250 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3(i)]

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1 250 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] MINISTRY OF FINANCE (Department of Revenue) (CENTRAL BOARD OF DIRECT TAXES) NOTIFICATION New Delh, the 1st Aprl, 2019 Income-tax G.S.R. 279(E). In exercse of the powers conferred by secton 139 read wth secton 295 of the Income-tax Act, 1961 (43 of 1961), the Central Board of Drect Taxes hereby makes the followng rules further to amend the Income-tax Rules, 1962, namely:- 1. Short ttle and commencement. (1) These rules may be called the Income-tax (Second Amendment) Rules, (2) They shall come nto force wth effect from the 1 st day of Aprl, In the Income-tax rules, 1962 (herenafter referred to as the prncpal rules), n rule 12, (a) n sub-rule (1),- (I) n the openng porton, for the fgures 2018, the fgures 2019 shall be substtuted; (II) n clause (a), n the provso, after tem (IC), the followng tems shall be nserted, namely: (ID) has clamed deducton under secton 57, other than deducton clamed (a) thereof; (IE) s a drector n any company; (IF) has held any unlsted equty share at any tme durng the prevous year; under clause (IG) s assessable for the whole or any part of the ncome on whch tax has been deducted at source n the hands of a person other than the assesse; ; (III) n clause (ca), () n the openng porton, for the words a Hndu undvded famly or a frm, other than a lmted lablty partnershp frm,, the words a Hndu undvded famly, who s a resdent other than not ordnarly resdent, or a frm, other than lmted lablty partnershp frm, whch s a resdent shall be substtuted; () n the provso, for tem (I), the followng tems shall be substtuted, namely: (I) has assets (ncludng fnancal nterest n any entty) located outsde Inda; (IA) has sgnng authorty n any account located outsde Inda; (IB) has ncome from any source outsde Inda; (IC) has ncome to be apportoned n accordance wth provsons of secton 5A; (ID) s a drector n any company; (IE) has held any unlsted equty share at any tme durng the prevous year; (IF) has total ncome, exceedng ffty lakh rupees; (IG) owns more than one house property, the ncome of whch s chargeable under the head Income from house property ; (IH) has any brought forward loss or loss to be carred forward under any head of ncome; (IJ) s assessable for the whole or any part of the ncome on whch tax has been deducted at source n the hands of a person other than the assesse; ; (IV) n clause (g), the words, brackets, fgures and letters or sub-secton (4E) or sub-secton (4F) shall be omtted; (b) n sub-rule (3), n the Table, n column (), aganst the entres at seral number 1, n column (), for tem (b), the followng tem shall be substtuted, namely:

2 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 251 (b) Where total ncome assessable under the Act durng the prevous year of a person, beng an ndvdual of the age of eghty years or more at any tme durng the prevous year, and who furnshes the return n Form number SAHAJ (ITR-1) or Form number SUGAM (ITR-4). ; (c) n sub-rule (5), for the fgures 2017, the fgures 2018 shall be substtuted. 3. In the prncpal rules, n Appendx II, for Forms Form Sahaj (ITR-1), Form ITR-2, Form ITR-3, Form Sugam (ITR-4), Form ITR-5, Form ITR-6, Form ITR-7 and Form ITR-V, the followng Forms shall, respectvely, be substtuted, namely;- FORM ITR-1 SAHAJ INDIAN INCOME TAX RETURN [For ndvduals beng a resdent (other than not ordnarly resdent) havng total ncome upto Rs.50 lakh, havng Income from Salares, one house property, other sources (Interest etc.), and agrcultural ncome upto Rs.5 thousand] [Not for an ndvdual who s ether Drector n a company or has nvested n unlsted equty shares] (Refer nstructons for elgblty) Assessment Year PART A GENERAL INFORMATION PAN Name Date of Brth Aadhaar Number (12 dgt)/aadhaar Enrolment Id (28 dgt) (If elgble for Aadhaar) D D M M Y Y Y Y Moble No. Emal Address Address: Flat/Door/Block No. Name of Premses/Buldng/Vllage Road/Street/Post Offce Area/localty Town/Cty/Dstrct State Country Pn code Fled u/s (Tck) [Please see nstructon] Or Fled n response to notce u/s 139(1)-On or before due date, 139(4)-Belated, 139(5)- Revsed, 119(2)(b)- after condonaton of delay. 139(9), 142(1), 148, 153A 153C If revsed/defectve, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) Nature of employment- Govt. PSU Pensoners Others / / If fled n response to notce u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b)- enter Unque Number & Date of such Notce or Order PART B GROSS TOTAL INCOME B1 Gross Salary (a + b + c) SALARY / PENSION a Salary as per secton 17(1) b Value of perqustes as per secton 17(2) c Proft n leu of salary as per secton 17(3) Less allowances to the extent exempt u/s 10 (drop down to be provded n e-flng utlty) Net Salary ( ) v Deductons u/s 16 (va + vb + vc) a Standard deducton u/s 16(a) b Entertanment allowance u/s 16() c Professonal tax u/s 16() v Income chargeable under the head Salares ( v) B2 Tck applcable opton Self Occuped Let Out Deemed Let Out HOUSE PROPERTY Gross rent receved/ recevable/ letable value durng the year Tax pad to local authortes Annual Value ( ) v 30% of Annual Value v Interest payable on borrowed captal v Arrears/Unrealsed rent receved durng the year less 30% v Income chargeable under the head House Property ( v v) + v B2 ( ) a b c va vb vc v v v v B1 / / Whole- Rupee( ) only

3 252 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] B3 Income from Other Sources (drop down to be provded n e-flng utlty specfyng nature of ncome) Less: Deducton u/s 57(a) (n case of famly penson only) B4 Gross Total Income (B1+B2+B3) (If loss, put the fgure n negatve) B4 ( ) PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer nstructons for Deducton lmt as per Income-tax Act) 80C 80D Drop down to be provded n e-flng utlty 80TTB Any Other Deducton (Please specfy secton) Exempt Income: For reportng purpose Drop down to be provded n e-flng utlty 80G Drop down to be provded n e- flng utlty specfyng name, address and PAN of donee, amount of donaton and amount elgble for deducton Total deductons C1 PART D COMPUTATION OF TAX PAYABLE B3 80GGA Drop down to be provded n e-flng utlty specfyng name, address and PAN of donee, amount of donaton and amount elgble for deducton 80TTA Total Income (B4-C1) Drop down to be provded n e-flng utlty mentonng nature of exempt ncome, relevant clause and secton D1 Tax payable on total D2 Rebate u/s 87A D3 Tax after Rebate D4 Health and educaton D5 Total Tax and D6 Relef u/s 89(1) 4% on D3 Cess D7 Interest u/s 234A D8 Interest u/s 234B D9 Interest u/s 234C D10 Fee u/s 234F D11 Total Tax, Fee and Interest (D5+D7+D8+D9+D10 D6) D12 Total Taxes Pad D13 Amount payable (D11-D12) (f D11>D12) D14 Refund (D12-D11) (f D12>D11) PART E OTHER INFORMATION Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) Sl. IFS Code of the Bank Name of the Bank Account Number (tck one account for refund) I II Schedule-IT Detals of Advance Tax and Self-Assessment Tax payments BSR Code Date of Depost Seral Number of Challan Tax pad (DD/MM/YYYY) Col (1) Col (2) Col (3) Col (4) R1 R2 Schedule-TDS Detals of TDS/TCS [As per Form 16/16A/16C/27D ssued by the Deductor(s)/ Employer(s)/ Payer(s)/ Collector(s)] T1 TAN of deductor/collector or PAN of the Tenant Name of the Deductor/ Collector/Tenant Gross payment/ recept whch s subject to tax deducton /collecton Year of tax deducton/ collecton Tax Deducted/ collected C2 TDS/TCS credt out of (5) clamed ths Year Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) T2 Stamp Recept No., Seal, Date & Sgn of Recevng Offcal VERIFICATION I, son/ daughter of solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return s correct and complete and s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng ths return n my capacty as (drop down to be provded n e-flng utlty) and I am also competent to make ths return and verfy t. I am holdng permanent account number.(please see nstructon). Date: Sgnature: If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof

4 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 253 FORM ITR-2 INDIAN INCOME TAX RETURN [For Indvduals and HUFs not havng ncome from profts and gans of busness or professon] (Please see Rule 12 of the Income-tax Rules, 1962) (Please refer nstructons) Assessment Year Part A-GEN GENERAL Frst name Mddle name Last name PAN PERSONAL INFORMATION Flat/Door/Block No. Name of Premses/Buldng/Vllage Status (Tck) Road/Street/Post Offce Area/localty Date of Brth/ Formaton (DD/MM/YYYY) Indvdual HUF Aadhaar Number (12 dgt)/ Aadhaar Enrolment Id (28 dgt) (f elgble for Aadhaar) Town/Cty/Dstrct State Pn code/zp code Country Resdental/Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Emal Address-1 (self) Emal Address-2 FILING STATUS 139(1)-On or before due date, 139(4)-After due date, 139(5)-Revsed Fled u/s (Tck)[Please see nstructon ] (a) Return, 92CD-Modfed return, 119(2)(b)-after condonaton of delay. Or Fled n response to notce u/s 139(9), 142(1), 148, 153A 153C (b) If revsed/defectve/modfed, then enter Recept No. and Date of flng orgnal return / / (DD/MM/YYYY) (c) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C/119(2)(b) enter date of such notce/order, or f fled u/s 92CD, enter date of advance prcng agreement / / (d) Resdental Status n Inda (for ndvduals) (Tck applcable A. Resdent You were n Inda for 182 days or more durng the prevous year [secton 6(1)(a)] You were n Inda for 60 days or more durng the prevous year, and have been n Inda for 365 days or more wthn the 4 precedng years [secton (6)(1)(c)] [where Explanaton 1 s not applcable] opton) B. Resdent but You have been a non-resdent n Inda n 9 out of 10 precedng years [secton 6(6)(a)] not Ordnarly You have been n Inda for 729 days or less durng the 7 precedng years [secton 6(6)(a)] Resdent C. Non-resdent You were a non-resdent durng the prevous year. ()Please specfy the jursdcton(s) of resdence durng the prevous year - S.No. Jursdcton(s) of resdence Taxpayer Identfcaton Number(s) 1 2 () In case you are a Ctzen of Inda or a Person of Indan Orgn (POI), please specfy - Total perod of stay n Inda durng the prevous year (n days) Total perod of stay n Inda durng the 4 precedng years (n days) Resdental Status n Inda (for HUF) (Tck applcable opton) Resdent Resdent but not Ordnarly Resdent Non-resdent (e) Do you want to clam the beneft under secton 115H? (applcable n case of resdent) Yes No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Capacty of the Representatve (drop down to be provded) (3) Address of the representatve (4) Permanent Account Number (PAN) of the representatve (h) Whether you were Drector n a company at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton - Name of Company PAN Whether ts shares are lsted or unlsted Drector Identfcaton Number (DIN)

5 254 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Do not wrte or stamp n ths area (Space for bar code) For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal () Whether you have held unlsted equty shares at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton n respect of equty shares Name of Shares transferred PAN Openng balance Shares acqured durng the year company durng the year Closng balance Issue Purchase prce Face prce per per share (n Date of No. of Cost of No. of value share (n case of No. of Sale No. of Cost of subscrpton shares acquston shares per case of purchase from shares consderaton shares acquston / purchase share fresh exstng ssue) shareholder) SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule S Name of Employer Detals of Income from Salary Nature of employment (Tck) Govt. PSU Pensoners Others TAN of Employer (mandatory f tax s deducted) Address of employer Town/Cty State Pn code/ Zp code SALARIES 1 Gross Salary (1a + 1b + 1c) 1 a Salary as per secton 17(1) (drop down to be provded) b Value of perqustes as per secton 17(2) (drop down to be provded) 1b Proft n leu of salary as per secton 17(3) (drop down to be c 1c provded) (Add multple rows for Gross Salary n case of more than one employer) 2 Total Gross Salary (from all employers) 2 3 Less allowances to the extent exempt u/s 10 (drop down to be provded n e-flng utlty) (please refer nstructons) 4 Net Salary (2-3) 4 5 Deducton u/s 16 (5a + 5b + 5c) 5 a Standard deducton u/s 16(a) b Entertanment allowance u/s 16() c Professonal tax u/s 16() 6 Income chargeable under the Head Salares (4-5) 6 1a 5a 5b 5c 3 Detals Of Income From House Property (Please Refer Instructons) (Drop down to be provded ndcatng ownershp of Schedule HP property) Address of property 1 Town/ Cty State PIN Code/ Zp Code 1 HOUSE PROPERTY Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner(s) Percentage Share n Property I II

6 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k [Tck the applcable opton] Let out Self-occuped Deemed let out Name(s) of Tenant PAN of Tenant(s) (f avalable) (f let out) I II a Gross rent receved or recevable or letable value 1a b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2)of the Act) f Annual value of the property owned (own percentage share x 1e) g 30% of 1f h Interest payable on borrowed captal Total (1g + 1h) j Arrears/Unrealsed rent receved durng the year less 30% 1g 1h PAN/TAN of Tenant(s) (f TDS credt s clamed) k Income from house property 1 (1f 1 + 1j) 1k Address of property 2 Town/ Cty State PIN Code/ Zp Code Is the property co-owned? Yes No (f YES please enter followng detals) 1e 1f 1 1j Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner(s) Percentage Share n Property I II [Tck the applcable opton] Let out Self-occuped Deemed let out Name(s) of Tenant PAN of Tenant(s) (Please see note) (f let out) I II Gross rent receved/ recevable/ letable value a (hgher of the two, f let out for whole of the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes d Total (2b + 2c) e Annual value (2a 2d) f Annual value of the property owned (own percentage share x 2e) g 30% of 2f h Interest payable on borrowed captal Total (2g + 2h) j Arrears/Unrealsed rent receved durng the year less 30% k Income from house property 2 (2f 2 + 2j) 3 Pass through ncome f any * 3 2c 2d 2g 2h PAN/TAN of Tenant(s) (Please see note) 4 Income under the head Income from house property (1k + 2k + 3) (f negatve take the fgure to 2 of schedule CYLA) 4 NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI and Pass through ncome referred to n schedule PTI whle computng the ncome under ths head. NOTE Furnshng of PAN of tenant s mandatory, f tax s deducted under secton 194-IB. Furnshng of TAN of tenant s mandatory, f tax s deducted under secton 194-I. 2a 2e 2f 2 2j 2k Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Sub-tems 3 and 4 are not applcable for resdents) Short-term Captal Gans 1 From sale of land or buldng or both (fll up detals separately for each property) a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed 1.05 tmes (a), take ths fgure as (a), or else take (a)] b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer a a b b

7 256 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Total (b + b + b) c Balance (a bv) d Deducton under secton 54B (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.No. Name of buyer(s) PAN of buyer(s) Percentage share Amount Address of property Pn code bv 1c A1e 2 NOTE Furnshng of PAN s mandatory, f the tax s deducted under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (2a bv) 2c Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are d 2d receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) e Short-term captal gan on equty share or equty orented MF (STT pad) (2c +2d) For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be 3 computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad b STCG on transactons on whch securtes transacton tax (STT) s not pad 4 For NON-RESIDENT- from sale of securtes (other than those at A2) by an FII as per secton 115AD a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed b manner c Full value of consderaton n respect of unquoted shares adopted as per c secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of securtes other than unquoted a shares Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (4a bv) d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) e Short-term captal gan on sale of securtes by an FII (other than those at A2) (4c +4d) 5 From sale of assets other than at A1 or A2 or A3 or A4 above a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed b manner c Full value of consderaton n respect of unquoted shares adopted as per c secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than unquoted shares a Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) b b bv 4c 4d b b bv A2e A3a A3b A4e

8 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 257 c Balance (5a bv) d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for 5d example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) e STCG on assets other than at A1 or A2 or A3 or A4 above (5c + 5d) 6 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under New asset acqured/constructed whch deducton Year n whch asset Amount utlsed out of clamed n that acqured/constructed Captal Gans account year B b Amount deemed to be short term captal gans, other than at a Total amount deemed to be short term captal gans (ax + b) 5c Amount not used for new asset or remaned unutlzed n Captal gans account (X) 7 Pass Through Income n the nature of Short Term Captal Gan, (Fll up schedule PTI) (A7a + A7b + A7c) A7 a Pass Through Income n the nature of Short Term Captal Gan, 15% b Pass Through Income n the nature of Short Term Captal Gan, 30% Pass Through Income n the nature of Short Term Captal Gan, chargeable at applcable c A7c rates Amount of STCG ncluded n A1 A7 but not chargeable to tax or chargeable at specal rates n Inda as per 8 DTAA Sl. No. Item No. A1 Amount of to A7 above ncome n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act A7a A7b Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II a Total amount of STCG not chargeable to tax n Inda as per DTAA b Total amount of STCG chargeable to tax at specal rates n Inda as per DTAA 9 Total Short-term Captal Gan (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6 + A7 - A8a) A9 B Long-term captal gan (LTCG) (Sub-tems 4, 5, 6, 7 & 8 are not applcable for resdents) Long-term Captal Gans 1 From sale of land or buldng or both (fll up detals separately for each property) a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed 1.05 tmes (a), take ths fgure as (a), or else take (a)] b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of Improvement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b + b) c Balance (a bv) d Deducton under secton 54/54B/54EC/54F/54GB (Specfy detals n tem D below) 1d e Long-term Captal Gans on Immovable property (1c - 1d) f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.No. Name of buyer(s) PAN of buyer(s) Percentage share Amount Address of property Pn code a a b b bv 1c A5e A6 A8a A8b B1e NOTE Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. 2 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston wthout ndexaton b

9 258 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 3 Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (2a bv) d Deducton under sectons 54F (Specfy detals n tem D below) e LTCG on bonds or debenture (2c 2d) From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable () GDR of an Indan company referred n sec. 115ACA a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b b b bv Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (3a bv) 3c d Deducton under sectons 54F (Specfy detals n tem D below) 3d e Long-term Captal Gans on assets at B3 above (3c 3d) B3e 4 From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) b A Cost of acquston A If the long term captal asset was acqured before , lower of B B1 and B2 B 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total deductons (b + b +b) bv c Balance (4a bv) 4c d Less- LTCG threshold lmt as per secton 112A (4c Rs. 1 lakh) 4d e Deducton under sectons 54F (Specfy detals n tem D below) 4e f Long-term Captal Gans on sale of captal assets at B4 above (4d 4e) B4f 5 For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 5a b Deducton under sectons 54F (Specfy detals n tem D below) 5b c LTCG on share or debenture (5a-5b) B5c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as referred 6 n sec. 115AC, () securtes by FII as referred to n sec. 115AD (other than securtes referred to n secton 112A for whch column B7 s to be flled up) a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares a b Far market value of unquoted shares determned n the prescrbed manner b c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) c Full value of consderaton n respect of securtes other than unquoted shares a Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (6a bv) 6c d Deducton under sectons /54F (Specfy detals n tem D below) 6d e Long-term Captal Gans on assets at 6 above n case of NON-REESIDENT (6c - 6d) B6e 7 For NON-RESIDENTS - From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 7a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) b A Cost of acquston A 2c 2d b b b bv B2e

10 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 259 If the long term captal asset was acqured before , lower of B B1 and B2 B 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total deductons (b + b +b) bv c Balance (7a bv) 7c d Less- LTCG threshold lmt as per secton 112A (7c Rs. 1 lakh) 7d e Deducton under secton 54F (Specfy detals n tem D below) 7e f Long-term Captal Gans on sale of captal assets at B7 above (7d 7e) B7f 8 From sale of foregn exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A) a LTCG on sale of specfed asset (computed wthout ndexaton) 8a b Less deducton under secton 115F (Specfy detals n tem D below) 8b c Balance LTCG on sale of specfed asset (8a 8b) B8c LTCG on sale of asset, other than specfed asset d 8d (computed wthout ndexaton) e Less deducton under secton 115F (Specfy detals n tem D below) 8e f Balance LTCG on sale of asset, other than specfed asset (8d- 8e) B8f 9 From sale of assets where B1 to B8 above are not applcable a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed b manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of mprovement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (9a bv) d Deducton under sectons 54F (Specfy detals n tem D below) e Long-term Captal Gans on assets at B9 above ( (9c 9d) 10 Amount deemed to be long-term captal gans Sl. a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Prevous year n whch asset transferred /54F/ 54GB B Secton under whch deducton Year n whch asset clamed n that acqured/ year constructed b Amount deemed to be long-term captal gans, other than at a New asset acqured/constructed Total amount deemed to be long-term captal gans (ax + ax + b) Amount utlsed out of Captal Gans account a a b b bv 9c 9d c Amount not used for new asset or remaned unutlzed n Captal gans account (X) 11 Pass Through Income n the nature of Long Term Captal Gan,(Fll up schedule PTI) (B11a + B11b) B11 a Pass Through Income n the nature of Long Term Captal Gan, 10% B11a b Pass Through Income n the nature of Long Term Captal Gan, 20% 12 Amount of LTCG ncluded n B1- B11 but not chargeable to tax or chargeable at specal rates n Inda as per DTAA Sl. No. Amount of ncome Item No. B1 to B11 above n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act B11b Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II a Total amount of LTCG not chargeable to tax as per DTAA B10 B12a

11 260 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Total amount of LTCG chargeable to tax at specal rates as per DTAA 13 Total long term captal gan chargeable under I.T. Act (B1e+B2e+B3e+B4f+B5c+B6e+B7f+B8c+B8f+B9e+B10 + B11 - B12a) (In case of loss take the fgure to 5x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A9 + B13) (take B13 as nl, f loss) (If C s negatve, take the fgure to 4x of schedule CFL and f t s postve, take the fgure to respectve row n tem E) D Informaton about deducton clamed aganst Captal Gans 1 In case of deducton u/s 54/54B/54EC/54F/54GB/115F gve followng detals a Deducton clamed u/s 54 Date of transfer of orgnal asset a dd/mm/yyyy Cost of new resdental house Date of purchase/constructon of new resdental house a dd/mm/yyyy a B12b B13 C b c d e f v Amount deposted n Captal Gans Accounts Scheme av before due date v Amount of deducton clamed av Deducton clamed u/s 54B Date of transfer of orgnal asset b dd/mm/yyyy Cost of new agrcultural land Date of purchase of new agrcultural land b dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme bv before due date v Amount of deducton clamed bv Deducton clamed u/s 54EC Date of transfer of orgnal asset c dd/mm/yyyy Amount nvested n specfed/notfed bonds (not exceedng ffty lakh rupees) Date of nvestment c dd/mm/yyyy v Amount of deducton clamed cv Deducton clamed u/s 54F Date of transfer of orgnal asset d dd/mm/yyyy Cost of new resdental house d Date of purchase/constructon of new resdental house d dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed dv Deducton clamed u/s 54GB Date of transfer of orgnal resdental property e dd/mm/yyyy PAN of the elgble company Amount utlsed for subscrpton of equty shares of elgble company v Date of subscrpton of shares ev dd/mm/yyyy v Cost of new plant and machnery purchased by the elgble ev company v Date of purchase of plant and machnery ev dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme ev before due date v Amount of deducton clamed ev Deducton clamed u/s 115F (for Non-Resdent Indans) Date of transfer of orgnal foregn exchange asset f dd/mm/yyyy b c dv e e Amount nvested n new specfed asset or savngs f certfcate Date of nvestment f dd/mm/yyyy v Amount of deducton clamed fv g Total deducton clamed (1a + 1b + 1c + 1d + 1e + 1f) 1g E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A8a & B12a whch s not chargeable under DTAA) Sl. Type of Captal Gan Captal Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss 15% 30% applcable rate DTAA rates Long term captal loss 10% 20% DTAA rates Current year s captal gans remanng after set off (9= )

