounts deted to the proft nd loss ccount, to the extent dsllowle 16 under secton 40 (8Aj of Prt A-OI) 16 Amounts deted to the proft nd loss ccount, to the extent dsllowle 17 under secton 40A (9f of Prt A-OI) 17 Any mount deted to proft nd loss ccount of the prevous yer ut 18 dsllowle under secton 43B (11h of Prt A-OI) 18 Interest dsllowle 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/ 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ 80-IA 22 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 llowle (ncludng ncome from slry, commsson, onus nd nterest 24 from frms n whch compny s prtner) 25 Totl ( ) Deducton llowle under secton 32(1)() Deducton llowle under secton 32AD Amount llowle s deducton under secton 32AC 28 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the mount deted to proft nd loss ccount (tem x(4) of Schedule ESR) (f 29 mount deductle under secton 35 or 35CCC or 35CCD s lower thn mount 29 deted to P&L ccount, t wll go to tem 24) Any mount dsllowed under secton 40 n ny precedng prevous yer ut 30 llowle durng the prevous yer(8b of Prt A-OI) 30 Any mount dsllowed under secton 43B n ny precedng prevous yer ut 31 llowle durng the prevous yer (10g of Prt A-OI) Deducton under secton 35AC Amount, f ny, deted to proft nd loss ccount 32 Amount llowle s deducton 32 c Excess mount llowle s deducton (32 32) 32c 33 Any other mount llowle s deducton Totl ( c+33) 34 3d 4 5d 7 7 7c 7d Pge S2

19 DEPRECIATION ON PLANT AND MACHINERY 35 Income ( ) Profts nd gns of usness or professon deemed to e under - Secton 44AE 36 Secton 44B Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v Secton 44DA 36v (tem 4 of Form 3CE) v Chpter-XII-G (tonnge) 36v (totl of col. 7 of tem 10 of Form 66) x Frst Schedule of Income-tx Act x Totl (36 to 36x) 37 Net proft or loss from usness or professon other thn specultve nd specfed usness (35+36x ) 37 Net Proft or loss from usness or professon other thn specultve usness nd specfed usness fter 38 pplyng rule 7A, 7B or 8, f pplcle (If rule 7A, 7B or 8 s not pplcle, enter sme fgure s n 37) (If A38 loss tke the fgure to 2 of tem E) B Computton of ncome from specultve usness 39 Net proft or loss from specultve usness 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 usness ( ) (f loss, tke the fgure to 6x of schedule CFL) B42 C Computton of ncome from specfed usness under secton 35AD 43 Net proft or loss from specfed usness 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 usness ( ) Deductons n ccordnce wth secton 35AD(1) or 35AD(1A) Income from Specfed Busness (46-47) (f loss, tke the fgure to 7x of schedule CFL) C48 D Income chrgele under the hed Profts nd gns from D usness or professon (A37+B42+C48) D E Intr hed set off of usness loss of current yer Sl. Type of Busness ncome Loss to e set off (Fll ths row only f fgure s negtve) v 36v 36v 36x Income of current yer (Fll ths column only f fgure s zero or postve) Busness loss set off 36x 45 Busness ncome remnng fter set off (1) (2) (3) = (1) (2) (A37) Income from specultve usness Income from specfed usness (B42) (C48) v Totl loss set off ( + ) v Loss remnng fter set off ( v) Deprecton on Plnt nd Mchnery (Other thn ssets on whch full cptl expendture s llowle s deducton under ny other Schedule DPM secton) 1 Block of ssets Plnt nd mchnery 2 Rte (%) 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 e 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 () () () (v) (v) (v) (v) Pge S3