12 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Captal Loss to (B3e*+ be set off (A2e*+ (Fll ths row A3a* + A4e*+A7b* (A1e*+A3b*+A5e*+ B4f* + (B1e*+B2e*+B5c*+ A8b A6* + A7c*) B6e* + B8f*+B9e*+B10*+B11b*) B12b only f computed A7a*) B7f* + fgure s negatve) B8c* + 15% (A2e*+A3a* + Short term 30% A4e* A7a*) + A7b* v captal applcable (A1e*+A3b*+ gan rate A5e*+A6* + A7c*) v v Long term captal v gan DTAA rates 10% 20% A8b (B3e*+B4f* + B6e* + B7f* + B8c* +B11a*) (B1e*+B2e*+B5c*+ B8f*+B9e*+B10*+ v DTAA B12b x Total loss set off ( + + v + v + v+v+v) x Loss remanng after set off ( x) TE The fgures of STCG n ths table (A1e* etc.) are the amounts of STCG computed n respectve column (A1-A6) as reduced by the amount of N STCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. F NOTE The fgures of LTCG n ths table (B1e* etc.) are the amounts of LTCG computed n respectve column (B1-B10) as reduced by the amount of LTCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. Informaton about accrual/recept of captal gan Type of Captal gan / Date Upto 15/6 () 1 Short-term captal gans taxable at the rate of 15% Enter value from tem 3 of schedule BFLA, f any. 2 Short-term captal gans taxable at the rate of 30% Enter value from tem 3v of schedule BFLA, f any. 3 Short-term captal gans taxable at applcable rates Enter value from tem 3v of schedule BFLA, f any. 4 Short-term captal gans taxable at DTAA rates Enter value from tem 3v of schedule BFLA, f any. 5 Long- term captal gans taxable at the rate of 10% Enter value from tem 3v of schedule BFLA, f any. 6 Long- term captal gans taxable at the rate of 20% Enter value from tem 3v of schedule BFLA, f any. 7 Long- term captal gans taxable at the rate DTAA rates Enter value from tem 3x of schedule BFLA, f any. 16/6 to 15/9 () 16/9 to 15/12 () 16/12 to 15/3 (v) Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under 16/3 to 31/3 (v) ths head Schedule OS Income from other sources 1 Gross ncome chargeable to tax at normal applcable rates (1a+ 1b+ 1c+ 1d + 1e) 1 a Dvdends, Gross 1a b Interest, Gross (b + b + b + bv) 1b From Savngs Bank b From Deposts (Bank/ Post Offce/ Co-operatve) b From Income-tax Refund b v In the nature of Pass through ncome bv v Others bv c Rental ncome from machnery, plants, buldngs, etc., Gross 1c d Income of the nature referred to n secton 56(2)(x) whch s chargeable to tax 1d (d + d + d + dv + dv) Aggregate value of sum of money receved wthout d consderaton In case mmovable property s receved wthout d consderaton, stamp duty value of property OTHER SOURCES

13 262 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] In case mmovable property s receved for nadequate consderaton, stamp duty value of property n excess of such consderaton v In case any other property s receved wthout dv consderaton, far market value of property In case any other property s receved for nadequate dv v consderaton, far market value of property n excess of such consderaton e Any other ncome (please specfy nature) 1e 2 Income chargeable at specal rates (2a+ 2b+ 2c+ 2d + 2e) 2 a Wnnngs from lotteres, crossword puzzles etc. chargeable u/s 115BB b Income chargeable u/s 115BBE (b + b + b + bv+ bv + bv) Cash credts u/s 68 b Unexplaned nvestments u/s 69 b Unexplaned money etc. u/s 69A b v Undsclosed nvestments etc. u/s 69B bv v Unexplaned expendture etc. u/s 69C bv v Amount borrowed or repad on hund u/s 69D bv c Accumulated balance of recognsed provdent fund taxable u/s 111 S.No. Assessment Year Income beneft Tax beneft () () () (v) d 2a 2b 2c d Any other ncome chargeable at specal rate (total of d to dxx) Dvdends receved by non-resdent (not beng company) d or foregn company chargeable u/s 115A(1)(a)() Interest receved from Government or Indan concern d on foregn currency debts chargeable u/s 115A(1)(a)() Interest receved from Infrastructure Debt Fund d chargeable u/s 115A(1)(a)(a) v Interest referred to n secton 194LC - chargeable u/s dv 115A(1)(a)(aa) v Interest referred to n secton 194LD - chargeable u/s dv 115A(1)(a)(ab) v Dstrbuted ncome beng nterest referred to n secton dv 194LBA - chargeable u/s 115A(1)(a)(ac) Income from unts of UTI or other Mutual Funds dv v specfed n secton 10(23D), purchased n Foregn Currency - chargeable u/s 115A(1)(a)() Income from royalty or fees for techncal servces dv v receved from Government or Indan concern - chargeable u/s 115A(1)(b) Income by way of nterest or dvdends from bonds or dx x GDRs purchased n foregn currency by non-resdents - chargeable u/s 115AC x Income by way of dvdends from GDRs purchased n dx foregn currency by resdents - chargeable u/s 115ACA Income (other than dvdend) receved by an FII n dx x respect of securtes (other than unts referred to n secton 115AB) - chargeable u/s 115AD(1)() Income by way of nterest receved by an FII on bonds dx x or Government securtes referred to n secton 194LD chargeable as per provso to secton 115AD(1)() x Tax on non-resdents sportsmen or sports assocatons dx chargeable u/s 115BBA xv Anonymous Donatons n certan cases chargeable u/s dxv 115BBC Income by way of dvdend receved by specfed dxv xv assessee, beng resdent, from domestc company exceedng rupees ten lakh chargeable u/s 115BBDA xv Income by way of royalty from patent developed and dxv regstered n Inda - chargeable u/s 115BBF 2d

14 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 263 NOTE xv Income by way of transfer of carbon credts - dxv chargeable u/s 115BBG xv Investment Income of a Non-Resdent Indan - dv chargeable u/s 115E xx Any other ncome (Please specfy) dxx e Pass through ncome n the nature of ncome from other sources chargeable at specal rates (drop down 2e to be provded) f Amount ncluded n 1 and 2 above, whch s chargeable at specal rates n Inda as per DTAA (total of 2f column (2) of table below) Sl. No. Amount of ncome Item No.2a to 2e n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II 3 Deductons under secton 57 (other than those relatng to ncome chargeable at specal rates under 2a, 2b & 2d) a Expenses / Deductons b Deprecaton 3b c Total 3c 4 Amounts not deductble u/s Profts chargeable to tax u/s Net Income from other sources chargeable at normal applcable rates ( ) (If negatve take the 6 fgure to 3x of schedule CYLA ) 7 Income from other sources (other than from ownng race horses) (2 + 6) (enter 6 as nl, f negatve) 7 8 Income from the actvty of ownng and mantanng race horses a Recepts 8a b Deductons under secton 57 n relaton to recepts 8b at 8a only c Amounts not deductble u/s 58 8c d Profts chargeable to tax u/s 59 8d e Balance (8a - 8b + 8c + 8d) (f negatve take the fgure to 6x of Schedule CFL) 8e 9 Income under the head Income from other sources (7 + 8e) (take 8e as nl f negatve) 9 10 Informaton about accrual/recept of ncome from Other Sources S.No. Other Source Income Upto 15/6 From 16/6 to From 16/9 to From 16/12 to From 16/3 to 15/9 15/12 15/3 31/3 () () () (v) (v) 1 Dvdend Income u/s 115BBDA Income by way of wnnngs from lotteres, crossword 2 puzzles, races, games, gamblng, bettng etc. referred to n secton 2(24)(x) Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head. 3a Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Detals of Income after Set off of current year losses Sl. No. Head/ Source of Income Income of current year (Fll ths column only f ncome s zero or postve) Loss to be set off (Fll ths row only f computed fgure s negatve) Salares (6 of Schedule S) House property loss of the current year set off Net loss from Other sources chargeable at normal applcable rates (other than loss from race horses) of the current year set off Current year s Income remanng after set off =1-2-3 ( 4 of Schedule HP) (6 of Schedule-OS)

15 264 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] House property ( 4 of Schedule HP) v Short-term captal gan 15% ( 9 of tem E of schedule CG) v Short-term captal gan 30% ( 9 of tem E of schedule CG) v Short-term captal gan taxable at ( 9v of tem E of applcable rates schedule CG) v Short-term captal gan taxable at specal (9v of tem E of rates n Inda as per DTAA schedule CG) v Long term captal gan 10% ( 9v of tem E of schedule CG) x Long term captal gan 20% ( 9v of tem E of schedule CG) x Long term captal gans taxable at specal (9v of tem E of rates n Inda as per DTAA schedule CG) x Net ncome from other sources chargeable (6 of schedule at normal applcable rates OS) x Proft from the actvty of ownng and (8e of schedule mantanng race horses OS) x Total loss set off ( + + v + v + v + v + v + x + x+x+x) xv Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT Sl. No. Loss remanng after set-off ( x) Detals of Income after Set off of Brought Forward Losses of earler years Head/ Source of Income Income after set off, f any, of current year s losses as per 4 of Schedule CYLA) Salares (4 of schedule CYLA) Brought forward loss set off Current year s ncome remanng after set off House property (4 of schedule CYLA) (B/f house property loss) Short-term captal gan 15% (4v of schedule CYLA) (B/f short-term captal loss) v Short-term captal gan 30% (4v of schedule CYLA) (B/f short-term captal loss) v Short-term captal gan taxable at applcable rates (4v of schedule CYLA) (B/f short-term captal loss) v Short-term captal gan taxable at specal rates n Inda as per DTAA (4v of schedule CYLA) (B/f short-term captal loss) v Long-term captal gan 10% (4v of schedule CYLA) (B/f short-term or long-term captal loss) v Long term captal gan 20% (4x of schedule CYLA) (B/f short-term or long-term captal loss) x Long term captal gans taxable at specal rates n Inda as per DTAA (4x of schedule CYLA) (B/f short-term or long-term captal loss) x Net ncome from other sources chargeable at normal applcable rates ( 4x of schedule CYLA) x Proft from ownng and mantanng race horses (4x of schedule CYLA) (B/f loss from horse races) x Total of brought forward loss set off ( v + 2v+ 2v + 2v + 2v + 2x + 2x) x Current year s ncome remanng after set off Total of ( v + 3v+ 3v + 3v + 3v+ 3x + 3x + 3x) Schedule CFL CARRY FORWARD OF LOSS v v v v v x Detals of Losses to be carred forward to future years Assessment Year Date of Flng House property Short-term captal Long-term Captal Loss from ownng and (DD/MM/YYYY) loss loss loss mantanng race horses Total of earler year losses

16 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 265 x x x Adjustment of above losses n Schedule BFLA (Current year losses) Total loss carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (( 2x+3x+4x+5x) of tem E of schedule CG) ((6x+7x+8x) of tem E of schedule CG) (2x of schedule BFLA) ( 8e of schedule OS, f ve) Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80C c 80CCD(1) e 80CCD(2) g 80D b 80CCC d 80CCD(1B) f 80CCG h 80DD TOTAL DEDUCTIONS 80DDB j 80E k 80EE l 80G m 80GG n 80GGA o 80GGC 2 Part C, CA and D- Deducton n respect of certan ncomes/other deducton p 80QQB r 80TTA q 80RRB s 80TTB t 80U u Total deductons under Chapter VI-A (Total of a to t) u Schedule 80G DETAILS OF DONATIONS A B C Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 50% deducton wthout qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Donaton n cash Donaton n other mode Total Donaton Total Donaton Total Donaton Elgble Amount of donaton Elgble Amount of donaton Elgble Amount of donaton

17 266 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] D Total Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total E Total donatons (A + B + C + D) Donaton n cash Donaton n other mode Total Donaton Elgble Amount of donaton Schedule 80GGA S. No. Detals of donatons for scentfc research or rural development Relevant clause under whch deducton s clamed (drop down to be provded) Total donaton Name and address of donee PAN of Donee Donaton n cash Amount of donaton Donaton n other mode Total Donaton Elgble Amount of donaton Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 12 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) a Deducton clamed under any secton ncluded n Chapter VI-A under 2a the headng C. Deductons n respect of certan ncomes 3 Adjusted Total Income under secton 115JC(1) (1+2a) 3 4 Tax payable under secton 115JC [18.5% of (3)] (f 3 s greater than Rs. 20 lakhs) 4 Schedule AMTC Computaton of tax credt under secton 115JD 1 Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (7 of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse enter 0] 3 4 Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of AMT Credt Brought Forward) S. No. Assessment Year (A) AMT Credt v v v v Current AY (enter 1-2, f 1>2 else enter 0) Gross (B1) Set-off n earler assessment years (B2) Balance brought forward to the current assessment year (B3) = (B1) (B2) AMT Credt Utlsed durng the Current Assessment Year (C) v Total 5 Amount of tax credt under secton 115JD utlsed durng the year [total of tem No. 4 (C)] 5 6 Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4 (D)] 6 Balance AMT Credt Carred Forward (D)= (B3) (C) Schedule SPI Income of specfed persons (spouse, mnor chld etc.) ncludable n ncome of the assessee as per secton 64 Sl No Name of person PAN of person (optonal) Relatonshp Amount (Rs Head of Income n whch ncluded 1

18 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Schedule SI SPECIAL RATE Sl No Income chargeable to tax at specal rates (please see nstructons No. 9 for rate of tax) Secton Specal rate (%) Income () 1 111A (STCG on shares unts on whch STT pad) 15 (3 of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (3v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 3v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 3v of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 3v of schedule BFLA) 6 115ACA (LTCG for an employee of specfed companay on GDR) 10 (part of 3v of schedule BFLA) 7 115AD (LTCG for FIIs on securtes) 10 (part of 3v of schedule BFLA) 8 115E (LTCG for non-resdent ndan on specfed asset) 10 (part of 3v of schedule BFLA) (LTCG on others) 20 (3v of schedule BFLA) A (LTCG on sale of shares or unts on whch STT s pad) 10 (part of 3v of schedule BFLA) 11 STCG Chargeable at specal rates n Inda as per DTAA (part of 3v of schedule BFLA) 12 LTCG Chargeable at specal rates n Inda as per DTAA (part of 3x of schedule BFLA) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (part of 2a of schedule OS) BBDA (Dvdend ncome from domestc company exceedng Rs.10 lakh) 10 (part of 2d of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (2b of schedule OS) BBF (Tax on ncome from patent) 10 (part of 2d of schedule OS) BBG (Tax on ncome from transfer of carbon credts) 10 (part of 2d of schedule OS) 18 Any other ncome chargeable at specal rate (Drop down to be provded n e- flng utlty) (part of 2d of schedule OS) 19 Other source of ncome chargeable at specal rates n Inda as per DTAA (part of 2f of schedule OS) 20 Pass Through Income n the nature of Short Term Captal Gan chargeable 15% (part of 3v of schedule BFLA) 21 Pass Through Income n the nature of Short Term Captal Gan chargeable 30% (part of 3v of schedule BFLA) 22 Pass Through Income n the nature of Long Term Captal Gan chargeable 10% (part of 3v of schedule BFLA) Pass Through Income n the nature of Long Term Captal Gan chargeable 20 20% (part of 3v of schedule BFLA) 24 Pass through ncome n the nature of ncome from other source chargeable at specal rates Total (2e of schedule OS) Tax thereon () Schedule EI EXEMPT INCOME Detals of Exempt Income (Income not to be ncluded n Total Income or not chargeable to tax) 1 Interest ncome 1 2 Dvdend ncome from domestc company (amount not exceedng Rs. 10 lakh) 2 3 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years v Net Agrcultural ncome for the year ( ) (enter nl f loss) 3 v In case the net agrcultural ncome for the year exceeds Rs.5 lakh, please furnsh the followng detals (Fll up detals separately for each agrcultural land) a Name of dstrct along wth pn code n whch agrcultural land s located b Measurement of agrcultural land n Acre c Whether the agrcultural land s owned or held on lease (drop down to be provded) d Whether the agrcultural land s rrgated or ran-fed (drop down to be provded) 4 Other exempt ncome (ncludng exempt ncome of mnor chld) 4 5 Income not chargeable to tax as per DTAA

19 268 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Sl. No. Amount of ncome Nature of ncome Country name & Code I II Artcle of DTAA Head of Income Whether TRC obtaned (Y/N) III Total Income from DTAA not chargeable to tax 5 6 Pass through ncome not chargeable to tax (Schedule PTI) 6 7 Total ( ) 7 Schedule PTI PASS THROUGH INCOME Sl. NOTE Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Name of busness trust/ nvestment fund PAN of the busness trust/ nvestment fund 1. House property Sl. Head of ncome Amount of ncome TDS on such amount, f any v Captal Gans a b Short term Long term Other Sources Income clamed to be exempt a b c u/s 10(23FBB) u/s.. u/s 2. House property Please refer to the nstructons for fllng out ths schedule. v Captal Gans a b Short term Long term Other Sources Income clamed to be exempt a b c u/s 10(23FBB) u/s.. u/s Schedule FSI Sl. Country Code Taxpayer Identfcaton Number Detals of Income from outsde Inda and tax relef Sl. Head of ncome Income from outsde Inda (ncluded n PART B-TI) Tax pad outsde Inda Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) 1 Salary House Property Captal Gans v Other sources Total 2 Salary House Property Captal Gans v Other sources NOTE Total Please refer to the nstructons for fllng out ths schedule.

20 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 269 Schedule TR 1 Summary of Tax relef clamed Country Code Summary of tax relef clamed for taxes pad outsde Inda Taxpayer Identfcaton Number Total taxes pad outsde Inda (total of (c) of Schedule FSI n respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Tax Relef Clamed under secton (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total 2 Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of total of 1(d)) 2 3 Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total of 1(d)) 3 4 Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below a Amount of tax refunded b Assessment year n whch tax relef allowed n Inda 4 Yes/No NOTE Please refer to the nstructons for fllng out ths schedule. Schedule FA Detals of Foregn Assets and Income from any source outsde Inda A1 Detals of Foregn Depostory Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country name Country code Name of fnancal nsttuton Address of fnancal nsttuton ZIP code Account number Status Account openng date Peak balance durng the perod Closng balance Gross nterest pad/credted to the account durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A2 Detals of Foregn Custodal Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod DETAILS OF FOREIGN ASSETS Sl No Country name Country code Name of fnancal nsttuton Address of fnancal nsttuton ZIP code Account number Status Account openng date Peak balance durng the perod Closng balance Gross amount pad/credted to the account durng the perod (drop down to be provded specfyng nature of amount vz. nterest/dvdend/proceeds from sale or redempton of fnancal assets/ other ncome) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A3 Detals of Foregn Equty and Debt Interest held (ncludng any benefcal nterest) n any entty at any tme durng the relevant accountng perod Sl No Country name Country code Name of entty Address of entty ZIP code Nature of entty Date of acqurng the nterest Intal value of the nvestme nt Peak value of nvestment durng the perod Closng value Total gross amount pad/credted wth respect to the holdng durng the perod Total gross proceeds from sale or redempton of nvestment durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) () () A4 Detals of Foregn Cash Value Insurance Contract or Annuty Contract held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod

21 270 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Sl No Country name Country code Name of fnancal nsttuton n whch nsurance contract held Address of fnancal nsttuton ZIP code Date of contract The cash value or surrender value of the contract Total gross amount pad/credted wth respect to the contract durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Nature of Name and Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Investment (at cost) (n rupees) Income Nature of accrued from Income such Interest Income taxable and offered n ths return Name and code entty Address of the Entty Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Address of the Property Ownershp- Drect/ Benefcal owner/ Benefcary Date of acquston Total Investment (at cost) (n rupees) Income derved from the property Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Nature of Asset Ownershp- Drect/ Benefcal owner/ Benefcary Date of acquston Total Investment (at cost) (n rupees) Income derved from the asset Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detals of account(s) n whch you have sgnng authorty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod and whch has not been ncluded n A to D above. Sl No Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Account Number Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account 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 Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl No Country Name and code Name and address of the trust Name and address of trustees Name and address of Settlor Name and address of Benefcares Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust If (8) 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) (12) ()

22 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 271 () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon Country Name and code Name and address of the person from whom derved Income derved Nature of ncome Whether taxable n your hands? If (6) s yes, Income offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule. In case of an ndvdual, not beng an Indan ctzen, who s n Inda on a busness, employment or student vsa, an asset acqured durng any prevous year n whch he was non-resdent s not mandatory to be reported n ths schedule f no ncome s derved from that asset durng the current prevous year. Schedule 5A Name of the spouse PAN of the spouse Heads of Income 1 House Property 2 Captal gans 3 Other sources 4 Total Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the head Amount apportoned n the hands of the spouse Amount of TDS deducted on ncome at () TDS apportoned n the hands of spouse () () () (v) (v) Schedule AL Assets and Labltes at the end of the year (applcable n a case where total ncome exceeds Rs.50 lakh) A Detals of mmovable assets Sl. No. Descrpton Address Pn code Amount (cost) n Rs. (1) (2) (3) (4) (5) () DETAILS OF ASSETS AND LIABILITIES () B Detals of movable assets Sl. No. Descrpton Amount (cost) n Rs. (1) (2) (3) () Jewellery, bullon etc. () Archaeologcal collectons, drawngs, pantng, sculpture or any work of art () Vehcles, yachts, boats and arcrafts (v) Fnancal assets (a) Bank (ncludng all deposts) (b) Shares and securtes (c) Insurance polces (d) Loans and advances gven (e) Cash n hand C Labltes n relaton to Assets at (A + B) Amount (cost) n Rs. NOTE Please refer to nstructons for fllng out ths schedule.

23 272 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PART-B Part B - TI Computaton of total ncome 1 Salares (6 of Schedule S) 1 2 Income from house property ( 4 of Schedule HP) (enter nl f loss) 2 TOTAL INCOME 3 Captal gans a Short term Short-term 15% (9 of tem E of schedule CG) a Short-term 30% (9 of tem E of schedule CG) Short-term chargeable at applcable rate (9v of tem E of schedule CG) v Short-term chargeable at specal rates n Inda as per DTAA (9v of tem E of Schedule CG) v Total Short-term (a + a + a + av) (enter nl f loss) 3av b Long-term Long-term 10% (9v of tem E of schedule CG) b Long-term 20% (9v of tem E of schedule CG) Long-term chargeable at specal rates n Inda as per DTAA (9v of tem E of schedule CG) a a av b b v Total Long-term (b + b + b) (enter nl f loss) c Total captal gans (3av + 3bv) (enter nl f loss) 4 Income from other sources a Net ncome from other sources chargeable to tax at normal applcable rates (6 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rates ( 2 of Schedule OS) c Income from the actvty of ownng and mantanng race horses ( 8e of Schedule OS) (enter nl f loss) d Total (4a + 4b + 4c) (enter nl f loss) 5 Total of head wse ncome (1+2+3c+4d) 5 6 Losses of current year set off aganst 5 (total of 2x and 3x of Schedule CYLA) 6 7 Balance after set off current year losses (5-6) (total of column 4 of Schedule CYLA+ 2 of Schedule OS) 7 8 Brought forward losses set off aganst 7 ( 2x of Schedule BFLA) 8 9 Gross Total ncome (7-8) (3x of Schedule BFLA + 2 of Schedule OS) 9 10 Income chargeable to tax at specal rate under secton 111A, 112, 112A etc. ncluded n Deductons under Chapter VI-A [u of Schedule VIA and lmted to ( 9-10)] Total ncome (9-11) Income whch s ncluded n 12 and chargeable to tax at specal rates (total of column () of schedule SI) Net agrcultural ncome/ any other ncome for rate purpose ( 3 of Schedule EI) Aggregate ncome ( ) [applcable f (12-13) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of row x of Schedule CFL) Deemed ncome under secton 115JC (3 of Schedule AMT) 17 3bv 4a 4b 4c 3c 4d Part B -TTI COMPUTATION OF TAX LIABILITY Computaton of tax lablty on total ncome 1 a Tax payable on deemed total ncome u/s 115JC (4 of Schedule AMT) 1a b Surcharge on (a) (f applcable) c Health and Educaton 4% on (1a + 1b) above d Total tax payable on deemed total ncome (1a + 1b + 1c) 2 Tax payable on total ncome a Tax at normal rates on 15 of Part B-TI 1b 1c 2a 1d

24 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 273 b Tax at specal rates (total of col. () of Schedule SI) 10 Deductons under Chapter VI-A (o of Schedule VIA) 11 Total ncome 12 Net agrcultural ncome/ any other ncome for rate purpo 13 Aggregate ncome (8+ 9) 14 Losses of current year to be carred forward (total of 2v c Rebate on agrcultural ncome [applcable f (12-13) of Part B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on Total Income (2a + 2b - 2c) 3 Rebate under secton 87A 3 4 Tax payable after rebate (2d - 3) % of 15() of Schedule SI On [(4) ( 15() of Schedule SI)] Total + 6 Health and Educaton 4% on (4 + 5) 6 7 Gross tax lablty ( ) 7 8 Gross tax payable (hgher of 1d and 7) 8 9 Credt u/s 115JD of tax pad n earler years (applcable only f 7 s hgher than 1d) (row 5 of Schedule AMTC) 9 10 Tax payable after credt u/s 115JD (8-9) Tax relef a Secton 89 b Secton 90/ 90A (2 of Schedule TR) c Secton 91 (3 of Schedule TR) d Total (11a + 11b + 11c) 12 Net tax lablty (10-11d) (enter zero f negatve) Interest and fee payable a Interest for default n furnshng the return (secton 234A) b Interest for default n payment of advance tax (secton 234B) c Interest for deferment of advance tax (secton 234C) d Fee for default n furnshng return of ncome (secton 234F) e Total Interest and Fee Payable (13a+13b+13c+13d) 14 Aggregate lablty e) Taxes Pad a Advance Tax (from column 5 of 22A) 11a 11b 11c 13a 13b 13c 13d 15a 2b 2c d 5 11d 13e TAXES PAID BANK ACCOUNT b TDS (total of column 5 of 22B and column 9 of 22C) c TCS (total of column 5 of 22D) d Self-Assessment Tax (from column 5 of 22A) e Total Taxes Pad (15a + 15b + 15c + 15d) 16 Amount payable (Enter f 14s greater than 15e, else enter 0) Refund (If 15e s greater than 14) (Refund, f any, wll be drectly credted nto the bank account) b 15c 15d Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) (In case of non-resdents, detals of any one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bank n case of Bank Accounts held n Inda (SWIFT Code n case of foregn Bank Account) Name of the Bank Account Number (IBAN n case of foregn Bank Accounts) 15e Indcate the account n whch you prefer to get your refund credted, f any (tck one account )

25 274 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 19 Do you at any tme durng the prevous year, () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] Yes No 20 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY Detals of payments of Advance Tax and Self-Assessment Tax Sl No BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 15a & 15d of Part B-TTI Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Sl No Tax Deducton Account Number (TAN) of the Employer Name of the Employer Income chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) I II C NOTE Please enter total of column 5 n 15b of Part B-TTI Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued or Form 16B/16C furnshed by Deductor(s)] Sl No TDS credt relatng to self /other person [spouse as per secton 5A/other person as per rule 37BA(2)] PAN of Other Person (f TDS credt related to other person) TAN of the Deductor/ PAN of Tenant/ Buyer Unclamed TDS brought forward (b/f) Fn. TDS Year n b/f whch deducted TDS of the current Fn. Year Deducted n own hands Deducted n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) TDS credt beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Clamed n own hands Clamed n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) Correspondng Income offered Gross Amount Head of Income (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Income TDS Income TDS PAN TDS credt beng carred forward NOTE Please enter total of column 9 n15b of Part B- TTI

26 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 275 D TCS Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Collecton Account Number of the Collector Name of the Collector Tax Collected Amount out of (4) beng clamed Amount out of (4) beng clamed n the hands of spouse, f secton 5A s applcable (1) (2) (3) (4) (5) (6) I II NOTE Please enter total of column (5) n 15c of Part B-TTI VERIFICATION I, son/ daughter of, solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and schedules thereto s correct and complete and s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng return n my capacty as and I am also competent to make ths return and verfy t. I am holdng permanent account number (f allotted) (Please see nstructon) I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable n a case where return s furnshed under secton 92CD) Date Sgn here

27 276 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR- 3 INDIAN INCOME TAX RETURN (For ndvduals and HUFs havng ncome from profts and gans of busness or professon) (Please see rule 12 of the Income-tax Rules,1962) (Please refer nstructons) Assessment Year Part A-GEN GENERAL Frst name Mddle name Last name PAN PERSONAL INFORMATION Flat/Door/Block No. Name Of Premses/Buldng/Vllage Status (Tck) Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Indvdual HUF Aadhaar Number (12 dgt)/ Aadhaar Enrolment Id (28 dgt) (f elgble for Aadhaar) Town/Cty/Dstrct State Pn code/zp code Country Resdental/Offce Phone Number wth STD code / Moble No. 1 Moble No. 2 Emal Address-1 (self) Emal Address-2 FILING STATUS 139(1)- On or Before due date, 139(4)- After due date, 139(5)- (a) Fled u/s (Tck)[Please see nstructon] Revsed Return, 92CD-Modfed return, 119(2)(b)- after condonaton of delay Or Fled n response to notce u/s 139(9) 142(1), 148, 153A, 153C If revsed/defectve/modfed, then enter Recept (b) No. and Date of flng orgnal return / / (DD/MM/YYYY) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b), enter date (c) (d) of such notce/order, or f fled u/s 92CD enter date of advance prcng agreement Resdental Status n Inda (for ndvduals) (Tck applcable Explanaton 1 s not applcable] opton) / / A. Resdent You were n Inda for 182 days or more durng the prevous year [secton 6(1)(a)] You were n Inda for 60 days or more durng the prevous year, and have been n Inda for 365 days or more wthn the 4 precedng years [secton (6)(1)(c)] [where B. Resdent but not Ordnarly Resdent You have been a non-resdent n Inda n 9 out of 10 precedng years [secton 6(6)(a)] You have been n Inda for 729 days or less durng the 7 precedng years [secton 6(6)(a)] C. Non-resdent You were a non-resdent durng the prevous year. ()Please specfy the jursdcton(s) of resdence durng the prevous year - S.No. Jursdcton of resdence Taxpayer Identfcaton Number 1 2 () In case you are a Ctzen of Inda or a Person of Indan Orgn (POI), please specfy - Total perod of stay n Inda durng the prevous year (n days) Total perod of stay n Inda durng the 4 precedng years (n days) Resdental Status n Inda (for HUF) (Tck applcable opton) Resdent Resdent but not Ordnarly Resdent Non-resdent (e) Do you want to clam the beneft under secton 115H? (applcable n case of resdent) Yes No Yes No (If YES please fll Schedule (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) 5A) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, furnsh followng (g) nformaton - (1) Name of the representatve (2) Capacty of the Representatve (drop down to be provded) (3) Address of the representatve (4) Permanent Account Number (PAN) of the representatve

28 277 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] For Offce Use Only For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal (h) Whether you were Drector n a company at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton - Whether ts shares are lsted or Name of Company PAN Drector Identfcaton Number (DIN) unlsted () Whether you are Partner n a frm? (Tck) Yes No Name of Frm If yes, please furnsh followng nformaton PAN (j) Whether you have held unlsted equty shares at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton n respect of equty shares Name of Shares transferred PAN Openng balance Shares acqured durng the year company durng the year Closng balance Issue Purchase prce Face prce per per share (n Date of No. of Cost of No. of value share (n case of No. of Sale No. of Cost of subscrpton shares acquston shares per case of purchase from shares consderaton shares acquston / purchase share fresh exstng ssue) shareholder) AUDIT INFORMATION (k) (l) In case of non-resdent, s there a permanent establshment (PE) n Inda? (Tck) Yes No Whether assessee s located n an Internatonal Fnancal Servces Centre and derves ncome solely n convertble foregn exchange? Yes No (a) Are you lable to mantan accounts as per secton 44AA? (Tck) Yes No (b) Are you lable for audt under secton 44AB? (Tck) Yes No (c) If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton below (1) Date of furnshng of the audt report (DD/MM/YYYY) / / (2) Name of the audtor sgnng the tax audt report (3) Membershp No. of the audtor (4) Name of the audtor (propretorshp/ frm) (5) Propretorshp/frm regstraton number (6) Permanent Account Number (PAN) of the propretorshp/ frm (7) Date of report of the audt (d) Are you lable for Audt u/s 92E? Yes Date of furnshng audt report? DD/MM/YYYY No If lable to furnsh other audt report, menton the date of furnshng the audt report? (DD/MM/YY) (Please see (d) Instructon 6) Sl. No. Secton Code Date (DD/MM/YYYY) (e) If lable to audt under any Act other than the Income-tax act, menton the Act, secton and date of furnshng the audt report? Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) NATURE OF BUSINESS S.No. NATURE OF BUSINESS OR PROFESSION, IF MORE THAN ONE BUSINESS OR PROFESSION INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS (OTHER THAN THOSE DECLARING INCOME UNDER SECTIONS 44AD, 44ADA AND 44AE) Code [Please see nstructon No.7()] Trade name of the propretorshp, f any Descrpton

29 278 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] () () () BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2019 OF THE PROPRIETORY BUSINESS Part A-BS OR PROFESSION (fll tems below n a case where regular books of accounts are mantaned, otherwse fll tem 6) 1 Propretor s fund SOURCES OF FUNDS APPLICATION OF FUNDS a Propretor s captal b Reserves and Surplus Revaluaton Reserve b Captal Reserve b Statutory Reserve b v Any other Reserve bv v Total (b + b + b + bv) bv c Total propretor s fund (a + bv) 2 Loan funds a Secured loans Foregn Currency Loans a Rupee Loans A From Banks B From others C Total ( A + B) Total (a + C) a b Unsecured loans (ncludng deposts) From Banks b From others b Total (b + b) b c Total Loan Funds (a + b) 3 Deferred tax lablty 3 4 Sources of funds (1c + 2c +3) 4 1 Fxed assets a Gross: Block b Deprecaton c Net Block (a b) d Captal work-n-progress e Total (1c + 1d) 2 Investments a Long-term nvestments Government and other Securtes - Quoted a Government and other Securtes Unquoted a Total (a + a) a b Short-term nvestments Equty Shares, ncludng share applcaton money Preference Shares b A B C 1a 1b 1c 1d b a 1c 2c 1e

30 279 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NO ACCOUNT CASE Debentures b v Total (b + b + b) c Total nvestments (a + bv) 3 Current assets, loans and advances a Current assets Inventores Stores/consumables ncludng packng A materal B Raw materals C Stock-n-process D Fnshed Goods/Traded Goods E Total (A + B + C + D) Sundry Debtors a Cash and Bank Balances A Cash-n-hand B Balance wth banks C Total (A + B) v Other Current Assets av v Total current assets (E + a + C + av) av b Loans and advances Advances recoverable n cash or n knd or for b value to be receved Deposts, loans and advances to corporates b and others Balance wth Revenue Authortes b v Total (b + b + b ) bv c Total of current assets, loans and advances (av + bv) d Current labltes and provsons Current labltes A Sundry Credtors B Lablty for Leased Assets C Interest Accrued on above D Interest accrued but not due on loans E Total (A + B + C + D) Provsons A Provson for Income Tax Provson for Leave B encashment/superannuaton/gratuty C Other Provsons D Total (A + B + C) Total (E + D) d e Net current assets (3c d) Mscellaneous expendture not wrtten off or 4 a adjusted b Deferred tax asset c Proft and loss account/ Accumulated balance d Total (4a + 4b + 4c) 5 Total, applcaton of funds (1e + 2c + 3e +4d) 5 6 In a case where regular books of account of busness or professon are not mantaned - (furnsh the followng nformaton as on 31 st day of March, 2019, n respect of busness or professon) a Amount of total sundry debtors A B C D A B C D A B C 4a 4b 4c A B bv 2c E C 3c E D 3e 4d 6a

31 280 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Amount of total sundry credtors c Amount of total stock-n-trade d Amount of the cash balance 6b 6c 6d Part A- Manufacturng Account 1 Openng Inventory A Manufacturng Account for the fnancal year (fll tems 1 to 3 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) Openng stock of raw-materal Openng stock of Work n progress Total ( + ) B Purchases (net of refunds and duty or tax, f any) C Drect wages D Drect expenses (D + D + D) Carrage nward Power and fuel Other drect expenses E Factory Overheads I Indrect wages I Factory rent and rates I Factory Insurance Iv Factory fuel and power V Factory general expenses V Deprecaton of factory machnery V Total (+++v+v+v) F Total of Debts to Manufacturng Account (A+B+C+D+Ev) 2 Closng Stock Raw materal Work-n-progress Total (2 +2) 2 3 Cost of Goods Produced transferred to Tradng Account (1F - 2) 3 Part A-Tradng Account CREDITS TO TRADING ACCOUNT v v v 2 2 Tradng Account for the fnancal year (fll tems 4 to 12 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 4 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a b c Total (a + b) v Total ( + + c) B Gross recepts from Professon C Dutes, taxes and cess receved or recevable n respect of goods and servces sold or suppled Unon Excse dutes Servce tax VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) v Integrated Goods & Servces Tax (IGST) a b c v v v A B C D Ev 1F Av B

32 281 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] DEBITS TO TRADING ACCOUNT v Unon Terrtory Goods & Servces Tax (UTGST) v Any other duty, tax and cess x Total ( v +v+ v+v+v) D Total Revenue from operatons (Av + B +Cx) 5 Closng Stock of Fnshed Stocks 5 6 Total of credts to Tradng Account (4D + 5v ) 6 7 Openng Stock of Fnshed Goods 7 8 Purchases (net of refunds and duty or tax, f any) 8 9 Drect Expenses ( ) 9 Carrage nward 9 Power and fuel 9 Other drect expenses Note: Row can be added as per the nature of Drect Expenses 10 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty Iv Unon excse duty V Servce tax V VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) Ix Integrated Goods & Servces Tax (IGST) X Unon Terrtory Goods & Servces Tax (UTGST) X Any other tax, pad or payable v v v 10v 10v 10v 10v 10x 10x 10x X Total ( v + 10v + 10v + 10v + 10v + 10x + 10x + 10x) 11 Cost of goods produced Transferred from Manufacturng Account Gross Proft from Busness/Professon - transferred to Proft and Loss account ( x-11) 12 Cx 4D 10x Proft and Loss Account for the fnancal year (fll tems 13 to 60 n a case where Part A-P& L regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 13 Gross proft transferred from Tradng Account 13 CREDITS TO PROFIT AND LOSS ACCOUNT 14 Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sale of fxed assets v v Proft on sale of nvestment beng securtes chargeable to Securtes Transacton Tax (STT) v v Proft on sale of other nvestment v v Gan (loss) on account of foregn exchange fluctuaton u/s 43AA v x Proft on converson of nventory nto captal asset u/s 28(va) (Far Market Value of nventory as on the date of x converson) x Agrcultural ncome x x Any other ncome (specfy nature and amount) a b xa xb

33 282 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] DEBITS TO PROFIT AND LOSS ACCOUNT x c Total (xa + xb) xc Total of other ncome ( v + v + v + v + v + x + x + xc) 15 Total of credts to proft and loss account (13+14x) Freght outward Consumpton of stores and spare parts Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages 22 Bonus 22 Rembursement of medcal expenses 22 v Leave encashment 22v v Leave travel benefts 22v v Contrbuton to approved superannuaton fund 22v v Contrbuton to recognsed provdent fund 22v v Contrbuton to recognsed gratuty fund 22v x Contrbuton to any other fund 22x x Any other beneft to employees n respect of whch an expendture has been ncurred 22x x Total compensaton to employees (total of 22 to 22x) 22x x 23 Insurance Whether any compensaton, ncluded n 22x, pad to nonresdents If Yes, amount pad to non-resdents xa xb Medcal Insurance 23 Lfe Insurance 23 Keyman s Insurance 23 v Other Insurance ncludng factory, offce, car, goods, etc. 23v Yes / No v Total expendture on nsurance ( v) 23v 24 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others 14x

34 283 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Total ( + ) Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty 44 Servce tax 44 VAT/ Sales tax 44 v Cess 44v v Central Goods & Servce Tax (CGST) 44v v State Goods & Servces Tax (SGST) 44v v Integrated Goods & Servces Tax (IGST) 44v v Unon Terrtory Goods & Servces Tax (UTGST) 44v x Any other rate, tax, duty or cess ncl STT and CTT 44x Total rates and taxes pad or payable ( v + 44v + 44v + 44v + 44v x +44x) 45 Audt fee Other expenses (specfy nature and amount) Total ( + ) 46 Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s clamed 47 and amount) v Rows can be added as requred 47v v Others (more than Rs. 1 lakh) where PAN s not avalable (provde name and complete 47v address) v Others (amounts less than Rs. 1 lakh) 47v v Total Bad Debt ( v + 47v+47v) 47v 48 Provson for bad and doubtful debts Other provsons 49 Proft before nterest, deprecaton and taxes [15 (16 to x + 23v + 24 to to x v )] 51 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Deprecaton and amortsaton Net proft before taxes ( ) 53 44x 50

35 284 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] PROVISIONS PROVISION FOR TAX AND APPROPRIATIONS 54 Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Transferred to reserves and surplus Balance carred to balance sheet n propretor s account (58 59) COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD SR.NO Name of Busness Busness code Descrpton PRESUMPTIVE INCOME CASES () Gross Turnover or Gross Recepts (a + b) 61 a Through a/c payee cheque or a/c payee bank draft or bank a electronc clearng system receved before specfed date b Any other mode b () Presumptve Income under secton 44AD (a + b) 61 a 6% of 61a, or the amount clamed to have been earned, a whchever s hgher b 8% of 61b, or the amount clamed to have been earned, b whchever s hgher NOTE If ncome s less than the above percentage of Gross Recepts/Turnover, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 62 COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA SR.NO Name of Busness Busness code Descrpton () Gross Recepts 62 () Presumptve Income under secton 44ADA (50% of 62, or the amount clamed to have been 62 earned, whchever s hgher) NOTE If ncome s less than 50% of Gross Recepts, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 63 COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE SR.NO Name of Busness Busness code Descrpton NO ACCOUNT CASE Regstraton No. of goods carrage Whether owned/leased/ hred Tonnage capacty of goods carrage (n MT) Number of months for whch goods carrage was owned/leased/hred by assessee Presumptve ncome u/s 44AE for the goods carrage Rs.1000 per ton per month n case tonnage exceeds 12MT, or Rs.7500 per month) or the amount clamed to have been actually earned, whchever s hgher () (1) (2) (3) (4) (5) (a) (b) Add row optons as necessary (upto maxmum 10) () Total presumptve ncome from goods carrage u/s 44AE [total of column (5) of table 63()] 63() NOTE If the profts are lower than prescrbed under S.44AE or the number of goods carrage owned / leased / hred at any tme durng the year exceeds 10, then, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 64 IF REGULAR BOOKS OF ACCOUNT OF BUSINESS OR PROFESSION ARE NOT MAINTAINED, furnsh the followng nformaton for prevous year n respect of busness or professon - () For assessee carryng on Busness a Gross recepts (a1 + a2) a 1 Through a/c payee cheque or a/c payee bank draft or bank a1 electronc clearng system receved before specfed date 2 Any other mode a2 b Gross proft b

36 285 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c Expenses c d Net proft 64 () For assessee carryng on Professon a Gross recepts (a1 + a2) a 1 Through a/c payee cheque or a/c payee bank draft or bank a1 electronc clearng system receved before specfed date 2 Any other mode a2 b Gross proft b c Expenses c d Net proft 64 () Total proft ( ) Turnover from speculatve actvty 65 Gross Proft 65 Expendture, f any 65 v Net ncome from speculatve actvty (65-65) 65v Part A- OI OTHER INFORMATION Other Informaton (mandatory f lable for audt under secton 44AB, for other fll, f applcable) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No Increase n the proft or decrease n loss because of devaton, f any, as per Income 3a Computaton Dsclosure Standards notfed under secton 145(2) [column 11a() of 3a Schedule ICDS] Decrease n the proft or ncrease n loss because of devaton, f any, as per Income 3b Computaton Dsclosure Standards notfed under secton 145(2) [column 11b() of 3b Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Increase n the proft or decrease n loss because of devaton, f any, from the 4d method of valuaton specfed under secton 145A e Decrease n the proft or ncrease n loss because of devaton, f any, from the 4e method of valuaton specfed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 5a b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value added tax, or refund of GST, where such 5b credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year 5c d any other tem of ncome 5d e captal recept, f any 5e f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 5f Amounts debted to the proft and loss account, to the extent dsallowable under secton 6 36 due to non-fulflment of condtons specfed n relevant clauses Premum pad for nsurance aganst rsk of damage a or destructon of stocks or store [36(1)()] 6a Premum pad for nsurance on the health of b employees [36(1)(b)] 6b Any sum pad to an employee as bonus or commsson c for servces rendered, where such sum was otherwse 6c payable to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed d captal [36(1)()] 6d Amount of dscount on a zero-coupon bond e [36(1)(a)] 6e f Amount of contrbutons to a recognsed provdent fund [36(1)(v)] 6f