20 SUMMARY OF DEPRECIATION ON ASSETS DEPRECIATION ON OTHER ASSETS 9 Amount on whch deprecton t hlf rte to e 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 Expendture ncurred n connecton wth trnsfer of sset/ ssets 17 Cptl gns/ loss under secton 50 ( ) (enter negtve only f lock ceses to exst) 18 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 llowle s deducton) 1 Block of ssets Buldng Furnture nd fttngs Intngle ssets Shps 2 Rte (%) 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 e 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 e 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 Expendture ncurred n connecton wth trnsfer of sset/ ssets 14 Cptl gns/ loss under secton 50* ( ) (enter negtve only f lock ceses to exst) 15 Wrtten down vlue on the lst dy of prevous yer* ( ) (enter 0 f result s negtve) Schedule DEP 1 Plnt nd mchnery () () () (v) (v) (v) Summry of deprecton on ssets (Other thn on ssets on whch full cptl expendture s llowle s deducton under ny other secton) Block enttled for 15 per cent ( Schedule DPM - 15 ) Block enttled for 30 per cent ( Schedule DPM - 15 ) Block enttled for 40 per cent c ( Schedule DPM - 15 ) Block enttled for 50 per cent d ( Schedule DPM - 15 v) Block enttled for 60 per cent e ( Schedule DPM - 15 v) Block enttled for 80 per cent f ( Schedule DPM 15 v) Block enttled for 100 per cent g ( Schedule DPM - 15 v) h Totl deprecton on plnt nd mchnery ( c + 1d+ 1e + 1f + 1g ) 2 Buldng 1 1 1c 1d 1e 1f 1g 1h Pge S4

21 CAPITAL GAINS Short-term Cptl Gns Block enttled for 5 per cent 2 (Schedule DOA- 12) Block enttled for 10 per cent 2 (Schedule DOA- 12) c Block enttled for 100 per cent 2c (Schedule DOA- 12) d Totl deprecton on uldng (2+2+2c) 2d 3 Furnture nd fttngs(schedule DOA- 12 v) 3 4 Intngle ssets (Schedule DOA- 12 v) 4 5 Shps (Schedule DOA- 12 v) 5 6 Totl deprecton ( 1h+2d+3+4+5) 6 Schedule DCG Deemed Cptl Gns on sle of deprecle ssets 1 Plnt nd mchnery Block enttled for 15 per cent 1 (Schedule DPM - 17) Block enttled for 30 per cent 1 (Schedule DPM 17) c Block enttled for 40 per cent 1c (Schedule DPM - 17) d Block enttled for 50 per cent 1d (Schedule DPM - 17v) e Block enttled for 60 per cent 1e (Schedule DPM 17v) f Block enttled for 80 per cent 1f (Schedule DPM 17v) g Block enttled for 100 per cent 1g (Schedule DPM 17v) h Totl ( c + 1d + 1e + 1f + 1g) 1h 2 Buldng Block enttled for 5 per cent 2 (Schedule DOA- 14) Block enttled for 10 per cent 2 (Schedule DOA- 14) c Block enttled for 100 per cent 2c (Schedule DOA- 14) d Totl ( c) 2d 3 Furnture nd fttngs ( Schedule DOA- 14v) 3 4 Intngle ssets (Schedule DOA- 14v) 4 5 Shps (Schedule DOA- 14v) 5 6 Totl ( 1h+2d+3+4+5) 6 Schedule ESR Sl No v v v v v x x 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) 35(2AB) 35CCC 35CCD Totl Amount, f ny, deted to proft nd loss ccount (2) Amount of deducton llowle (3) Amount of deducton n excess of the mount deted to proft nd loss ccount (4) = (3) - (2) Schedule CG Cptl Gns A Short-term Cptl Gns (STCG) (Items 4, 5 & 8 re not pplcle for resdents) 1 From sle of lnd or uldng or oth Full vlue of consderton receved/recevle Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) Deductons under secton 48 Pge S5