37 286 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Amount of contrbutons to an approved g superannuaton fund [36(1)(v)] Amount of contrbuton to a penson scheme referred h to n secton 80CCD [36(1)(va)] Amount of contrbutons to an approved gratuty fund [36(1)(v)] j Amount of contrbutons to any other fund Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up under ESI Act or any other fund for the k welfare of employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] m Provson for bad and doubtful debts [36(1)(va)] 6m Amount transferred to any specal reserve n 6n [36(1)(v)] Expendture for the purposes of promotng famly o 6o plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of p transacton n securtes f such ncome s not 6p ncluded n busness ncome [36(1)(xv)] Marked to market loss or other expected loss as q computed n accordance wth the ICDS notfed u/s 6q 145(2) [36(1)(xv)] r Any other dsallowance 6r s Total amount dsallowable under secton 36 (total of 6a to 6r) 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton a Expendture of captal nature [37(1)] 7a b Expendture of personal nature [37(1)] 7b Expendture lad out or expended wholly and exclusvely c 7c NOT for the purpose of busness or professon [37(1)] Expendture on advertsement n any souvenr, d brochure, tract, pamphlet or the lke, publshed by a 7d poltcal party [37(2B)] Expendture by way of penalty or fne for volaton of e 7e any law for the tme beng n force f Any other penalty or fne 7f Expendture ncurred for any purpose whch s an g 7g offence or whch s prohbted by law h Amount of any lablty of a contngent nature 7h Any other amount not allowable under secton 37 7 j Total amount dsallowable under secton 37 (total of 7a to 7) 8 Amounts debted to the proft and loss account, to the extent dsallowable under A secton 40 Amount dsallowable under secton 40 (a)(), on a account of non-complance wth the provsons of Aa Chapter XVII-B Amount dsallowable under secton 40(a)(a) on b account of non-complance wth the provsons of Ab Chapter XVII-B Amount dsallowable under secton 40(a)(b), on c account of non-complance wth the provsons of Ac Chapter VIII of the Fnance Act, 2016 Amount dsallowable under secton 40(a)() on d account of non-complance wth the provsons of Ad Chapter XVII-B Amount of tax or rate leved or assessed on the bass e Ae of profts [40(a)()] f Amount pad as wealth tax [40(a)(a)] Af Amount pad by way of royalty, lcense fee, servce g Ag fee etc. as per secton 40(a)(b) Amount of nterest, salary, bonus, commsson or h remuneraton pad to any partner or member [40(b)] Ah 6g 6h 6 6j 6k 6l 6s 7j

38 287 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Any other dsallowance j Total amount dsallowable under secton 40(total of Aa to A) 8Aj Any amount dsallowed under secton 40 n any precedng prevous year but B 8B allowable durng the prevous year Amounts debted to the proft and loss account, to the extent dsallowable under secton 9 40A a Amounts pad to persons specfed n secton 40A(2)(b) 9a Amount pad otherwse than by account payee cheque or account payee bank draft or use of electronc clearng b 9b system through a bank account, dsallowable under secton 40A(3) c Provson for payment of gratuty [40A(7)] 9c Any sum pad by the assessee as an employer for settng d up or as contrbuton to any fund, trust, company, AOP, 9d or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance 9e f Total amount dsallowable under secton 40A 9f Any amount dsallowed under secton 43B n any precedng prevous year but allowable 10 durng the prevous year Any sum n the nature of tax, duty, cess or fee under any a 10a law Any sum payable by way of contrbuton to any provdent b fund or superannuaton fund or gratuty fund or any 10b other fund for the welfare of employees Any sum payable to an employee as bonus or commsson c 10c for servces rendered Any sum payable as nterest on any loan or borrowng d from any publc fnancal nsttuton or a State fnancal 10d corporaton or a State Industral nvestment corporaton Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other e 10e than a prmary agrcultural credt or a prmary cooperatve agrcultural and rural development bank f Any sum payable towards leave encashment 10f Any sum payable to the Indan Ralways for the use of g 10g ralway assets h Total amount allowable under secton 43B (total of 10a to 10g) 10h Any amount debted to proft and loss account of the prevous year but dsallowable 11 under secton 43B Any sum n the nature of tax, duty, cess or fee under any a 11a law Any sum payable by way of contrbuton to any provdent b fund or superannuaton fund or gratuty fund or any 11b other fund for the welfare of employees Any sum payable to an employee as bonus or commsson c 11c for servces rendered Any sum payable as nterest on any loan or borrowng d from any publc fnancal nsttuton or a State fnancal 11d corporaton or a State Industral nvestment corporaton Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other e 11e than a prmary agrcultural credt socety or a prmary co-operatve agrcultural and rural development bank f Any sum payable towards leave encashment 11f Any sum payable to the Indan Ralways for the use of g 11g ralway assets h Total amount dsallowable under Secton 43B (total of 11a to 11g) 11h 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Central Goods & Servce Tax (CGST) A 12a 12b 12c 12d

39 288 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e State Goods & Servces Tax (SGST) f Integrated Goods & Servces Tax (IGST) g Unon Terrtory Goods & Servces Tax (UTGST) h Any other tax Total amount outstandng (total of 12a to 12h) 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and 15 loss account (net) Amount of expendture dsallowed u/s 14A 16 12e 12f 12g 12h 12 Part A QD QUANTITATIVE DETAILS Quanttatve detals (mandatory f lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern 6 Raw materals a Openng stock b Purchases durng the prevous year c Consumpton durng the prevous year d Sales durng the prevous year e Closng stock f Yeld fnshed products g Percentage of yeld h Shortage/ excess, f any 7 Fnshed products/ By-products a openng stock b purchase durng the prevous year c quantty manufactured durng the prevous year d sales durng the prevous year e closng stock f shortage/ excess, f any 6a 6b 6c 6d 6e 6f 6g 6h 7a 7b 7c 7d 7e 7f SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule S Detals of Income from Salary Name of Employer Nature of employment (Tck) Govt. PSU Pensoners Others TAN of Employer (mandatory f tax s deducted) Address of employer Town/Cty State Pn code/zp code SALARIES 1 Gross Salary (1a + 1b + 1c) 1 a Salary as per secton 17(1) (drop down to be provded) 1a b Value of perqustes as per secton 17(2) (drop down to be provded) 1b c Proft n leu of salary as per secton 17(3) (drop down to be provded) 1c (Add multple rows for Gross Salary n case of more than one employer)

40 289 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 2 Total Gross Salary (from all employers) 2 3 Less allowances to the extent exempt u/s 10 (drop down to be provded n e-flng utlty) (please refer nstructons) 4 Net Salary (2-3) 4 5 Deducton u/s 16 (5a + 5b + 5c) 5 a Standard deducton u/s 16(a) 5a b Entertanment allowance u/s 16() c Professonal tax u/s 16() 5c 6 Income chargeable under the Head Salares (4-5) 6 5b 3 Detals of Income from House Property (Please refer nstructons) (Drop down to be provded ndcatng ownershp of Schedule HP property) Address of property 1 Town/ Cty State PIN Code/ Zp Code 1 Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II HOUSE PROPERTY [Tck the applcable opton] Let out Self-occuped Deemed let out Name(s) of Tenant (f let out) I II a Gross rent receved or recevable or letable value PAN of Tenant(s) (f avalable) b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2)of the Act) f Annual value of the property owned (own percentage share x 1e) g 30% of 1f 1g h Interest payable on borrowed captal 1h Total (1g+ 1h) j Arrears/Unrealsed rent receved durng the year less 30% PAN/TAN of Tenant(s) (f TDS credt s clamed) k Income from house property 1 (1f 1 + 1j) 1k Address of property 2 Town/ Cty State PIN Code/ Zp Code 2 1a 1e 1f 1 1j Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property (optonal) I II [Tck the applcable opton] Let out Self-occuped Deemed let out Name(s) of Tenant (f let out) I II PAN(s) of Tenant (Please see note) Gross rent receved or recevable/ letable value a (hgher of the two, f let out for whole of the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d PAN/TAN of Tenant(s) (Please see note) 2a

41 290 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e Annual value (2a 2d) f Annual value of the property owned (own percentage share x 2e) g 30% of 2f 2g h Interest payable on borrowed captal 2h Total (2g + 2h) j Arrears/Unrealsed rent receved durng the year less 30% k Income from house property 2 (2f 2 + 2j) 3 Pass through ncome f any * 3 4 Income under the head Income from house property (1k + 2k + 3) (f negatve take the fgure to 2 of schedule CYLA) 4 NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI and Pass through ncome referred to n schedule PTI whle computng the ncome under ths head NOTE Furnshng of PAN of tenant s mandatory, f tax s deducted under secton 194-IB. Furnshng of TAN of tenant s mandatory, f tax s deducted under secton 194-I. 2e 2f 2 2j 2k Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 53, 61(), 62(), 63(), 64() and 65(v) of P&L ) 2a Net proft or loss from speculatve busness ncluded n 1 (enter ve sgn n case of loss) [Sl.no 65v of Schedule 2a 2b Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) 2b INCOME FROM BUSINESS OR PROFESSION 3 Income/ recepts credted to proft and loss account consdered under other heads of ncome/chargeable u/s 115BBF/ chargeable u/s 115BBG a Salares 3a b House property 3b c Captal 3c gans d Other 3d sources e u/s 115BBF 3e f u/s 115BBG 3f Proft or loss ncluded n 1, whch s referred to n 4a secton 44AD/44ADA/44AE/44B/44BB/44BBA/44DA 4a (drop down to be provded 4b Proft from actvtes covered under rule 7, 7A, 7B(1), 7B(1A) and 8 (Dropdown to be provded and capture 4b 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b Any other exempt ncome (specfy c nature and amount) c c Total (c + c) 5c d Total exempt ncome (5a + 5b + 5c) 5d 6 Balance (1 2a 2b 3a - 3b 3c - 3d 3e - 3f 4a-4b 5d) 6 7 Expenses debted to proft and loss account consdered under other heads of ncome/related to ncome chargeable u/s 115BBF or u/s 115BBG a Salares b House property c Captal gans d Other 7a 7b 7c 7d e u/s 115BBF 7e f u/s 115BBG 7f 8a Expenses debted to proft and loss account whch relate to exempt ncome 8a 8b Expenses debted to proft and loss account whch relate to exempt ncome and dsallowed u/s 14A (16 of 8b 9 Part Total A-OI) (7a + 7b + 7c + 7d + 7e + 7f + 8a+8b) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act 1

42 291 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Deprecaton allowable under secton 32(1)() 12 and 32(1)(a) (tem 6 of Schedule-DEP) Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of 12 Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 (6r of Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 (7j of Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 (8Aj of Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A (9f of 17 Any amount debted to proft and loss account of the prevous year but dsallowable under secton 18 Interest dsallowable under secton 23 of the Mcro, Small and Medum Enterprses Development Deemed ncome under secton Deemed ncome under secton 32AD/ 33AB/ 21 33ABA/ 35ABA /35ABB/ 40A(3A)/ 72A/80HHD/ Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 23 Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch ndvdual/huf/prop. 25 Increase n proft or decrease n loss on account of ICDS adjustments and devaton n method of valuaton of stock (Column 3a + 4d of Part A - OI) 26 Total ( ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD 28 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft 29 and loss account (tem x(4) of Schedule ESR) (f 29 amount deductble under secton 35 or 35CCC or 35CCD s lower than amount debted to P&L account, Any amount dsallowed under secton 40 n any 30 precedng prevous year but allowable durng the 30 prevous year(8b of PartA-OI) Any amount dsallowed under secton 43B n any 31 precedng prevous year but allowable durng the 31 prevous year(10g of PartA-OI) 32 Any other amount allowable as deducton Decrease n proft or ncrease n loss on account of 33 ICDS adjustments and devaton n method of valuaton of stock (Column 3b + 4e of Part A- OI) 34 Total ( ) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AD (61() of schedule P&L) 36 Secton 44ADA (62() of schedule P&L) 36 Secton 44AE (63() of schedule P&L) v Secton 44B 36 36v v Secton 44BB 36v v Secton 44BBA 36v v Secton 44DA 36v (tem 4 of Form 3CE) v Total (36 to 36v) v

43 292 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 37 Net proft or loss from busness or professon other than speculatve and 37 specfed busness ( v) Net Proft or loss from busness or professon other than speculatve 38 busness and specfed busness after applyng rule 7A, 7B or 8, f A38 applcable (If rule 7A, 7B or 8 s not applcable, enter same fgure as n 37) (If loss take a Income chargeable under Rule 7 38a b Deemed ncome chargeable under Rule 7A 38b c Deemed ncome chargeable under Rule 7B(1) 38c d Deemed ncome chargeable under Rule 7B(1A) 38d e Deemed ncome chargeable under Rule 8 38e f Income other than Rule 7A, 7B & 8 (Item No. 37) 38f 39 Balance of ncome deemed to be from agrculture, after applyng Rule 7, 7A, 7B(1), 7B(1A) and Rule 8 for the purpose of aggregaton of ncome as per Fnance Act 39 B Computaton of ncome from speculatve busness 40 Net proft or loss from speculatve busness as per proft or loss account 40 (Item No. 2a) 41 Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Income from speculatve busness ( ) (f loss, take the fgure to 6x of B43 schedule CFL) C Computaton of ncome from specfed busness under secton 35AD D NOTE 44 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 47 Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) Income from Specfed Busness (47-48) (f loss, take the fgure to 7x of schedule C49 CFL) Relevant clause of sub-secton (5) of secton 35AD whch covers the specfed busness 50 C50 (to be selected from drop down menu) Income chargeable under the head Profts and gans from busness or professon (A38 + B43 + C49) E Intra head set off of busness loss of current year Sl. v v Type of Busness ncome Loss to be set off (Fll ths row only f fgure s Income from speculatve busness Income from specfed busness Total loss set off ( + ) Loss remanng after set off ( v) Income of current year (Fll ths column only f fgure s zero or Busness loss set off 46 D Busness ncome remanng after set off (1) (2) (3) = (1) (2) (B43) (C49) (A38) Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as Schedule DPM deducton under any other secton) 1 Block of assets Plant and machnery DEPRECIATION ON PLANT AND MACHINERY 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 () () ()

44 293 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Addtonal deprecaton relatng to mmedately precedng year' on asset put to use for less than 180 days 15 Total deprecaton ( ) 16 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net aggregate deprecaton (15-16) 18 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth transfer of asset/ assets 20 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 21 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Land Buldng (not ncludng land) Furnture and Intangble Shps fttngs assets 2 Rate (%) Nl DEPRECIATION ON OTHER ASSETS 3 Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Total deprecaton (10+11) () () () (v) (v) (v) (v)

45 294 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 13 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net aggregate deprecaton (12-13) 15 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 14) 16 Expendture ncurred n connecton wth transfer of asset/ assets 17 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 18 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) Summary of deprecaton on assets (Other than assets on whch full captal expendture s allowable as Schedule DEP deducton under any other secton) 1 Plant and machnery SUMMARY OF DEPRECIATION ON ASSETS a Block enttled for 15 per cent 1a ( Schedule DPM -17 or 18 as applcable) b Block enttled for 30 per cent 1b ( Schedule DPM - 17 or 18 as applcable) c Block enttled for 40 per cent 1c ( Schedule DPM - 17 or 18 as applcable) d Total deprecaton on plant and machnery ( 1a + 1b + 1c) 2 Buldng (not ncludng land) a Block enttled for 5 per cent 2a (Schedule DOA- 14 or 15 as applcable) b Block enttled for 10 per cent 2b (Schedule DOA- 14 or 15 as applcable) c Block enttled for 40 per cent 2c (Schedule DOA- 14v or 15v as applcable) d Total deprecaton on buldng (total of 2a + 2b + 2c) 3 Furnture and fttngs(schedule DOA- 14v or 15v as applcable) 3 4 Intangble assets (Schedule DOA- 14v or 15v as applcable) 4 5 Shps (Schedule DOA- 14v or 15v as applcable) 5 6 Total deprecaton (1d+2d+3+4+5) 6 1d 2d Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery a Block enttled for 15 per cent 1a (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 Total ( 1a +1b + 1c) 2 Buldng (not ncludng land) DEEMED CAPITAL GAINS a Block enttled for 5 per cent 2a (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 Total ( 2a + 2b + 2c) 2d 3 Furnture and fttngs ( Schedule DOA- 17v) 3 4 Intangble assets (Schedule DOA- 17v) 4 5 Shps (Schedule DOA- 17v) 5 6 Total ( 1d+2d+3+4+5) 6 1d

46 295 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule ESR Expendture on scentfc Research etc. (Deducton under secton 35 or 35CCC or 35CCD) Sl No Expendture of the nature referred to n secton (1) Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) 35(1)() v V v v v x 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD X Total In case any deducton s clamed under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA), please provde the detals as per NOTE Schedule RA. Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Sub-tems 4 and 5 are not applcable for resdents) 1 From sale of land or buldng or both (fll up detals separately for each property) a Full value of consderaton receved/recevable a CAPITAL GAINS Short-term Captal Gans Value of property as per stamp valuaton authorty a Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans () [n case (a) does not exceed 1.05 tmes (a), take ths fgure as (a), or else take (a)] a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b + b) bv c Balance (a bv) 1c d Deducton under secton 54B/54D/ 54G/54GA (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.No. Name of buyer(s) PAN of Percentage Amoun buyer(s) share t NOTE Address of property Pn code Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) 3 b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) A2c From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (3a bv) 3c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss 3d arsng out of sale of such asset to be gnored (Enter postve value only) e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e

47 296 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 4 For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a b STCG on transactons on whch securtes transacton tax (STT) s not pad A4b 5 For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 115AD a In case securtes sold nclude shares of a company other than quoted shares, enter the a Full value of consderaton receved/recevable n respect of unquoted b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of c unquoted shares adopted as per secton 50CA for the purpose of Captal Gans Full value of consderaton n respect of securtes other than unquoted shares Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (5a bv) 5c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) 5d e Short-term captal gan on sale of securtes (other than those at A3 above) by an FII (5c 6 +5d) From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of c unquoted shares adopted as per secton 50CA for the purpose of Captal Gans Full value of consderaton n respect of assets other than unquoted shares Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (6a bv) 6c In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- d for example f asset bought/acqured wthn 3 months pror to record 6d date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) e Deemed short term captal gans on deprecable assets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e -6f) A6g 7 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous Secton under New asset acqured/constructed Amount not A5e

48 297 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b year n whch whch asset deducton transferred clamed n that D/54G/54G A B Year n whch asset acqured/constructed Amount deemed to be short term captal gans u/s 54B/54D/54G/54GA, other than at a Amount utlsed out of Captal Gans used for new asset or remaned Total amount deemed to be short term captal gans (X + X + b) A7 8 Pass Through Income n the nature of Short Term Captal Gan, (Fll up schedule PTI) (A8a + A8b + A8c) A8 a Pass Through Income n the nature of Short Term Captal Gan, A8a b chargeable Pass 15% Income n the nature of Short Term Captal Gan, A8b c chargeable Pass 30% Income n the nature of Short Term Captal Gan, A8c chargeable at applcable rates 9 Amount of STCG ncluded n A1-A8 but not chargeable to tax or chargeable at specal rates as per DTAA Sl. No. Amount Item No. A1 to Country of A8 above n name & ncome whch ncluded Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act Applcable Rate as rate [lower per I.T. of (6) or Act (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II a Total amount of STCG not chargeable to tax as per DTAA A9a b Total amount of STCG chargeable to tax at specal rates as per DTAA A9b 10 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7+A8 A9a) B Long-term captal gan (LTCG) (Sub-tems 5, 6, 7, 8 & 9 are not applcable for resdents) 1 From sale of land or buldng or both (fll up detals separately for each property) Long-term Captal Gans a Full value of consderaton a Value of property as per stamp valuaton a Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans a [n case (a) does not exceed 1.05 tmes (a), b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of Improvement wth ndexaton b Expendture wholly and exclusvely n b v Total (b + b + b) bv c Balance (a bv) 1c d Deducton under secton 54/54B/54D/54EC/54F/54G/54GA/54GB (Specfy 1d e detals n tem D below) Long-term Captal Gans on Immovable property (1c - 1d) B1e f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.No. Name of PAN of Percentage Amoun Address of Pn buyer(s) buyer(s) share t property code NOTE Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) 2c d Deducton u/s 54EC /54F (Specfy detals n tem D 2d below) e Long term captal gans from slump sale (2c-2d) B2e 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton b b

49 298 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Expendture wholly and exclusvely n connecton wth v Total (b + b +b) c Balance (3a bv) 3c d Deducton under sectons /54F (Specfy detals n tem D below) 3d e LTCG on bonds or debenture (3c 3d) B3e From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso 4 under secton 112(1) s applcable () GDR of an Indan company referred n sec. 115ACA a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c d Deducton under secton 54F (Specfy detals n tem D below) 4d e Long-term Captal Gans on assets at B4 above (4c 4d) B4e 5 From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 5a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) b A Cost of acquston A B If the long term captal asset was acqured before , B lower of B1 and B2 1 Far Market Value of captal asset as per secton B1 55(2)(ac) 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer v Total deductons (b + b +b) c Balance (5a bv) d Less- LTCG threshold lmt as per secton 112A (5c Rs. 1 lakh) e Deducton under sectons 54F (Specfy detals n tem D below) f Long-term Captal Gans on sale of captal assets at B5 above (5d 5e) B5f 6 For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 6a b Deducton under sectons /54F (Specfy detals n tem D below) 6b c LTCG on share or debenture (6a-6b) For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds 7 or GDR as referred n sec. 115AC, () securtes by FII as referred to n sec. 115AD (other than securtes referred to n secton 112A for whch column B8 s to be flled up) a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of securtes other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (a bv) 7c d Deducton under sectons /54F (Specfy detals n tem D below) 7d b bv b bv 5c 5d 5e a b c a a

50 299 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e Long-term Captal Gans on assets at 7 above n case of NON-RESIDENT (7c 7d) B7e 8 For NON-RESIDENTS - From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 8a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) A Cost of acquston B If the long term captal asset was acqured before , lower of B1 and B2 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total deductons (b + b +b) bv c Balance (8a bv) 8c d Less- LTCG threshold lmt as per secton 112A (8c Rs. 1 lakh) 8d e Deducton under sectons 54F (Specfy detals n tem D below) 8e f Long-term Captal Gans on sale of captal assets at B8 above (8d 8e) B8f 9 From sale of foregn exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A) a LTCG on sale of specfed asset (computed wthout ndexaton) 9a b Less deducton under secton 115F (Specfy detals n tem D below) 9b c Balance LTCG on sale of specfed asset (9a- 9b) B9c d LTCG on sale of asset, other than specfed asset (computed wthout ndexaton) 9d e Less deducton under secton 115F (Specfy detals n tem D below) 9e f Balance LTCG on sale of asset, other than specfed asset (9d- 9e) B9f 10 From sale of assets where B1 to B9 above are not applcable a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of a unquoted shares b Far market value of unquoted shares determned n the b prescrbed manner c Full value of consderaton n respect of unquoted shares c adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than a unquoted shares Total (c + ) a b Deductons under secton 48 Cost of acquston wth ndexaton Cost of mprovement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (10a bv) d Deducton under secton 54D//54F/54G/54GA (Specfy detals n tem D below) e Long-term Captal Gans on assets at B10 above (10c- 10d) 11 Amount deemed to be long-term captal gans b b b A B b bv 10c 10d B10e a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevou s year n whch asset transfer Secton under whch deducton clamed n that year New asset acqured/constructed Year n whch asset acqured/constructed Amount utlsed out of Captal Gans account Amount not used for new asset or remaned unutlzed n Captal gans account (X)

51 300 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] /54D/54F/54 G/54GA B 17 b Amount deemed to be long-term captal gans, other than at a Total amount deemed to be long-term captal gans (X + X + b) B11 12 Pass Through Income n the nature of Long Term Captal Gan, (Fll up schedule PTI) (B12a + B12b) B12 13 a Pass Through Income n the nature of Long Term Captal Gan, 10% B12a b Pass Through Income n the nature of Long Term Captal Gan, 20% B12b -Amount of LTCG ncluded n tems B1 to B12 but not chargeable to tax or chargeable at specal rates n Inda as per DTAA Amo Item unt No. B1 Country Rate as per Rate as Sl. of to B12 Artcle of name & Treaty Whether TRC obtaned Secton of I.T. Applcable rate per I.T. No. nco above DTAA (enter NIL, f not (Y/N) Act [lower of (6) or (9)] Code chargeable) Act me n (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II B13 a Total amount of LTCG not chargeable to tax as per DTAA a b Total amount of LTCG chargeable to tax at specal rates as per DTAA B13 b Total long term captal gan chargeable under I.T. Act (B1e + B2e + B3e + B4e + B5f + B6c + B7e + 14 B8f + B9c + B9f + B10e + B11 + B12 - B13a) (In case of loss take the fgure to 9x of schedule CFL) B14 C Income chargeable under the head CAPITAL GAINS (A10 + B14) (take B14 as nl, f loss) D Informaton about deducton clamed aganst Captal Gans 1 In case of deducton u/s 54/54B/54D/54EC /54F/54G/54GA/115F gve followng detals a Deducton clamed u/s 54 b c d e Date of transfer of orgnal asset a dd/mm/yyyy Cost of new resdental house Date of purchase /constructon of new resdental house a dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due av date v Amount of deducton clamed av Deducton clamed u/s 54B Date of transfer of orgnal asset b dd/mm/yyyy Cost of new agrcultural land Date of purchase of new agrcultural land b dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54D Date of acquston of orgnal asset c dd/mm/yyyy Cost of purchase/ constructon of new land or buldng for ndustral undertakng Date of purchase of new land or buldng c dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54EC Date of transfer of orgnal asset d dd/mm/yyyy Amount nvested n specfed/notfed bonds (not exceedng ffty lakh rupees) Date of nvestment d dd/mm/yyyy v Amount of deducton clamed Deducton clamed u/s 54F Date of transfer of orgnal asset e dd/mm/yyyy Cost of new resdental house Date of purchase/constructon of new resdental house e dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed a b bv bv c cv cv d dv e ev ev C

52 301 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] f g h Deducton clamed u/s 54G Date of transfer of orgnal asset from urban area f dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new asset f Date of purchase/constructon of new asset n an area other than urban area f dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date fv v Amount of deducton clamed fv Deducton clamed u/s 54GA Date of transfer of orgnal asset from urban area g dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new asset g Date of purchase/constructon of new asset n SEZ g dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date gv v Amount of deducton clamed gv Deducton clamed u/s 115F (for Non-Resdent Indans) Date of transfer of orgnal foregn exchange asset h dd/mm/yyyy Amount nvested n new specfed asset or savngs certfcate h Date of nvestment h dd/mm/yyyy v Amount of deducton clamed hv Total deducton clamed (1a + 1b + 1c + 1d + 1e + 1f + 1g + 1h) 2 In case of deducton u/s 54GB, furnsh PAN of the E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A8 & B12 whch s chargeable under DTAA) Sl Type of Captal. Gan Captal Gan of current year (Fll ths column only f computed fgure s postve) 15% Short term captal loss 30 % 1 applcable rate DTA A rates Long term captal loss 10% 20% Current year s captal gans reman DTA A rates Captal Loss to be set off (Fll ths row only, f fgure computed s negatve) (A3e*+A4a*+A8 a*) (A5e * + A8b *) (A1e*+A2c*+A4b*+A6g*+A7* +A8c*) A9b (B4e*+B5f *+ B7e* +B8f*+ B9c* + B12a*) (B1e*+ B2e*+B3e*+B6 c*+ B9f*+ B13b B10e*+ B11*+ B12b*) 15% (A3e*+A4a*+A8a* ) Short 30% (A5e*+ A8b*) term applcabl (A1e*+A2c*+A4b* v captal e rate +A6g* +A7*+A8c*) gan DTAA v A9b rates (B4e*+B5f*+ B7e* v 10% +B8f*+ Long B9c*+B12a*) term (B1e*+ capt B2e*+B3e*+B6c*+ v 20% B9f*+ B10e*+ al B11*+ B12b*) gan DTAA v B13b rates x Total loss set off ( + + v + v + v + v+v) x Loss remanng after set off (- x) The fgures of STCG n ths table (A1e* etc.) are the amounts of STCG computed n respectve column (A1-A8) as reduced by the amount of STCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. The fgures of LTCG n ths table (B1e* etc.) are the amounts of LTCG computed n respectve column (B1-B12) as reduced by the amount of LTCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. F Informaton about accrual/recept of captal gan

53 302 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Type of Captal gan / Date 1 Short-term captal gans taxable at the rate of 15% Short-term captal gans taxable at the rate of 2 30% Short-term captal gans taxable at applcable 3 rates Short-term captal gans taxable at DTAA rates 4 Enter value from tem 5x of schedule BFLA, f any. 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) Long- term captal gans taxable at the rate of 5 10% Long- term captal gans taxable at the rate of 6 20% Long- term captal gans taxable at the rate DTAA 7 rates Enter value from tem 5x of NOTE Please nclude the ncome of the specfed persons(spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head Schedule OS OTHER SOURCES Income from other sources 1 Gross ncome chargeable to tax at normal applcable rates (1a+ 1b+ 1c+ 1d + 1e) 1 a Dvdends, Gross 1a b Interest, Gross (b + b + b + bv) 1b From Savngs Bank b From Deposts (Bank/ Post Offce/ Cooperatve) Socety/) b From Income-tax Refund b v In the nature of Pass through ncome bv v Others bv c Rental ncome from machnery, plants, buldngs, etc., Gross 1c Income of the nature referred to n secton 56(2)(x) whch s 1d d chargeable to tax Aggregate value of sum of money receved wthout consderaton In case mmovable property s receved wthout consderaton, stamp duty value of property In case mmovable property s receved for nadequate consderaton, stamp duty value of property n excess of such In case any other property s receved wthout consderaton, far v market value of property In case any other property s receved for nadequate v consderaton, far market value of property n excess of such consderaton e Any other ncome (please specfy nature) 2 Income chargeable at specal rates (2a+ 2b+ 2c+ 2d + 2e) 2 a Wnnngs from lotteres, crossword puzzles etc. chargeable u/s 2a b Income chargeable u/s 115BBE (b + b + b + bv+ bv + bv) Cash credts u/s 68 b Unexplaned nvestments u/s 69 Unexplaned money etc. u/s 69A v Undsclosed nvestments etc. u/s 69B v Unexplaned expendture etc. u/s 69C v Amount borrowed or repad on hund u/s c Accumulated balance of recognsed provdent fund taxable u/s 111 S.No. Assessment Year Income beneft Tax beneft () () () (v) b b bv bv bv d d d dv dv 1e 2b 2c d Any other ncome chargeable at specal rate (total of d to dxx) Dvdends receved by non-resdent (not beng company) or foregn company chargeable u/s 115A(1)(a)() d 2d

54 303 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Interest receved from Government or Indan d concern on foregn currency debts chargeable u/s 115A(1)(a)() Interest receved from Infrastructure Debt d Fund chargeable u/s 115A(1)(a)(a) Interest referred to n secton 194LC - dv v chargeable u/s 115A(1)(a)(aa) Interest referred to n secton 194LD - dv v chargeable u/s 115A(1)(a)(ab) Dstrbuted ncome beng nterest referred to n dv v secton 194LBA - chargeable u/s Income from unts of UTI or other Mutual dv v Funds specfed n secton 10(23D), purchased n Foregn Currency - chargeable u/s Income from royalty or fees for techncal dv v servces receved from Government or Indan concern - chargeable u/s 115A(1)(b) Income by way of nterest or dvdends from dx x bonds or GDRs purchased n foregn currency by non-resdents - chargeable u/s 115AC Income by way of dvdends from GDRs dx x purchased n foregn currency by resdents - chargeable u/s 115ACA Income (other than dvdend) receved by an dx x FII n respect of securtes (other than unts referred to n secton 115AB) - chargeable u/s Income by way of nterest receved by an FII dx on bonds or Government securtes referred to x n secton 194LD chargeable as per provso to secton 115AD(1)() Tax on non-resdents sportsmen or sports dx x assocatons chargeable u/s 115BBA Anonymous Donatons n certan cases dxv xv chargeable u/s 115BBC Income by way of dvdend receved by dxv xv specfed assessee, beng resdent, from domestc company exceedng rupees ten lakh Income by way of royalty from patent dxv xv developed and regstered n Inda - chargeable Income by way of transfer of carbon credts -dxv xv chargeable u/s 115BBG Investment Income of a Non-Resdent Indan - dv xv chargeable u/s 115E xx Any other ncome (Please specfy) dxx Pass through ncome n the nature of ncome from other sources chargeable at specal e rates (drop down to be provded) Amount ncluded n 1 and 2 above, whch s chargeable at specal rates n Inda as per f DTAA (total of column (2) of table below) Sl. No. Amount of ncome Item No.2a to 2e n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 2e 2f 3 I II Deductons under secton 57 (other than those relatng to ncome chargeable at specal rates under 2a, 2b & 2d) a Expenses / Deductons 3a b Deprecaton 3b c Total 3c 4 Amounts not deductble u/s Profts chargeable to tax u/s Net Income from other sources chargeable at normal applcable rates ( ) (If 6 negatve take the fgure to 4 of schedule CYLA)

55 304 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 7 Income from other sources (other than from ownng race horses) (2 +6 ) (enter 6 as nl, f 8 negatve) Income from the actvty of ownng and mantanng race horses a Recepts 8a Deductons under secton 57 n relaton to b 8b recepts at 8a only c Amounts not deductble u/s 58 8c d Profts chargeable to tax u/s 59 8d e Balance (8a - 8b + 8c + 8d) (f negatve take the fgure to 10x of Schedule CFL) 9 Income under the head Income from other sources (7 + 8e) (take 8e as nl, f negatve) 9 10 Informaton about accrual/recept of ncome from Other Sources S.No. Other Source Income Upto 15/6 From 16/6 to 15/9 From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3 () () () (v) (v) Dvdend Income 1 u/s 115BBDA Income by way of wnnngs from lotteres, crossword 2 puzzles, races, games, gamblng, bettng etc. referred to n secton 2(24)(x) Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome NOTE under ths head. 7 8e Schedule CYLA Detals of Income after set-off of current years losses Sl.No Head/ Source of Income Income of current House property loss Busness Loss year of the current year (other than (Fll ths column set off speculaton loss only f ncome s or specfed zero or postve) busness loss) of the current year set off CURRENT YEAR LOSS ADJUSTMENT Loss to be set off (Fll ths row only f computed fgure s negatve) Salares ( 6 of Schedule S) House property v Income from Busness (excludng speculaton proft and ncome from specfed busness) or professon v v Speculatve Income Specfed Busness Income Short-term captal gan taxable 15% Short-term captal gan taxable 30% Short-term captal gan taxable at x applcable rates Short-term captal gan taxable at x specal rates n Inda as per DTAA Long term captal gan x 10% x x xv Long term captal gan 20% Long term captal gans taxable at specal rates n Inda as per DTAA Net ncome from other sources chargeable at normal applcable rates Other sources loss (other than loss from ownng race horses) of the current year set off Current year s Income remanng after set off = ( 4 of Schedule HP) (A38 of Schedule BP) (3 of tem E of schedule BP) (3 of tem E of schedule BP) (9 of tem E of schedule CG) (9 of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (6 of schedule OS) ( 4 of Schedule HP) (2v of tem E of Schedule BP) (6 of Schedule-OS)

56 305 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Proft from the actvty of xv ownng and mantanng race horses Income from other sources xv taxable at specal rates n Inda as per DTAA xv Total loss set off xv Loss remanng after set-off ( xv) (8e of schedule OS) (2f of schedule OS) Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years Sl. Head/ Source of Income Income after set off, Brought forward loss Brought No. f any, of current set off forward year s losses as per 5 deprecaton set of Schedule CYLA) off BROUGHT FORWARD LOSS ADJUSTMENT Salares (5 of schedule CYLA) x x 10% Long term captal gan 20% Long term captal gans taxable at specal rates n Inda as per DTAA Net ncome from other sources x chargeable at normal applcable rates Proft from ownng and xv mantanng race horses xv Income from other sources ncome taxable at specal rates n Inda as per DTAA Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5x of schedule CYLA) (5x of schedule CYLA) (5xv of schedule CYLA) (5xv of schedule CYLA) (5xv of schedule CYLA) House property (5 of schedule (B/f house property CYLA) loss) Busness (excludng speculaton (B/f busness loss, other ncome and ncome from (5v of schedule CYLA) than speculaton or specfed busness) specfed busness loss) v Speculaton Income (B/f normal busness or (5v of schedule CYLA) speculaton loss) v Specfed Busness Income (B/f normal busness or (5v of schedule CYLA) specfed busness loss) v Short-term captal gan taxable (5v of schedule (B/f short-term 15% CYLA) loss) Short-term captal gan taxable (5v of schedule (B/f short-term captal 30% CYLA) loss) Short-term captal gan taxable at (B/f short-term captal v (5x of schedule CYLA) applcable rates loss) x Short-term captal gan taxable at (B/f short-term captal specal rates n Inda as per (5x of schedule CYLA) loss) DTAA x Long-term captal gan (B/f short-term or long- (5x of schedule CYLA) term captal loss) (B/f short-term or longterm captal loss) (B/f short-term or longterm captal loss) (B/f loss from horse races) Total of brought forward loss set off ( v + 2v xv + 2v + 2v +2v + 2x + 2x + 2x + 2x + 2xv) Current year s ncome remanng after set off Total of ( v+ 5v + 5v + 5v + 5v + 5x + 5x + 5x xv +5x + 5x+ 5xv + 5xv) Schedule CFL Detals of Losses to be carred forward to future years Sl. Assessment Year Date of Flng House Loss from No. (DD/MM/YYYY) property loss busness other than loss from speculatve busness and specfed busness CARRY FORWARD OF LOSS Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses

57 306 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v v v v v Total of earler year x losses b/f Adjustment of above x losses n Schedule BFLA x x (Current year losses to be carred forward) Total loss Carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2v of schedule BFLA) (B43 of schedule BP, f ve) (2v of schedule BFLA) (C49 of schedule BP, f ve) (2x+3x+4x+5x) of tem E of schedule CG) (( 6x+7x+8x) of tem E of schedule CG) (2xv of schedule BFLA) (8e of schedule OS, f ve) Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought forward unabsorbed deprecaton Amount of deprecaton set-off aganst the current year ncome Balance carred forward to the next year Amount of brought forward unabsorbed allowance Amount of Balance allowance set-off Carred aganst the forward to current year the next ncome year (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Year v v Total (3xv of BFLA) (4xv of BFLA) Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X 11a. 11b. Accountng Polces Valuaton of Inventores (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Constructon Contracts Revenue Recognton Tangble Fxed Assets Changes n Foregn Exchange Rates Government Grants Securtes (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Borrowng Costs Provsons, Contngent Labltes and Contngent Assets Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negatve)

58 307 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone DEDUCTION U/S 10AA Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce/provde servces c Total deducton under secton 10AA (a + b) Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G DETAILS OF DONATIONS A B C D Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 50% deducton wthout qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 50% deducton subject to qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Total E Total donatons (A + B + C + D) Donaton n cash Total Donaton Total Donaton Total Donaton Donaton n Total other mode Donaton Elgble Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Schedule RA Detals of donatons to research assocatons etc. [deducton under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA)] Name and address of donee PAN of Donee Amount of donaton Total Donaton n cash Donaton n other mode Total Donaton Elgble Amount of donaton

59 308 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule 80-IA a b c d e Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Cross-country natural gas dstrbuton network] a1 a2 b1 b2 c1 c2 d1 d2 Undertakng No. 1 Undertakng No. 2 Undertakng No. 1 Undertakng No. 2 Undertakng No. 1 Undertakng No. 2 Undertakng No. 1 Undertakng No. 2 (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2) e Schedule 80-IB a b c d e f g h Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] Deducton n the case of multplex theatre [Secton 80-IB(7A)] Deducton n the case of conventon centre [Secton 80-IB(7B)] Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] Deducton n the case of an undertakng developng and buldng housng projects [Secton 80-IB(10)] Deducton n the case of an undertakng operatng a cold chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f1 Undertakng no. 1 f2 Undertakng no. 2 g1 Undertakng no. 1 g2 Undertakng no. 2 h1 Undertakng no. 1 h2 Undertakng no. 2 1 Undertakng no. 1 2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBB of the undertakng) (10(v) of Form 10CCBB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of Deducton n the case of an undertakng engaged n j1 Undertakng no. 1 the undertakng) j ntegrated busness of handlng, storage and (30 of Form 10CCB of transportaton of food grans [Secton 80-IB(11A)] j2 Undertakng no. 2 the undertakng) k Deducton n the case of an undertakng engaged n k1 Undertakng no. 1 (11(v) of From 10CCBC)

60 309 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] operatng and mantanng a rural hosptal [Secton 80-IB(11B)] Deducton n the case of an undertakng engaged n l operatng and mantanng a hosptal n any area, other than excluded area [Secton 80-IB(11C) m Total deducton under secton 80-IB (Total of a1 to l2) k2 l1 l2 Undertakng no. 2 (11(v) of From 10CCBC) Undertakng no. 1 (11(d) of From 10CCBD) Undertakng 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 a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East da Assam db Arunachal Pradesh dc Manpur dd Mzoram de Meghalaya df Nagaland dg Trpura da1 Undertakng no. 1 (30 of Form 10CCB of the da2 Undertakng no. 2 (30 of Form 10CCB of the db1 Undertakng no. 1 (30 of Form 10CCB of the db2 undertakng) Undertakng no. 2 (30 of Form 10CCB of the dc1 undertakng) Undertakng no. 1 (30 of Form 10CCB of the dc2 undertakng) Undertakng no. 2 (30 of Form 10CCB of the dd1 Undertakng no. 1 (30 of Form 10CCB of the dd2 undertakng) Undertakng no. 2 (30 of Form 10CCB of the de1 Undertakng no. 1 (30 of Form 10CCB of the de2 Undertakng no. 2 (30 of Form 10CCB of the df1 undertakng) Undertakng no. 1 (30 of Form 10CCB of the df2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dg1 Undertakng no. 1 (30 of Form 10CCB of the dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c1 Undertakng no. 2 dh e (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80C b 80CCC c 80CCD(1) d 80CCD(1B) TOTAL DEDUCTIONS e 80CCD(2) g 80D 80DDB k 80EE m 80GG f 80CCG h 80DD j 80E l 80G n 80GGC Total Deducton under Part B (total of a to n ) 1 2 Part C- Deducton n respect of certan ncomes o 80-IA (e of Schedule 80-IA) p 80-IAB

61 310 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 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 Total Deducton under Part C (total of o to w ) 2 3 Part CA and D- Deducton n respect of other ncomes/other deducton x 80TTA y 80TTB z 80U Total Deducton under Part CA and D (total of x, y and z) 3 4 Total deductons under Chapter VI-A ( ) 4 Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 14 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) Deducton clamed under any secton ncluded n a Chapter VI-A under the headng C. Deductons n respect of certan ncomes b Deducton clamed u/s 10AA Deducton clamed u/s 35AD as reduced by the amount c of deprecaton on assets on whch such deducton s clamed d Total Adjustment (2a+ 2b+ 2c) 3 Adjusted Total Income under secton 115JC(1) (1+2d) 3 4 Tax payable under secton 115JC [18.5% of (3)] (f 3 s greater than Rs. 20 lakhs) 4 2a 2b 2c 2d Schedule AMTC Computaton of tax credt under secton 115JD 1 Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2 of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, 3 otherwse enter 0] 4 Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of AMT Credt Brought Forward) S. No. Assessment Year (A) AMT Credt v v v v Current AY (enter 1-2, f 1>2 else enter 0) v Total Gross (B1) Set-off n earler assessment years (B2) Balance brought forward to the current assessment year (B3) = (B1) (B2) AMT Credt Utlsed durng the Current Assessment Year (C) Balance AMT Credt Carred Forward (D)= (B3) (C)