22 Cost of cquston wthout ndexton Cost of Improvement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) v c Blnce ( v) 1c d Deducton under secton 54D/ 54G/54GA (Specfy detls n tem D elow) e Short-term Cptl Gns on Immovle property (1c - 1d) A1e 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) 3 4 Net worth of the under tkng or dvson 2 (6(e) of Form 3CEA) c Short term cptl gns from slump sle (2-2) From sle of equty shre or unt of equty orented Mutul Fund (MF) or unt of usness trust on whch STT s pd under secton 111A or 115AD(1)() provso (for FII) Full vlue of consderton 3 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 v) 3c d Loss to e dsllowed u/s 94(7) or 94(8)- for exmple f sset ought/cqured wthn 3 months pror to record dte nd dvdend/ncome/onus unts re receved, then loss rsng out of sle of such sset to e 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 eng n FII- from sle of shres or deentures of n Indn compny (to e computed wth foregn exchnge djustment under frst provso to secton 48) STCG on trnsctons on whch securtes trnscton tx (STT) s pd A4 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 ove) y n FII s per secton 115AD Full vlue of consderton 5 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 v) 5c d Loss to e dsllowed u/s 94(7) or 94(8)- for exmple f securty ought/cqured wthn 3 months pror to record dte nd dvdend/ncome/onus unts re receved, then loss rsng out of sle of such securty to e gnored (Enter postve vlue only) e Short-term cptl gn on securtes (other thn those t A3 ove) y n FII (5c +5d) A5e 6 From sle of ssets other thn t A1 or A2 or A3 or A4 or A5 ove Full vlue of consderton 6 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 (6 v) 6c d In cse of sset (securty/unt) loss to e dsllowed u/s 94(7) or 94(8)- for exmple f sset ought/cqured wthn 3 months pror to record dte nd dvdend/ncome/onus unts re receved, then loss rsng out of sle of such sset to e gnored (Enter postve vlue only) 6d e Deemed short term cptl gns on deprecle 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 ove (6c + 6d + 6e 6f) A6g 7 Amount deemed to e short-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yers shown elow ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcle. If yes, then provde the detls elow Sl. Prevous yer Secton under whch New sset cqured/constructed Amount not used for v 5d v 1d v 3d A2c A4 Pge S6

23 Long-term Cptl Gns n whch sset deducton clmed n trnsferred tht yer D/54G/54GA Yer n whch sset Amount utlsed out of cqured/constructed Cptl Gns ccount Amount deemed to e short-term cptl gns u/s 54D/54G/54GA, other thn t Totl Amount deemed to e short-term cptl gns u/s 54D/54G/54GA (X + ) 8 FOR NON-RESIDENTS- STCG ncluded n A1-A7 ut not chrgele to tx n Ind s per DTAA Sl. I II Country nme, code Whether Tx Resdency Artcle of DTAA Certfcte otned? III Totl mount of STCG not chrgele to tx n Ind s per DTAA new sset or remned unutlzed n Cptl gns ccount (X) Item No.A1 to A7 ove n Amount of whch ncluded STCG A1e/A2c/A3e/A4/A4/A5e/A6g/A 7 A1e/A2c/A3e/A4/A4/A5e/A6g/A 7 9 Totl Short-term Cptl Gn (A1e+ A2c+ A3e+ A4+ A4+ A5e+ A6g+A7-A8) A9 B Long-term cptl gn (LTCG) (Items 5, 6 & 9 re not pplcle for resdents) 1 From sle of lnd or uldng or oth Full vlue of consderton receved/recevle Vlue of property s per stmp vluton uthorty Full vlue of consderton dopted s per secton 50C for the purpose of Cptl Gns ( or ) Deductons under secton 48 Cost of cquston wth ndexton Cost of Improvement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + + ) c Blnce ( v) Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n tem D d elow) e Long-term Cptl Gns on Immovle property (1c - 1d) 2 From slump sle Full vlue of consderton 2 (5 of Form 3CEA) Net worth of the under tkng or dvson 2 (6(e) of Form 3CEA) c Blnce (2 2) d Deducton u/s 54EC/54EE e Long term cptl gns from slump sle (2c-2d) 3 From sle of onds or deenture (other thn cptl ndexed onds ssued y Government) 4 Full vlue of consderton 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 (3 v) d Deducton under sectons 54EC /54EE (Specfy detls n tem D elow) e LTCG on onds or deenture (3c 3d) From sle of lsted securtes (other thn unt) or zero coupon onds where provso under secton 112(1) s pplcle Full vlue of consderton 4 2c 2d v 1c 1d 3 v Deductons under secton 48 Cost of cquston wthout ndexton Cost of mprovement wthout ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + +) v c Blnce (4 v) 4c d Deducton under sectons 54EC /54EE (Specfy detls n tem D elow) 4d e Long-term Cptl Gns on ssets t B4 ove (4c 4d) B4e For NON-RESIDENTS- from sle of shres or deenture of Indn compny (to e computed wth foregn 5 exchnge djustment under frst provso to secton 48) LTCG computed wthout ndexton eneft 5 Deducton under sectons 54EC /54EE (Specfy detls n tem D elow) 5 c LTCG on shre or deenture (5-5) B5c For NON-RESIDENTS- from sle of, () unlsted securtes s per sec. 112(1)(c), () unts referred n sec. 115AB, 6 () onds or GDR s referred n sec. 115AC, (v) securtes y FII s referred to n sec. 115AD Full vlue of consderton 6 3c 3d A7 A8 B1e B2e B3e Pge S7

24 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 (6 v) 6c d Deducton under sectons 54EC/54EE (Specfy detls n tem D elow) 6d e Long-term Cptl Gns on ssets t 6 ove n cse of NON-REESIDENT (6c 6d) B6e 7 From sle of ssets where B1 to B6 ove re not pplcle Full vlue of consderton 7 Deductons under secton 48 Cost of cquston wth ndexton Cost of mprovement wth ndexton Expendture wholly nd exclusvely n connecton wth trnsfer v Totl ( + +) v c Blnce (7 v) 7c d Deducton under secton 54D/54EC/54EE /54G/54GA (Specfy detls n tem D elow) 7d e Long-term Cptl Gns on ssets t B7 ove (7c-7d) B7e 8 Amount deemed to e long-term cptl gns Whether ny mount of unutlzed cptl gn on sset trnsferred durng the prevous yer shown elow ws deposted n the Cptl Gns Accounts Scheme wthn due dte for tht yer? Yes No Not pplcle. If yes, then provde the detls elow Sl. New sset cqured/constructed Prevous yer n Secton under whch whch sset deducton clmed n Amount 8tlzed Yer n whch sset trnsferred tht yer out of Cptl cqured/constructed Gns ccount /54D/54F/54G/54GA Amount deemed to e long-term cptl gns, other thn t Totl mount deemed to e long-term cptl gns (X + ) v Amount not used for new sset or remned unutlzed n Cptl gns ccount (X) 9 FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 ut not chrgele to tx n Ind s per DTAA B8 10 Sl. Country nme, code Whether Tx Resdency Artcle of DTAA Certfcte otned? Item B1 to B8 ove n whch ncluded B1e/B2e/B3e/ B4c/ I B5e/B6c/B6f/B7e/B8 II B1e/B2e/B3e/ B4c/ B5e/B6c/B6f/B7e/B8 III Totl mount of LTCG not chrgele to tx n Ind s per DTAA Amount of LTCG 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 chrgele under the hed CAPITAL GAINS (A9 + B10) (tke B10 s nl, f loss) D Informton out deducton clmed 1 In cse of deducton u/s 54B/54D/54EC/54EE /54G/54GA gve followng detls Secton under whch deducton clmed 1 mount of deducton Cost of new sset Dte of ts cquston/constructon dd/mm/yyyy Amount deposted n Cptl Gns Accounts Scheme efore due dte Secton under whch deducton clmed 1 mount of deducton Cost of new sset Dte of ts cquston/constructon dd/mm/yyyy Amount deposted n Cptl Gns Accounts Scheme efore due dte c Totl deducton clmed (1 + 1) 1c B9 B10 C E Set-off of current yer cptl losses wth current yer cptl gns (excludng mounts ncluded n A7 & B9 whch s chrgele 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 Long term cptl loss set off 15% 30% pplcle rte 10% 20% Current yer s cptl gns remnng fter set off (7= ) Loss to e set off (Fll ths row f fgure computed s negtve) (A3e+A4) A5e (A1e+A2c+A4 +A6g +A7) (B4e+ + B6e) (B1e+B2e+B3e+ B5c+ B7e+B8) Pge S8