62 311 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 5 6 Amount of tax credt under secton 115JD utlsed durng the year [total of tem no 4 (C)] Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4 (D)] 5 6 Schedule SPI Income of specfed persons (spouse, mnor chld etc.) ncludable n ncome of the assessee as per secton 64 Sl No Name of person PAN of person (optonal) Relatonshp Amount (Rs) Head of Income n whch ncluded Schedule SI.SPECIAL RATE Sl No Income chargeable to tax at specal rates (please see nstructons No. 7 for rate of tax) Secton Specal rate (%) Income () 1 111A (STCG on shares unts on whch where STT pad) 15 (part of 5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (part of 5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout 10 (part of 5x of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5x of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5x of schedule BFLA) 6 115AC (Income of non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 2dx of schedule OS) 7 115ACA (LTCG for an employee of specfed company on 10 (part of 5x of schedule BFLA) 8 115AD (LTCG for FIIs on securtes) 10 (part of 5x of schedule BFLA) 9 115E (LTCG for non-resdent ndan on specfed asset) 10 (part of 5x of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) A (LTCG on sale of shares or unts on whch STT s pad) 10 (B5f and B8f of schedule CG) 12 STCG Chargeable at specal rates n Inda as per DTAA (part of 5x of schedule BFLA) 13 LTCG Chargeable at specal rates n Inda as per DTAA (part of 5x of schedule BFLA) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (2a of schedule OS) BBDA (Dvdend ncome from domestc company exceedng 10 (2dxv of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 60 (2b of schedule OS) BBF (Tax on ncome from patent) a Income under head busness or professon 10 (3e of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) BBG (Tax on ncome from transfer of carbon credts) a Income under head busness or professon 10 (3f of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) A(1)(b) (Income of a non-resdent from Royalty) 25 (part of 2dv of schedule OS) Tax thereon () 20 Income from other sources chargeable at specal rates n Inda as per DTAA 21 Pass Through Income n the nature of Short Term Captal Gan 15% Pass Through Income n the nature of Short Term Captal Gan 30% Pass Through Income n the nature of Long Term Captal Gan 10% Pass Through Income n the nature of Long Term Captal Gan 20% Pass through ncome n the nature of ncome from other source chargeable at specal rates (part of 2f of schedule OS) (part of 5v of schedule BFLA) (part of 5v of schedule BFLA) (part of 5x of schedule BFLA) (part of 5x of schedule BFLA) (2e of schedule OS) Total

63 312 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule IF Informaton regardng partnershp frms n whch you are partner Number of frms n whch you are partner Whether Percentage Whether the secton 92E Name of the PAN of the frm s lable s Share Sl. No. Frm frm for audt? applcable n the (Yes/No) to frm? proft (Yes/ No) of the frm 1 FIRMS IN WHICH PARTNER Total Amount of share n the proft Captal balance on 31 st March n the frm Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income or not chargeable to tax) 1 Interest ncome 1 EXEMPT INCOME Schedule PTI Sl. PASS THROUGH INCOME 2 Dvdend ncome from domestc company (amount not exceedng Rs. 10 lakh) 2 3 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years v Net Agrcultural ncome for the year ( ) (enter nl f loss) 3 In case the net agrcultural ncome for the year exceeds Rs.5 lakh, please furnsh the v followng detals (Fll up detals separately for each agrcultural land) a Name of dstrct along wth pn code n whch agrcultural land s located b Measurement of agrcultural land n Acre c Whether the agrcultural land s owned or held on lease (drop down to be provded) d Whether the agrcultural land s rrgated or ran-fed (drop down to be provded) 4 Other exempt ncome (ncludng exempt ncome of mnor chld) (please specfy) 4 5 Income not chargeable to tax as per DTAA Sl. No. Amount of ncome Nature of ncome Country name & Code Artcle of DTAA Head of Income Whether TRC obtaned (Y/N) I II III Total Income from DTAA not chargeable to tax 5 6 Pass through ncome not chargeable to tax (Schedule PTI) 6 7 Total ( ) 7 Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Name of busness trust/ nvestment fund PAN of the busness trust/ nvestment fund Sl. Head of ncome Amount of ncome 1. House property Captal Gans a Short term b Long term Other Sources v Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s 2. House property Captal Gans a Short term b Long term Other Sources v Income clamed to be exempt TDS on such amount, f any

64 313 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NOTE a b c Please refer to the nstructons for fllng out ths schedule. u/s 10(23FBB) u/s.. u/s Schedule FSI Detals of Income from outsde Inda and tax relef Sl. Country Taxpayer Sl. Head of ncome Income from Tax pad Code Identfcaton outsde Inda outsde Number (ncluded n Inda PART B-TI) 1 Salary Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) INCOME FROM OUTSIDE INDIA House Property Busness or Professon v Captal Gans v Other sources Salary Total 2 House Property Busness or Professon v Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Total tax relef avalable Identfcaton (total of (c) of Schedule FSI n (total of (e) of Schedule FSI Number respect of each country) n respect of each country) TAX RELIEF FOR TAX PAID OUTSIDE INDIA Secton under whch relef clamed (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) 2 (Part of total of 1(d)) Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) 3 (Part of total of 1(d)) Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been 4 refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below Amount of tax a b refunded NOTE Please refer to the nstructons for fllng out ths schedule. Assessment year n whch tax relef allowed n Inda Yes/No

65 314 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule FA DETAILS OF FOREIGN ASSETS Detals of Foregn Assets and Income from any source outsde Inda A1 Detals of Foregn Depostory Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod) Sl No Country name Country code ZIP code Account number Status Account openng date Closng balance Name of fnancal nsttuton Address of fnancal nsttuton Peak balance durng the perod Gross nterest pad/credted to the account durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A2 Detals of Foregn Custodal Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl Country Country ZIP Account Closng No name code code number balance Name of fnancal nsttuton Address of fnancal nsttuton Status Account openng date Peak balance durng the perod Gross amount pad/credted to the account durng the perod (drop down to be provded specfyng nature of amount vz. nterest/dvdend/proceeds from sale or redempton of fnancal assets/ other ncome) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A3 Sl No Detals of Foregn Equty and Debt Interest held (ncludng any benefcal nterest) n any entty at any tme durng the relevant accountng perod Country Country Name of Address of ZIP name code entty entty code Nature of entty Date of acqurng the nterest Intal value of the nvestment Peak value Closng of value nvestment durng the perod Total gross amount pad/credted wth respect to the holdng durng the perod Total gross proceeds from sale or redempton of nvestment durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) () () A4 Sl No Detals of Foregn Cash Value Insurance Contract or Annuty Contract held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Country Country ZIP code Date of contract name code Name of fnancal nsttuton n whch nsurance contract held Address of fnancal nsttuton The cash value or surrender value of the contract Total gross amount pad/credted wth respect to the contract durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Nature of entty Name and Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Investment (at cost) (n rupees) Income Nature of accrued from Income such Interest Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Address of the Property Date of acquston Total Investment (at cost) (n rupees) Income derved from the property Nature of Income Income taxable and offered n ths return Amount Ownershp- Drect/ Benefcal owner/ Benefcary Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) ()

66 315 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Nature of Asset Date of acquston Total Investment (at cost) (n rupees) Income derved from the asset Nature of Income Income taxable and offered n ths return Amount Ownershp- Drect/ Benefcal owner/ Benefcary Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detals of account(s) n whch you have sgnng authorty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod and whch has not been ncluded n A to D above. Sl No Account Number If (7) s yes, Income offered n ths return Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl No Country Name and code Name and address of Benefcares Date snce If (8) s yes, Income offered n ths return Amount Name and address of the trust Name and address of trustees Name and address of Settlor poston held Whether ncome derved s taxable n your hands? 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 Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon If (6) s yes, Income offered n ths return Country Name and address of Income Whether taxable Name and the person from whom Nature of ncome Amount Schedule Item number of derved n your hands? code derved where schedule offered (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule. In case of an ndvdual, not beng an Indan ctzen, who s n Inda on a busness, employment or student vsa, an asset acqured durng any prevous year n whch he was non-resdent s not mandatory to be reported n ths schedule f no ncome s derved from that asset durng the current prevous year. Schedule 5A Name of the spouse PAN of the spouse Heads of Income 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the head Amount apportoned n the hands of the spouse Amount of TDS deducted on ncome at () TDS apportoned n the hands of spouse () () () (v) (v)

67 316 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule AL Assets and Labltes at the end of the year (other than those ncluded n Part A- BS) (applcable n a case where total ncome exceeds Rs.50 lakh) A Detals of mmovable assets Sl. Descrpton Address Pn code Amount (cost) n Rs. No. (1) (2) (3) (4) (5) () DETAILS OF ASSETS AND LIABILITIES () B Detals of movable assets Sl. Descrpton Amount (cost) n Rs. No. (1) (2) (3) () Jewellery, bullon etc. Archaeologcal collectons, drawngs, pantng, sculpture or any work of () art () Vehcles, yachts, boats and arcrafts (v) Fnancal assets Amount (cost) n Rs. (a) Bank (ncludng all deposts) (b) Shares and securtes (c) Insurance polces (d) Loans and advances gven (e) Cash n hand C Interest held n the assets of a frm or assocaton of persons (AOP) as a partner or member thereof Sl. Name and address of the frm(s)/ PAN of the frm/ AOP Assessee s nvestment n the frm/ AOP on cost No. AOP(s) bass (1) (2) (3) (4) () () D Labltes n relaton to Assets at (A + B + C) NOTE Please refer to nstructons for fllng out ths schedule. Schedule INFORMATION REGARDING TURNOVER/GROSS RECEIPT REPORTED FOR GST GST Sl. No. GSTIN No(s). Annual value of outward supples as per the GST return(s) fled DETAILS OF GST (1) (2) (3) NOTE Please furnsh the nformaton above for each GSTIN No. separately Part B TI TOTAL INCOME Computaton of total ncome PART-B 1 Salares (6of Schedule S) 1 2 Income from house property (4 of Schedule-HP) (enter nl f loss) 2 3 Profts and gans from busness or professon Proft and gans from busness other than speculatve busness and specfed busness (A38 of Schedule BP) (enter nl f loss) Proft and gans from speculatve busness (B43 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) Proft and gans from specfed busness (C49 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) Income chargeable to tax at specal rates (3e & 3f of v Schedule BP) v Total ( v) (enter nl f 3v s a loss) 4 Captal gans v 3v

68 317 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] a Short term Short-term 15% (9 of tem E of schedule CG) Short-term 30% (9 of tem E of schedule CG) Short-term chargeable at applcable rate (9v of tem E of schedule CG) Short-term chargeable at specal rates n Inda as v per DTAA (9v of tem E of Schedule CG) v Total Short-term (a + a + a+av) (enter nl f loss) b Long-term Long-term 10% (9v of tem E of schedule CG) Long-term 20% (9v of tem E of schedule CG) Long-term chargeable at specal rates n Inda as per DTAA (9v of tem E of schedule CG) v Total Long-term (b + b+b) (enter nl f loss) c Total captal gans (4av+4bv) (enter nl f loss) 5 Income from other sources a Net ncome from other sources chargeable to tax at normal applcable rates (6 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rates (2 of Schedule OS) c Income from the actvty of ownng and mantanng race horses ( 8e of Schedule OS) (enter nl f loss) d Total (5a + 5b + 5c) (enter nl f loss) 6 Total of head wse ncome ( v +4c +5d) 6 Losses of current year to be set off aganst 6 (total of 2xv, 3xv and 4xv of Schedule 7 CYLA) 7 Balance after set off current year losses (6 7) (total of column 5 of Schedule 8 CYLA+5b+3v) 8 Brought forward losses to be set off aganst 8 (total of 2xv, 3xv and 4xv of Schedule 9 BFLA) 9 10 Gross Total ncome (8-9) (5xv of Schedule BFLA+ 5b+ 3v) 10 Income chargeable to tax at specal rate under secton 111A, 112, 112A etc. ncluded n Deductons under Chapter VI-A a Part-B, CA and D of Chapter VI-A [(1 + 3) of Schedule VI-A and lmted upto (10-11)] a a a av 4av b b b 4bv b Part-C of Chapter VI-A [(2 of Schedule VI-A and lmted upto ( )] c Total (12a + 12b) [lmted upto (10-11)] 13 Deducton u/s 10AA (c of Sch. 10AA) Total ncome (10-12c - 13) 14 Income whch s ncluded n 14 and chargeable to tax at specal rates (total of () of 15 schedule SI) Net agrcultural ncome/ any other ncome for rate purpose ( 3 of Schedule EI) 16 Aggregate ncome ( )[applcable f (14-15) exceeds maxmum amount not chargeable to 17 tax] Losses of current year to be carred forward (total of row x of Schedule CFL) Deemed ncome under secton 115JC (3 of Schedule AMT) 19 Part B TTI COMPUTATION OF TAX LIABILITY Computaton of tax lablty on total ncome 1 a Tax payable on deemed total ncome under secton 115JC (4 of Schedule AMT) 1a b Surcharge on (a) (f applcable) c Health and Educaton 4% on (1a+1b) above d Total Tax Payable on deemed total ncome (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on 17 of Part B-TI b Tax at specal rates (total of col. () of Schedule-SI) 2a 2b 5a 5b 5c 4c 5d 11 12a 12b 12c 1b 1c 1d

69 318 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TAXES PAID BANK ACCOUNT c Rebate on agrcultural ncome [applcable f (14-15) of Part B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on Total Income (2a + 2b 2c) e Rebate under secton 87A f Tax payable after rebate (2d 2e) g 25% of 16() of Schedule SI On [(2f) (16() of Schedule SI)] Total ( + ) h Health and Educaton 4% on (2f + 2g) Gross tax lablty (2f + 2g + 2h) 3 Gross tax payable (hgher of 1d and 2) 3 Credt under secton 115JD of tax pad n earler years (applcable f 2 s more than 4 1d) (5 of Schedule AMTC) 4 5 Tax payable after credt under secton 115JD (3-4) 5 6 Tax relef a Secton 89 b Secton 90/ 90A ( 2 of Schedule TR) c Secton 91 ( 3 of Schedule TR) d Total (6a + 6b+ 6c) 7 Net tax lablty (5-6d) (enter zero f negatve) 7 8 Interest and fee payable a Interest for default n furnshng the return (secton b Interest for default n payment of advance tax (secton c Interest for deferment of advance tax (secton 234C) d Fee for default n furnshng return of ncome (secton e Total Interest and Fee Payable (8a+8b+8c+8d) 9 Aggregate lablty (7 + 8e) 9 10 Taxes Pad a Advance Tax (from column 5 of 17A) b TDS (total of column 5 of 18B and column 9 of c TCS (column 7 of17d) d Self-Assessment Tax (from column 5 of 17A) e Total Taxes Pad (10a+10b+10c+10d) 11 Amount payable (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (Refund, f any, wll be drectly credted nto the bank account) a 6b 6c 10a 10b 10c 10d 2c Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) (In case of non-resdents, detals of any one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bank n case of Bank Accounts held n Inda (SWIFT Code n case of foregn Name of the Bank 8a 8b 8c 8d 2g 2g Account Number (IBAN n case of foregn Bank Accounts) 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] 2d 2e 2f 2g 2h 2 6d 8e 10e Indcate the account n whch you prefer to get your refund credted, f any (tck one account ) Yes No 15 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A Detals of payments of Advance Tax and Self-Assessment Tax

70 319 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY Sl No BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Amount (Rs) Challan (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Sl No Tax Deducton Account Number (TAN) of the Employer Name of the Employer Income chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) I II NOTE Please enter total of column 5 n 10b of Part B-TTI C Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued or Form 16B/16C furnshed by Deductor(s) ] Sl No TDS credt relatng to self /other person [spouse as per secton 5A/other person as per rule 37BA(2)] PAN of Other Person (f TDS credt related to other person) TAN of the Deductor/ PAN of Tenant/ Buyer Unclamed TDS brought forward (b/f) Fn. TDS Year n b/f whch deducted TDS of the current Fn. Year Deducted n own hands Deducted n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) TDS credt beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Clamed n own hands Clamed n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) Correspondng Income offered Gross Amount Head of Income TDS credt beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Income TDS Income TDS PAN NOTE Please enter total of column 9 n10b of Part B- TTI D TDS ON OTHER INCOME Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl. No. Tax Deducton and Tax Collecton Account Number of the Collector Name of the Collector Unclamed TCS brought forward (b/f) Fn. Year n whch collected Amount b/f TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (5) or (6) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) n 10c of Part B-TTI VERIFICATION I, son/ daughter of solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and schedules thereto s correct and complete and s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng returns n my capacty as (drop down to be provded) and I am also competent to make ths return and verfy t. I am holdng permanent account number (f allotted) (Please see nstructon). I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable n a case where return s furnshed under secton 92CD) Date Sgn here

71 320 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-4 SUGAM INDIAN INCOME TAX RETURN [For Indvduals, HUFs and Frms (other than LLP) beng a resdent havng total ncome upto Rs.50 lakh and havng ncome from busness and professon whch s computed under sectons 44AD, 44ADA or 44AE] [Not for an ndvdual who s ether Drector n a company or has nvested n unlsted equty shares] (Please refer nstructons for elgblty) Assessment Year PART A GENERAL INFORMATION (A1) Frst Name (A2) Mddle Name (A3) Last Name (A4) Permanent Account Number (A5) Date of Brth/Formaton (DD/MM/YYYY) (A6) Flat/Door/Block No. (A7) Name of Premses/ Buldng/ Vllage (A8) Road/Street/Post Offce (A9) Area/localty (A10) Town/Cty/Dstrct (A11) State (A12) Country (A13) Pn code/zp code (A14) Aadhaar Number (12 dgt)/ Aadhaar Enrolment Id (28 dgt) (f elgble for Aadhaar) (A16) Resdental/Offce Phone Number wth STD code/ Moble No.1 (A17) Moble No. 2 (A15) Status Indvdual than LLP) HUF Frm (other (A18) Emal Address-1 (self) Emal Address -2 (A19) Nature of employment - Govt. PSU Pensoners Others (A20) Fled u/s (Tck) [Please see nstructon]- 139(1)-On or before due date, 139(4)-After due date, 139(5)-Revsed Return, 119(2)(b)- after condonaton of delay Or Fled n response to notce u/s 139(9) 142(1) A 153C (A21)If revsed/defectve then enter Recept No. and Date of flng of orgnal return / / (DD/MM/YYYY) (A22)If fled n response to notce u/s 139(9) /142(1)/148/153A/153C or order u/s 119(2)(b)- enter Unque Number & Date of such Notce or Order / / (A23) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Capacty of the representatve (3) Address of the representatve (4) Permanent Account Number (PAN) of the representatve PART B GROSS TOTAL INCOME B1 Income from Busness & Professon (NOTE-Enter value from E8 of Schedule BP) B1 B2 Gross Salary a Salary as per secton 17(1) a b Value of perqustes as per secton 17(2) b c Proft n leu of salary as per secton 17(3) c Less allowances to the extent exempt u/s 10 (drop down to be provded n e-flng utlty) Net Salary ( ) v Deductons u/s 16 (va + vb+vc) v a Standard deducton u/s 16(a) va b Entertanment allowance u/s 16() vb c Professonal tax u/s 16() vc v Income chargeable under the head Salares ( v) (NOTE- Ensure to Fll Sch TDS1 ) B2 B3 Tck applcable opton Self Occuped Let Out Deemed Let Out Gross rent receved/ recevable/ letable value durng the year Tax pad to local authortes Annual Value ( ) v 30% of Annual Value v v Interest payable on borrowed captal v v Arrears/Unrealzed Rent receved durng the year Less 30% v v Income chargeable under the head House Property ( v v) + v B3 ( ) (If loss, put the fgure n negatve) B4 Income from Other Sources (drop down to be provded n e-flng utlty specfyng nature of ncome) NOTE- Fll Sch TDS2 f applcable. Less: Deducton u/s 57(a) (n case of famly penson only) B4 SALARY / PENSION HOUSE PROPERTY B5 Gross Total Income (B1+B2+B3+B4) B5( ) FOR OFFICE USE ONLY Whole- Rupee( ) only

72 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 321 STAMP RECEIPT NO. HERE SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer to nstructons for lmts on Amount of Deductons as per Income Tax Act ) C1 80C C2 80CCC C3 80CCD (1) C4 80CCD(1B) C5 80CCD(2) C6 80CCG BANK ACCOUNT C7 80D Drop down to be provded n e-flng utlty C8 80DD Drop down to be provded n e-flng utlty C9 80DDB Drop down to be provded n e-flng utlty C10 80E C11 80EE C12 80G Please fll up Schedule 80G C13 80GG C14 80GGC C15 80TTA C16 80TTB C17 80U Drop down to be provded n e-flng utlty C18 Total deductons (Add tems C1 to C17) C18 C19 Taxable Total Income (B5 - C18 ) C19 PART D TAX COMPUTATIONS AND TAX STATUS D1 Tax payable on total ncome (C19 D1 D2 Rebate on 87A D2 D3 Tax payable after Rebate (D1-D2) D3 D4 Health and Educaton 4% on (D3) D4 D5 Total Tax, and Cess ( D3+D4) D5 D6 Relef u/s 89 D6 D7 Balance Tax after Relef (D5 D6) D7 D8 Total Interest u/s 234A D8 D9 Total Interest u/s 234B D9 D10 Total Interest u/s 234C D10 D11 Fee u/s 234F D12 Total Tax, Fee and Interest (D7 + D8 + D9 + D10 + D11) D12 D13 Total Advance Tax Pad D14 Total Self-Assessment Tax Pad D15 Total TDS Clamed (total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2) D15 D16 Total TCS Collected (total of column (5) of Schedule-TCS) D17 Total Taxes Pad (D13 + D14 + D15 +D16) D18 Amount payable (D12 D17, If D12 > D17) D18 D19 Refund (D17 D12, If D17 > D12) D19 D20 Exempt ncome only for reportng purposes (If agrcultural ncome s more than Rs.5,000/-, use ITR 3/5) (Drop down to be provded n e-flng utlty mentonng nature of exempt ncome, relevant clause and secton) D21 Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) Sl. IFS Code of the Bank Name of the Bank Account Number (tck one account for refund ) D11 D13 D14 D16 D17 D20 SCHEDULE BP DETAILS OF INCOME FROM BUSINESS OR PROFESSION COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD S. Name of Busness Busness code Descrpton No. () E1 Gross Turnover or Gross Recepts a Through a/c payee cheque or a/c payee bank draft or bank electronc clearng system receved before E1a

73 322 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] specfed date E2 b Any other mode E1b Presumptve Income under secton 44AD a 6% of E1a or the amount clamed to have been earned, whchever s hgher E2a b 8% of E1b or the amount clamed to have been earned, whchever s hgher E2b c Total (a + b) E2c NOTE If Income s less than the above percentage of Gross Recepts, t s mandatory to have a tax audt under 44AB & regular ITR 3 or 5 has to be flled not ths form COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA S. Name of Busness Busness code Descrpton No. () E3 Gross Recepts E3 E4 Presumptve Income under secton 44ADA (50% of E3) or the amount clamed to have been earned, whchever s hgher NOTE If Income s less than 50% of Gross Recepts, t s mandatory to have a tax audt under 44AB & regular ITR 3 or 5 has to be flled not ths form E4 COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE S. Name of Busness Busness code Descrpton No. () Regstraton No. of goods carrage Whether owned/ leased/ hred Tonnage capacty of goods carrage (n MT) Number of months for whch goods carrage was owned/ leased/hred by assessee Presumptve ncome u/s 44AE for the goods carrage Rs.1000 per ton per month n case tonnage exceeds 12MT, or Rs.7500 per month) or the amount clamed to have been actually earned, whchever s hgher () (1) (2) (3) (4) (5) (a) (b) Add row optons as necessary (upto maxmum 10) E5 Presumptve Income from Goods Carrage under secton 44AE [total of column (5)] NOTE If the profts are lower than prescrbed under S.44AE or the number of Vehcles owned at any tme exceed 10 then the regular ITR 3/5 form has to be flled and not ths form E6 Salary and nterest pad to the partners E6 NOTE Ths s to be flled up only by frms E7 Presumptve Income u/s 44AE (E5-E6) E7 E8 Income chargeable under Busness or Professon (E2c+E4+E7 ) E8 INFORMATION REGARDING TURNOVER/GROSS RECEIPT REPORTED FOR GST Note Please furnsh the nformaton below for each GSTIN No. separately E9 GSTIN No(s). E9 E10 Annual value of outward supples as per the GST returns fled E10 E5 ` FINANCIAL PARTICULARS OF THE BUSINESS NOTE For E11 to E25 furnsh the nformaton as on 31 st day of March, 2019 E11 Partners/ Members own captal E11 E12 Secured loans E12 E13 Unsecured loans E13 E14 Advances E14 E15 Sundry credtors E15 E16 Other labltes E16 E17 Total captal and labltes (E11+E12+E13+E14+E15+E16) E17 E18 Fxed assets E18 E19 Inventores E19 E20 Sundry debtors E20 E21 Balance wth banks E21 E22 Cash-n-hand E22 E23 Loans and advances E23

74 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 323 E24 Other assets E24 E25 Total assets (E18+E19+E20+E21+E22+E23+E24) E25 NOTE Please refer to nstructons for fllng out ths schedule (E15, E19, E20, E22 are mandatory and others f avalable) Schedule 80G A DETAILS OF DONATIONS ENTITLED FOR DEDUCTION UNDER SECTION 80G Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Donaton n cash Donaton n other mode Total donaton Elgble Amount of donaton Total DETAILS OF DONATIONS B Donatons enttled for 50% deducton wthout qualfyng lmt C Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt Donaton n cash Donaton n other mode Name and address of donee PAN of Donee Amount of donaton Donaton n cash Donaton n other mode Total donaton Total donaton Elgble Amount of donaton Elgble Amount of donaton D Total Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total Donaton n cash Donaton n other mode Total donaton Elgble Amount of donaton E Total donatons (A + B + C + D) SCHEDULE IT DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS BSR Code Date of Depost (DD/MM/YYYY) Challan No. Tax pad R1 R2 R3 Col (1) Col (2) Col (3) Col (4) NOTE Enter the totals of Advance tax and Self-Assessment tax n D14 & D15 Schedule TCS Detals of Tax Collected at Source [As per Form 27D ssued by the Collector(s)] Sl No Tax Collecton Account Number of the Collector Name of the Collector Detals of amount pad as mentoned n Form 26AS Tax Collected Amount out of (4) beng clamed (1) Col (1) Col (2) Col (3) Col (4) Col (5) NOTE Please enter total of column (5) of Schedule-TCS n D17 SCHEDULE TDS1 DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 ssued by Employer(s)]

75 324 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] TAN Name of the Employer Income under Salary Tax deducted Col (1) Col (2) Col (3) Col (4) S1 S2 S3 NOTE Enter the total of column 4 of Schedule-TDS1 and column 9 of Schedule-TDS2 n D16 SCHEDULE TDS2 DETAILS OF TAX DEDUCTED AT SOURCE ON INCOME OTHER THAN SALARY [As per Form 16 A ssued or Form 16C furnshed by Deductor(s)] Sl. No. TAN of the Deductor/ PAN of Tenant Unclamed TDS brought forward (b/f) TDS of the current Fn. Year TDS credt beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) VERIFICATION Correspondng Income offered TDS credt beng carred forward Fn. Year n whch TDS b/f TDS Deducted TDS Clamed Gross Head of deducted Amount Income (1) (2) (3) (4) (5) (6) (7) (8) (9) I, son/ daughter of solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return s correct and complete and s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng returns n my capacty as (drop down to be provded n e-flng utlty) and I am also competent to make ths return and verfy t. I am holdng permanent account number. (Please see nstructon) Place: Date : If the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: Sgnature here TRP PIN (10 Dgt) Name of TRP Counter Sgnature of TRP Amount to be pad to TRP

76 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 325 FORM ITR-5 INDIAN INCOME TAX RETURN [For persons other than,- () ndvdual, () HUF, () company and (v) person flng Form ITR-7] (Please see Rule 12 of the Income-tax Rules,1962) (Please refer nstructons) Assessment Year Part A-GEN Name GENERAL PAN PERSONAL INFORMATION Is there any change n the name? If yes, please furnsh the old name Lmted Lablty Partnershp Identfcaton Number (LLPIN) ssued by MCA, f applcable Flat/Door/Block No Name of Premses/Buldng/Vllage Date of formaton (DDMMYYYY) Date of commencement of busness (DD/MM/YYYY) Road/Street/Post Offce Area/Localty Status (frm-1sub-status- Partnershp Frm, LLP, local authorty-2, AOP/BOI- 3 sub-status- other cooperatve bank, other cooperatve socety, socety regstered under socety regstraton Act, 1860 or any other Law correspondng to that state, Prmary agrcultural credt socety/cooperatve bank, Rural development bank, Trust other than trust elgble to fle Return n ITR 7, any other AOP/BOI,, artfcal jurdcal person-4, sub-status- Estate of the deceased, Estate of the nsolvent, Other AJP), Busness trust 5, nvestment fund -6 Town/Cty/Dstrct State Pn code/zp code Country Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Emal Address -1 Emal Address -2 FILING STATUS (a) (b) Fled u/s (Tck) [Please see nstructon] Or Fled n response to notce u/s 139(1)-On or before due date, 139(4)-After due date, 139(5)-Revsed Return, 92CD-Modfed return, 119(2)(b)- after condonaton of delay. 139(9), 142(1), 148, 153A 153C Whether you are a busness trust? Yes No Whether you are a nvestment fund referred to n secton 115UB? Yes No If revsed/n response to notce for Modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) / / If fled n response to a notce u/s 139(9)/142(1)/148/153A/153C/119(2)(b) enter date of such notce/order, or f fled u/s (c) 92CD enter date of advance prcng agreement (d) Resdental Status (Tck) Resdent Non-Resdent (e) Whether assessee s located n an Internatonal Fnancal Servces Centre and derves ncome solely n convertble foregn exchange? (f) Whether you are recognzed as start up by DPIIT Yes No (g) If yes, please provde start up recognton number allotted by the DPIIT (h) Whether certfcate from nter-mnsteral board for certfcaton s receved? Yes No () If yes, please provde the certfcaton number (j) In the case of non-resdent, s there a permanent establshment (PE) n Inda (Tck) Yes No (k) Whether you are an FII / FPI? Yes/No If yes, please provde SEBI Regn. No. (l) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Capacty of the Representatve (drop down to be provded) (3) Address of the representatve (4) Permanent Account Number (PAN) of the representatve (m) Whether you are Partner n a frm? (Tck) Yes No If yes, please furnsh followng nformaton Name of Frm PAN / /

77 326 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] (n) Whether you have held unlsted equty shares at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton n respect of equty shares Name of Shares transferred PAN Openng balance Shares acqured durng the year company durng the year No. of shares Cost of acquston No. of shares Date of subscrpton / purchase Face value per share Issue prce per share (n case of fresh ssue) Purchase prce per share (n case of purchase from exstng shareholder) No. of shares Sale consderaton Closng balance No. of shares Cost of acquston a Whether lable to mantan accounts as per secton 44AA? (Tck) Yes No b Whether lable for audt under secton 44AB? (Tck) Yes No c If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton- () Date of furnshng of the audt report (DD/MM/YYYY) / / AUDIT INFORMATION () () (v) (v) (v) (v) Name of the audtor sgnng the tax audt report Membershp no. of the audtor Name of the audtor (propretorshp/ frm) Propretorshp/frm regstraton number Permanent Account Number (PAN) of the audtor (propretorshp/ frm) Date of audt report d Are you lable for Audt u/s 92E? Yes No Date of furnshng audt report? DD/MM/YYYY d If lable to furnsh other audt report under the Income-tax Act, menton the date of furnshng of the audt report? (DD/MM/YY) (Please see Instructon 6()) 92 Sl. No. Secton Code Date (DD/MM/YYYY) PARTNERS/ MEMBERS/TRUST INFORMATION e A If lable to audt under any Act other than the Income-tax Act, menton the Act, secton and date of furnshng the audt report? Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) Whether there was any change durng the prevous year n the partners/members of the frm/aop/boi (Tck) Yes No (In case of socetes and cooperatve banks gve detals of Managng Commttee) If Yes, provde the followng detals Sl. Name of the Partner/member Admtted/Retred Date of admsson/retrement Percentage of share (f determnate) B Is any member of the AOP/BOI/executor of AJP a foregn company? (Tck) Yes No C If Yes, menton the percentage of share of the foregn company n the AOP/BOI/ executor of AJP D E Whether total ncome of any member of the AOP/BOI/executor of AJP (excludng hs share from such assocaton or body or executor of AJP) exceeds the maxmum amount whch s not chargeable to tax n the case of that member? (Tck) Yes No Partculars of persons who were partners/ members n the frm/aop/boi or settlor/trustee/benefcary n the trust or executors n the case of estate of deceased / estate of nsolvent as on 31 st day of March, 2019 or date of dssoluton Aadhaar Desgnated Status Percentage Number/ Partner Rate of Remunerato (see S.No Name and Address of share (f PAN Enrolment Id Identfcaton Interest on n pad/ nstructon determnate) (f elgble for Number, n case Captal payable No. 6()) Aadhaar) partner n LLP (1) (2) (3) (4) (5) (6) (7) (8) (9) For persons referred to n secton 160(1)() or (v) F To be flled n case of persons referred to n secton 160(1)() or (v) 1 Whether shares of the benefcary are determnate or known? Yes No 2 Whether the person referred n secton 160(1)(v) has Busness Income? Yes No Whether the person referred n secton 160(1)(v) s declared by a Wll and /or s exclusvely for the beneft of any 3 dependent relatve of the settlor and/or s the only trust declared by the settlor? Yes No 4 Please furnsh the followng detals (as applcable) :

78 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 327 NATURE OF BUSINESS () Whether all the benefcares have ncome below basc exempton lmt? Yes No () Whether the relevant ncome or any part thereof s recevable under a trust declared by any person by wll and such trust s the only trust so declared by hm? Yes No () Whether the trust s non-testamentary trust created before for the exclusve beneft of relatves/member of HUF of the settlor manly dependent on hm/famly? Yes No (v) Whether the trust s created on behalf of a provdent fund, superannuaton fund, gratuty fund, penson fund or any other fund created bona fde by a person carryng on Busness or professon exclusve for the employees n such Busness or Professon? Yes No G Nature of busness or professon, f more than one busness or professon ndcate the three man actvtes/ products (Other than those declarng ncome under sectons 44AD, 44ADA and 44AE) S.No. Code [Please see nstructon] Trade name of the busness, f any Descrpton () () Part A-BS BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2019 OR DATE OF DISSOLUTION (fll tems A and B n a case where regular books of accounts are mantaned, otherwse fll tem C) SOURCES OF FUNDS APPLICA TION OF A Sources of Funds 1 Partners / members fund a Partners / members captal b Reserves and Surplus Revaluaton Reserve b Captal Reserve b Statutory Reserve b v Any other Reserve v Credt balance of Proft and loss account bv v Total (b + b + b + bv + bv) c Total partners / members fund (a + bv) 2 Loan funds a Secured loans Foregn Currency Loans a Rupee Loans A From Banks B From others C Total ( A + B) Total secured loans (a + C) b Unsecured loans (ncludng deposts) Foregn Currency Loans b Rupee Loans A From Banks B From persons specfed n secton 40A(2)(b) of the I. T. Act C From others D Total Rupee Loans ( A + B + C) Total unsecured loans (b + D) c Total Loan Funds (a + b) 3 Deferred tax lablty 3 4 Advances From persons specfed n secton 40A(2)(b) of the I. T. Act From others Total Advances ( + ) 5 Sources of funds (1c + 2c ) 5 B Applcaton of funds 1 Fxed assets a Gross: Block bv A B C A B C D 1a a bv 1c a B 2c 4

79 328 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Deprecaton 1b c Net Block (a b) 1c d Captal work-n-progress 1d e Total (1c + 1d) 2 Investments a Long-term nvestments Investment n property Equty nstruments A Lsted equtes A 1e B Unlsted equtes B C Total C Preference shares v Government or trust securtes v v Debenture or bonds v v Mutual funds v v Others v v Total Long-term nvestments ( + C + + v + v + v + v) b Short-term nvestments Equty nstruments A Lsted equtes A B Unlsted equtes B av C Total Preference shares Government or trust securtes v Debenture or bonds v Mutual funds v Others v Total Short-term nvestments (C v + v + v) c Total nvestments (av + bv) 3 Current assets, loans and advances a Current assets Inventores A Raw materals B Work-n-progress C Fnshed goods D Stock-n-trade (n respect of goods acqured for tradng) E Stores/consumables ncludng packng materal C v v v A B C D E bv 2c F Loose tools F G Others G H Total (A + B + C + D + E + F + G) H Sundry Debtors A Outstandng for more than one year A B Others B C Total Sundry Debtors C Cash and bank balances A Balance wth banks A B Cash-n-hand B C Others C D Total Cash and cash equvalents (A + B + C) D v Other Current Assets av

80 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 329 v Total current assets (H +C + D + av) av NO ACCOUNT CASE b Loans and advances Advances recoverable n cash or n knd or for value to be receved Deposts, loans and advances to corporate and others b Balance wth Revenue Authortes v Total (b + b + b) v Loans and advances ncluded n bv whch s c Total (av + bv) a for the purpose of busness or professon b not for the purpose of busness or professon d Current labltes and provsons Current labltes A Sundry Credtors 1 Outstandng for more than one year 1 2 Others 2 b b 3 Total (1 + 2) A3 B Lablty for leased assets C Interest Accrued and due on borrowngs D Interest accrued but not due on borrowngs E Income receved n advance F Other payables G Total (A3 + B + C + D + E + F) Provsons A Provson for Income Tax B Provson for Leave encashment/superannuaton/gratuty C Other Provsons D Total (A + B + C) Total (E + D) e Net current assets (3c d) 4 a Mscellaneous expendture not wrtten off or adjusted 4a b Deferred tax asset c Debt balance n Proft and loss account/ accumulated balance d Total (4a + 4b + 4c) 5 Total, applcaton of funds (1e + 2c + 3e +4d) 5 C In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton as on 31 st day of March, 2019, n respect of busness or professon 1 Amount of total sundry debtors C1 2 Amount of total sundry credtors C2 3 Amount of total stock-n-trade C3 4 Amount of the cash balance C4 va vb B C D E F A B C 4b 4c bv 3c G E d 3e 4d Part A- Manufacturng Account 1 Openng Inventory A Manufacturng Account for the fnancal year (fll tems 1 to 3 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) Openng stock of raw-materal Openng stock of Work n progress Total ( + ) B Purchases (net of refunds and duty or tax, f any) C Drect wages D Drect expenses (D + D + D) A B C D

81 330 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Part A-Tradng Account CREDITS TO TRADING ACCOUNT DEBITS TO TRADING ACCOUNT Carrage nward Power and fuel Other drect expenses E Factory Overheads Indrect wages Factory rent and rates Factory Insurance v Factory fuel and power v Factory general expenses v Deprecaton of factory machnery v Total (+++v+v+v) F Total of Debts to Manufacturng Account (A+B+C+D+Ev) 2 Closng Stock Raw materal 2 Work-n-progress Total (2 +2) 2 3 Cost of Goods Produced transferred to Tradng Account (1F-2) 3 4 Revenue from operatons v v v 2 Tradng Account for the fnancal year (fll tems 4 to 12 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a b c Total (a + b) v Total ( + + c) B Gross recepts from Professon C Dutes, taxes and cess receved or recevable n respect of goods and servces sold or suppled Unon Excse dutes Servce tax VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) v Integrated Goods & Servces Tax (IGST) v Unon Terrtory Goods & Servces Tax (UTGST) v Any other duty, tax and cess x Total ( v +v+ v+v+v) D Total Revenue from operatons (Av + B +Cx) 5 Closng Stock of Fnshed Stocks 5 6 Total of credts to Tradng Account (4D + 5v ) 6 7 Openng Stock of Fnshed Goods 7 8 Purchases (net of refunds and duty or tax, f any) 8 9 Drect Expenses ( ) 9 Carrage nward Power and fuel Other drect expenses Note: Row can be added as per the nature of Drect Expenses 10 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty 10 a b c v v v v v Ev F Av B Cx 4D

82 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 331 Counter velng duty Specal addtonal duty v Unon excse duty v Servce tax v VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) x Integrated Goods & Servces Tax (IGST) x Unon Terrtory Goods & Servces Tax (UTGST) x Any other tax, pad or payable v 10v 10v 10v 10v 10x 10x 10x x Total ( v + 10v + 10v + 10v + 10v + 10x + 10x + 10x) 11 Cost of goods produced Transferred from Manufacturng Account Gross Proft from Busness/Professon - transferred to Proft and Loss account ( x-11) 12 Proft and Loss Account for the fnancal year (fll tems 13 to 60 n a case where regular books of accounts are Part A-P& L mantaned, otherwse fll tems 61 to 64 as applcable) 13 Gross proft transferred from Tradng Account 13 CREDITS TO PROFIT AND LOSS ACCOUNT DEBITS TO PROFIT AND LOSS ACCOUNT 14 Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sale of fxed assets v v Proft on sale of nvestment beng securtes chargeable to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Gan (loss) on account of foregn exchange fluctuaton u/s 43AA v x Proft on converson of nventory nto captal asset u/s 28(va) (FMV of nventory as on the date of converson) x Agrcultural ncome x x x Any other ncome (specfy nature and amount) a b c Total (xa + xb) xc Total of other ncome ( v + v + v + v + v + x + x+ xc) 15 Total of credts to proft and loss account (13+14x) Freght outward Consumpton of stores and spare parts Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages 22 Bonus 22 Rembursement of medcal expenses 22 v Leave encashment 22v v Leave travel benefts 22v v Contrbuton to approved superannuaton fund 22v v Contrbuton to recognsed provdent fund 22v v Contrbuton to recognsed gratuty fund 22v x Contrbuton to any other fund 22x v x xa xb 10x 14x

83 332 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Any other beneft to employees n respect of whch an expendture has been x 22x ncurred x Total compensaton to employees (total of 22 to 22x) 22x x Whether any compensaton, ncluded n 22x, pad to non-resdents xa Yes / No 23 Insurance If Yes, amount pad to non-resdents Medcal Insurance 23 Lfe Insurance 23 Keyman s Insurance 23 v Other Insurance ncludng factory, offce, car, goods, etc. 23v v Total expendture on nsurance ( v) 23v 24 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson 31 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 30 Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty 44 Servce tax 44 VAT/ Sales tax 44 v Cess 44v v Central Goods & Servce Tax (CGST) 44v v State Goods & Servces Tax (SGST) 44v v Integrated Goods & Servces Tax (IGST) 44v v Unon Terrtory Goods & Servces Tax (UTGST) 44v x Any other rate, tax, duty or cess ncl STT and CTT 44x xb

84 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 333 PROVISION FOR TAX AND x Total rates and taxes pad or payable ( v + 44v + 44v + 44v + 44v +44x) 44x 45 Audt fee Salary/Remuneraton pad to Partners of the frm Other expenses (specfy nature and amount) Total ( + ) Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s clamed and amount) v Rows can be added as requred 48v v Others (more than Rs. 1 lakh) where PAN s not avalable (provde name and complete address) 48v v Others (amounts less than Rs. 1 lakh) 48v v Total Bad Debt ( v + 48v + 48v) 48v 49 Provson for bad and doubtful debts Other provsons Proft before nterest, deprecaton and taxes [15 (16 to x + 23v + 24 to to x v )] 52 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Deprecaton and amortsaton Net proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Transferred to reserves and surplus Balance carred to balance sheet n propretor s account (59 60) COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD (Only for Resdent Partnershp Frm other than LLP) SR.NO. Name of Busness Busness code Descrpton 51 PRESUMPTIVE INCOME CASES () Gross Turnover or Gross Recepts (a + b) a Through a/c payee cheque or a/c payee bank draft or bank electronc clearng system receved before specfed date b Any other mode () Presumptve Income under secton 44AD (a + b) a 6% of 62a, or the amount clamed to have been earned, whchever s hgher b 8% of 62b, or the amount clamed to have been earned, whchever s hgher NOTE If ncome s less than the above percentage of Gross Recepts/Turnover, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 63 COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA (Only for Resdent Partnershp Frm other than LLP) SR.NO. Name of Busness Busness code Descrpton a b a b () Gross Recepts 63 () Presumptve Income under secton 44ADA (50% of 63, or the amount clamed to have been earned, whchever s 63 hgher) NOTE If ncome s less than 50% of Gross Recepts, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 64 COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE SR.NO. Name of Busness Busness code Descrpton

85 334 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NO ACCOUNT CASE Regstraton No. of goods carrage Whether owned/leased/ hred Tonnage capacty of goods carrage (n MT) Number of months for whch goods carrage was owned/ leased/ hred by assessee Presumptve ncome u/s 44AE for the goods carrage Rs.1000 per ton per month n case tonnage exceeds 12MT, or Rs.7500 per month) or the amount clamed to have been actually earned, whchever s hgher () (1) (2) (3) (4) (5) (a) (b) Add row optons as necessary (upto maxmum 10) () Total presumptve ncome from goods carrage u/s 44AE [total of column (5) of table 64()] 64() () Less: Salary/Remuneraton to Partners of the frm 64() (v) Total Presumptve Income u/s 44AE (-) 64(v) NOTE If the profts are lower than prescrbed under S.44AE or the number of goods carrage owned at any tme durng the year exceeds 10, then the regular ITR 3 or ITR 5 form has to be flled up. 65 IF REGULAR BOOKS OF ACCOUNT OF BUSINESS OR PROFESSION ARE NOT MAINTAINED, furnsh the followng nformaton for prevous year n respect of busness or professon - () For assessee carryng on Busness a Gross recepts (a1 + a2) 1 Through a/c payee cheque or a/c payee bank draft or bank electronc clearng a1 system receved before specfed date 2 Any other mode a2 b Gross proft c Expenses d Net proft () For assessee carryng on Professon a Gross recepts (a1 + a2) 1 Through a/c payee cheque or a/c payee bank draft or bank electronc clearng a1 system receved before specfed date 2 Any other mode a2 b Gross proft c Expenses d Net proft () Total proft ( ) 66 Turnover from speculatve actvty 66 Gross Proft Expendture, f any v Net ncome from speculatve actvty (66-66) a b c a b c v OTHER INFORMATION Part A- OI Other Informaton (mandatory f lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No Increase n the proft or decrease n loss because of devaton, f any, as per Income Computaton Dsclosure 3a 3a Standards notfed under secton 145(2) [column 11a() of Schedule ICDS] Decrease n the proft or ncrease n loss because of devaton, f any, as per Income Computaton Dsclosure 3b 3b Standards notfed under secton 145(2) [column 11b() of Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Increase n the proft or decrease n loss because of devaton, f any, from the method of valuaton specfed under secton 145A e Decrease n the proft or ncrease n loss because of devaton, f any, from the method of valuaton specfed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value added tax, or refund of GST, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year d any other tem of ncome e captal recept, f any 5a 5b 5c 5d 5e 4d 4e

86 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 335 f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to nonfulflment of condton specfed n relevant clauses- Premum pad for nsurance aganst rsk of damage or destructon a 6a of stocks or store [36(1)()] b Premum pad for nsurance on the health of employees [36(1)(b)] c d Any sum pad to an employee as bonus or commsson for servces rendered, where such sum was otherwse payable to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed captal [36(1)()] e Amount of dscount on a zero-coupon bond [36(1)(a)] Amount of contrbutons to a recognsed provdent fund f [36(1)(v)] Amount of contrbutons to an approved superannuaton fund g [36(1)(v)] Amount of contrbuton to a penson scheme referred to n secton h 80CCD [36(1)(va)] Amount of contrbutons to an approved gratuty fund [36(1)(v)] 6 j Amount of contrbutons to any other fund k Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up under ESI Act or any other fund for the welfare of employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] 6l m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] o Expendture for the purposes of promotng famly plannng amongst employees [36(1)(x)] 6o p Amount of securtes transacton pad n respect of transacton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] 6p Marked to market loss or other expected loss as computed n q accordance wth the ICDS notfed u/s 145(2) [36(1)(xv)] 6q r Expendture for purchase of sugarcane n excess of the government approved prce [36(1)(xv)] 6r s Any other dsallowance t Total amount dsallowable under secton 36 (total of 6a to 6s) u Total number of employees employed by the company (mandatory n case company has recognzed Provdent Fund) deployed n Inda deployed outsde Inda Total 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] b Expendture of personal nature [37(1)] Expendture lad out or expended wholly and exclusvely NOT for c the purpose of busness or professon [37(1)] Expendture on advertsement n any souvenr, brochure, tract, d pamphlet or the lke, publshed by a poltcal party [37(2B)] Expendture by way of penalty or fne for volaton of any law for e the tme beng n force f Any other penalty or fne Expendture ncurred for any purpose whch s an offence or whch g s prohbted by law h Amount of any lablty of a contngent nature Any other amount not allowable under secton 37 7 j Total amount dsallowable under secton 37 (total of 7a to 7) 8 A. Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 Amount dsallowable under secton 40 (a)(), on account of a non-complance wth the provsons of Chapter XVII-B Amount dsallowable under secton 40(a)(a) on account of b non-complance wth the provsons of Chapter XVII-B Amount dsallowable under secton 40 (a)(b), on account of c non-complance wth the provsons of Chapter VIII of the Fnance Act, 2016 Amount dsallowable under secton 40(a)() on account of d non-complance wth the provsons of Chapter XVII-B 6b 6c 6d 6e 6f 6g 6h 6j 6k 6m 6n 6s 7a 7b 7c 7d 7e 7f 7g 7h Aa Ab Ac Ad 5f 6t 7j

87 336 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] B. e Amount of tax or rate leved or assessed on the bass of profts [40(a)()] f Amount pad as wealth tax [40(a)(a)] Af Amount pad by way of royalty, lcense fee, servce fee etc. as g per secton 40(a)(b) Amount of nterest, salary, bonus, commsson or h remuneraton pad to any partner or member [40(b)] Any other dsallowance A j Total amount dsallowable under secton 40(total of Aa to A) 8Aj Any amount dsallowed under secton 40 n any precedng prevous year but allowable durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A 10 a Amounts pad to persons specfed n secton 40A(2)(b) b Amount pad otherwse than by account payee cheque or account payee bank draft or use of electronc clearng system through a bank account, dsallowable under secton 40A(3) c Provson for payment of gratuty [40A(7)] d e any sum pad by the assessee as an employer for settng up or as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] Marked to market loss or other expected loss except as allowable u/s 36(1)(xv) [40A(13)] f Any other dsallowance g Total amount dsallowable under secton 40A Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng the prevous year a Any sum n the nature of tax, duty, cess or fee under any law b c d e Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other fund for the welfare of employees Any sum payable to an employee as bonus or commsson for servces rendered Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal corporaton or a State Industral nvestment corporaton Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other than a prmary agrcultural credt socety or a prmary co-operatve agrcultural and rural development bank f Any sum payable towards leave encashment g Any sum payable to the Indan Ralways for the use of ralway assets h Total amount allowable under secton 43B (total of 10a to 10g) 11 Any amount debted to proft and loss account of the prevous year but dsallowable under secton 43B a Any sum n the nature of tax, duty, cess or fee under any law b Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other fund for the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered d Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other than a prmary agrcultural credt socety or a prmary co-operatve agrcultural and rural development bank f Any sum payable towards leave encashment g Any sum payable to the Indan Ralways for the use of ralway 11g assets h Total amount dsallowable under Secton 43B(total of 11a to 11g) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Central Goods & Servce Tax (CGST) e State Goods & Servces Tax (SGST) Ae Ag Ah 9a 9b 9c 9d 9e 9f 10a 10b 10c 10d 10e 10f 10g 11a 11b 11c 11d 11e 11f 12a 12b 12c 12d 12e 8B 9g 10h 11h

88 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 337 f Integrated Goods & Servces Tax (IGST) 12f g Unon Terrtory Goods & Servces Tax (UTGST) 12g h Any other tax 12h Total amount outstandng (total of 12a to 12h) Amounts deemed to be profts and gans under secton 33AB or 33ABA or 33AC Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss account (net) Amount of expendture dsallowed u/s 14A 16 Part A QD Quanttatve detals (mandatory f lable for audt under secton 44AB) QUANTITATIVE DETAILS (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern 6 Raw materals a Openng stock 6a b Purchases durng the prevous year 6b c Consumpton durng the prevous year 6c d Sales durng the prevous year 6d e Closng stock f Yeld fnshed products 6f g Percentage of yeld 6g h Shortage/ excess, f any 7 Fnshed products/ By-products a openng stock 7a b purchase durng the prevous year 7b c quantty manufactured durng the prevous year 7c d sales durng the prevous year 7d e closng stock 7e f shortage/ excess, f any 7f 6e 6h SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule HP Detals of Income from House Property (Please refer nstructons) (Drop down to be provded ndcatng ownershp of property) Address of property 1 Town/ Cty State PIN Code/ Zp code 1 Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property HOUSE PROPERTY Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II [Tck the applcable opton] Let out Deemed let out Name(s) of Tenant (f let out) I PAN of Tenant(s) (f avalable) II a Gross rent receved or recevable or letable value (hgher of the two, f let out for whole of the year, lower of the two f let out for part of the year) b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c PAN/TAN of Tenant(s) (f TDS credt s clamed) 1a

89 338 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 2 d Total (1b + 1c) 1d e Annual value (1a 1d) 1e f Annual value of the property owned (own percentage share x 1e) 1f g 30% of 1f 1g h Interest payable on borrowed captal 1h Total (1g + 1h) 1 j Arrears/Unrealsed rent receved durng the year less 30% 1j k Income from house property 1 (1f 1 + 1j) 1k Address of property 2 Town/ Cty State PIN Code/ Zp code Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II [Tck the applcable opton] Let out Deemed let out Name(s) of Tenant (f let out) I PAN of Tenant(s) (Please see note) II a Gross rent receved or recevable or letable value (hgher of the two, f let out for whole of the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes d Total (2b + 2c) e Annual value (2a 2d) f Annual value of the property owned (own percentage share x 2e) g 30% of 2f h Interest payable on borrowed captal Total (2g + 2h) 2 j Arrears/Unrealsed rent receved durng the year less 30% k Income from house property 2 (2f 2 + 2j) 3 Pass through ncome f any * 3 4 Income under the head Income from house property (1k + 2k + 3) (f negatve take the fgure to 2 of schedule CYLA) 4 NOTE Furnshng of PAN of tenant s mandatory, f tax s deducted under secton 194-IB. Furnshng of TAN of tenant s mandatory, f tax s deducted under secton 194-I. 2c 2d 2g 2h PAN/TAN of Tenant(s) (Please see note) 2a 2e 2f 2j 2k Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness Proft before tax as per proft and loss account (tem 54, 62(), 63(), 64(v), 65() & 66(v) of Part A-P&L ) 1 1 INCOME FROM BUSINESS OR PROFESSION 2a 2b 3 4a 4b 4c Net proft or loss from speculatve busness ncluded n 1 (enter ve sgn n case of loss) [Sl. No. 66v of Schedule P&L] Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) Income/ recepts credted to proft and loss account consdered under other heads of ncome/chargeable u/s 115BBF/ chargeable u/s 115BBG a House property b Captal gans c Other sources d u/s 115BBF e 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/ Frst Schedule of Income-tax Act (other than proft from lfe nsurance busness referred to n secton 115B) (Dropdown to be provded) Proft and gans from lfe nsurance busness referred to n secton 115B 4b Proft from actvtes covered under rule 7, 7A, 7B(1), 7B(1A) and 8 (Dropdown to be provded) 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a 2a 2b 3a 3b 3c 3d 3e 4a 4c

90 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 339 b Share of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nature and amount) Total (c + c) d Total exempt ncome (5a + 5b + 5c) c c 5c 6 Balance (1 2a 2b 3a - 3b 3c 3d 3e 4a 4b - 4c 5d) 6 7 Expenses debted to proft and loss account consdered under other heads of ncome/related to ncome chargeable u/s 115BBF/or u/s 115BBG a House property b Captal gans c Other sources d u/s 115BBF e u/s 115BBG Expenses debted to proft and loss account whch relate to exempt ncome 8a 8a 8b Expenses debted to proft and loss account whch relate to exempt ncome and dsallowed u/s 14A (16 of Part A-OI) 9 Total (7a + 7b + 7c + 7d + 7e + 8a+ 8b) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act I Deprecaton allowable under secton 32(1)() and 32(1)(a) (column 6 of Schedule-DEP) I Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) I Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) 13 Amounts debted to the proft and loss account, to the extent 14 dsallowable under secton 36 (6s of Part A-OI) Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 (7j of Part A-OI) 15 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 8Aj of Part A-OI) 16 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A (9f of PartA-OI) 17 Any amount debted to proft and loss account of the prevous year but dsallowable under secton 43B (11h of Part A-OI) 18 Interest dsallowable under secton 23 of the Mcro, Small and 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/ 80-IA Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DB d 7a 7b 7c 7d 7e 8b Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch assessee s a partner) Increase n proft or decrease n loss on account of ICDS adjustments and devaton n method of valuaton of stock (Column 3a + 4d of Part A- OI) 26 Total ( ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem x(4) of Schedule ESR) (f amount deductble under secton 35 or 35CCC or 35CCD s lower than amount debted to P&L account, t wll go to tem 24) Any amount dsallowed under secton 40 n any precedng prevous year but allowable durng the prevous year(8b of Part A-OI) 30

91 340 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 31 Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng the prevous year(10g of Part A-OI) Any other amount allowable as deducton Decrease n proft or ncrease n loss on account of ICDS adjustments and devaton n method of valuaton of stock (Column 3b + 4e of Part A- OI) 34 Total ( ) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AD [62() of schedule] 36 Secton 44ADA [63() of schedule] 36 Secton 44AE [64(v) of schedule] 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-tax Act (other than 115B) 36x x Total (36 to 36x) 36x Net proft or loss from busness or professon other than speculatve and specfed busness 37 ( x) Net Proft or loss from busness or professon other than speculatve busness and specfed busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same fgure as n37) (If loss take the fgure to 2 of tem E) (38a+ 38b + 38c + 38d + 38e + 38f) a Income chargeable under Rule 7 b Deemed ncome chargeable under Rule 7A c Deemed ncome chargeable under Rule 7B(1) d Deemed ncome chargeable under Rule 7B(1A) e Deemed ncome chargeable under Rule 8 f Income other than Rule 7A, 7B & Rule 8 (Item No. 37) Balance of ncome deemed to be from agrculture, after applyng Rule 7, 7A, 7B(1), 7B(1A) and Rule 8 for the purpose of aggregaton of ncome as per Fnance Act [4c-(38a+38b+38c+38d+38e)] B Computaton of ncome from speculatve busness 40 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DB Deductons n accordance wth secton 28 to 44DB Income from speculatve busness (f loss, take the fgure to 6x of schedule CFL) B43 C Computaton of ncome from specfed busness under secton 35AD 44 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DB Deductons n accordance wth secton 28 to 44DB (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 47 Proft or loss from specfed busness ) Deductons n accordance wth secton 35AD(1) Income from Specfed Busness (47-48) (f loss, take the fgure to 7x of schedule CFL) C49 50 Relevant clause of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from C50 drop down menu) D Income chargeable under the head Profts and gans from busness or professon (A38+B43+C49) D E Intra head set off of busness loss of current year Sl. Type of Busness ncome Loss to be set off (Fll ths row only f fgure s negatve) 33 Income of current year (Fll ths column only f fgure s zero or postve) 38a 38b 38c 38d 38e 38f Busness loss set off A Busness ncome remanng after set off (1) (2) (3) = (1) (2) (A38)

92 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 341 Income from speculatve busness Income from specfed busness v Proft and gans from lfe nsurance busness u/s 115B v Total loss set off ( + + v) v Loss remanng after set off ( v) (B43) (C49) (A4b) Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton under any other Schedule DPM secton) 1 Block of assets Plant and machnery DEPRECIATION ON PLANT AND MACHINERY DEPRECIATION ON OTHER ASSETS 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result n negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Addtonal deprecaton relatng to mmedately precedng year' on asset put to use for less than 180 days 15 Total deprecaton* ( ) 16 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net aggregate deprecaton (15-16) 18 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth transfer of asset/ assets 20 Captal gans/ loss under secton 50* ( ) (enter negatve only f block ceases to exst) 21 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) Schedule DOA () () () Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Land Buldng (not ncludng land) Furnture and fttngs Intangble assets Shps 2 Rate (%) Nl Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year () () () (v) (v) (v) (v)

93 342 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result n negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Total deprecaton* (10+11) 13 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net aggregate deprecaton (12-13) 15 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 14) 16 Expendture ncurred n connecton wth transfer of asset/ assets 17 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 18 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) Summary of deprecaton on assets (Other than assets on whch full captal expendture s allowable as deducton under any other Schedule DEP secton) 1 Plant and machnery SUMMARY OF DEPRECIATION ON ASSETS a Block enttled for 15 per cent ( Schedule DPM - 17 or 18 as applcable) b Block enttled for 30 per cent ( Schedule DPM - 17 or 18 as applcable) c Block enttled for 40 per cent ( Schedule DPM - 17 or 18 as applcable) d Total deprecaton on plant and machnery ( 1a + 1b + 1c) 2 Buldng (not ncludng land) a Block enttled for 5 per cent (Schedule DOA- 14 or 15 as applcable) b Block enttled for 10 per cent (Schedule DOA- 14 or 15 as applcable) c Block enttled for 40 per cent (Schedule DOA- 14v or 15v as applcable) d Total deprecaton on buldng (total of 2a + 2b + 2c) 3 Furnture and fttngs(schedule DOA- 12v) 3 4 Intangble assets (Schedule DOA- 12v) 4 5 Shps (Schedule DOA- 12v) 5 6 Total deprecaton ( 1d+2d+3+4+5) 1a 1b 1c 2a 2b 2c 1d 2d 6 Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery a Block enttled for 15 per cent (Schedule DPM - 1a 20) b Block enttled for 30 per cent 1b (Schedule DPM 20) c Block enttled for 40 per cent 1c (Schedule DPM - 20) d Total ( 1a +1b + 1c) 1d 2 Buldng (not ncludng land) a Block enttled for 5 per cent 2a (Schedule DOA- 17) b Block enttled for 10 per cent 2b (Schedule DOA- 17) c Block enttled for 40 per cent (Schedule DOA- 2c 17v) d Total ( 2a + 2b + 2c) 2d 3 Furnture and fttngs ( Schedule DOA- 17v) 3 4 Intangble assets (Schedule DOA- 17v) 4 5 Shps (Schedule DOA- 17v) 5 6 Total ( 1d+2d+3+4+5) 6

94 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 343 Schedule ESR Sl No v v v v v x x Expendture on scentfc Research etc. (Deducton under secton 35 or 35CCC or 35CCD) Expendture of the nature referred to n secton (1) 35(1)() 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) NOTE In case any deducton s clamed under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA), please provde the detals as per Schedule RA. Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Sub-tems 4 & 5 are not applcable for resdents) Short-term Captal Gans 1 From sale of land or buldng or both a I Full value of consderaton receved/recevable a I Value of property as per stamp valuaton authorty I Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed 1.05 tmes (a), take ths fgure as (a), or else take (a)] b Deductons under secton 48 I Cost of acquston wthout ndexaton I Cost of Improvement wthout ndexaton I Expendture wholly and exclusvely n connecton wth transfer Iv Total (b + b + b) bv c Balance (a bv) 1c d Deducton under secton 54D/ 54G/54GA (Specfy detals n tem D below) e Short-term Captal Gans on Immovable property (1c - 1d) A1e a a b b b 1d f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.No. Name of buyer(s) PAN of buyer(s) Percentage share Amount Address of property Pn code NOTE Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) 3 b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 I Cost of acquston wthout ndexaton I Cost of Improvement wthout ndexaton I Expendture wholly and exclusvely n connecton wth transfer Iv Total ( + + ) c Balance (3a bv) 3c b b b bv A2c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 3d 4 e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a

95 344 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b STCG on transactons on whch securtes transacton tax (STT) s not pad A4b 5 For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 115AD a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of securtes other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (5a bv) 5c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) e Short-term captal gan on securtes (other than those at A3 above) by an FII (5c +5d) A5e 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed b manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) c Full value of consderaton n respect of assets other than unquoted shares a Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (6a bv) 6c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 6d e Deemed short term captal gans on deprecable assets (6 of schedule- DCG) f Deducton under secton 54D/54G/54GA 6f g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e 6f) A6g 7 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year Secton under whch n whch asset deducton clamed n transferred that year New asset acqured/constructed b c a a b b bv 5d b b bv Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account D/54G/54GA b Amount deemed to be short term captal gans u/s 54D/54G/54GA, other than at a Amount deemed to be short term captal gans (X + b) 6e Amount not used for new asset or remaned unutlzed n Captal gans account (X) 8 Pass Through Income n the nature of Short Term Captal Gan, (Fll up schedule PTI) (A8a + A8b + A8c) a Pass Through Income n the nature of Short Term Captal Gan, 15% A8a b Pass Through Income n the nature of Short Term Captal Gan, 30% A8b A7 A8

96 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k c Pass Through Income n the nature of Short Term Captal Gan, chargeable at applcable rates Amount of STCG ncluded n A1 A8 but not chargeable to tax or chargeable at specal rates n Inda as per DTAA Sl. No. Amount of ncome Item No. A1 to A8 above n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC Secton of obtaned I.T. Act (Y/N) Rate as per I.T. Act A8c Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II a Total amount of STCG not chargeable to tax n Inda as per DTAA b Total amount of STCG chargeable to tax at specal rates n Inda as per DTAA 10 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7 + A8 A9a) A10 B Long-term captal gan (LTCG) (Sub-tems 5, 6, 7, 8 & 9 are not applcable for resdents) 1 From sale of land or buldng or both (fll up detals separately for each property) a I Full value of consderaton receved/recevable a I Value of property as per stamp valuaton authorty I Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed 1.05 tmes (a), take ths fgure as (a), or else take (a)] b Deductons under secton 48 I Cost of acquston wth ndexaton I Cost of Improvement wth ndexaton I Expendture wholly and exclusvely n connecton wth transfer Iv Total (b + b + b) c Balance (a bv) a a b b b bv 1c A9a A9b d Deducton under secton 54D/54EC/54G/54GA (Specfy detals n tem D below) 1d e Long-term Captal Gans on Immovable property (1c - 1d) f In case of transfer of mmovable property, please furnsh the followng detals (see note) B1e Long-term Captal Gans S.No. Name of buyer(s) PAN of buyer(s) Percentage share Amount Address of property Pn code NOTE Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) d Deducton u/s 54EC e Long term captal gans from slump sale (2c-2d) 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) 4 a Full value of consderaton b Deductons under secton 48 I Cost of acquston wthout ndexaton I Cost of mprovement wthout ndexaton I Expendture wholly and exclusvely n connecton wth transfer Iv Total (b + b +b) c Balance (3a bv) d Deducton under sectons (Specfy detals n tem D below) e LTCG on bonds or debenture (3c 3d) From sale of lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable a Full value of consderaton 4a b Deductons under secton 48 2c 2d 3a b b b bv 3c 3d B2e B3e Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c

97 346 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] d Deducton under sectons (Specfy detals n tem D below) e Long-term Captal Gans on assets at B4 above (4c 4d) B4e From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) A Cost of acquston B If the long term captal asset was acqured before , lower of B1 and B2 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total deductons (b + b +b) c Balance (5a bv) d Less- LTCG exempt as per secton 112A (5c Rs. 1 lakh) e Deducton under sectons 54F (Specfy detals n tem D below) f Long-term Captal Gans on sale of captal assets at B5 above (5d 5e) For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) 5a b A B b b bv 5c a LTCG computed wthout ndexaton beneft 6a b Deducton under sectons 54EC (Specfy detals n tem D below) c LTCG on share or debenture (6a- 6b) For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () unts referred n sec. 115AB, () bonds or GDR as referred n sec. 115AC, (v) securtes by FII as referred to n sec. 115AD 5d 5e 4d 6b B5f B6c a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares a b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) b c 8 Full value of consderaton n respect of securtes other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (a bv) 7c d Deducton under sectons 54EC (Specfy detals n tem D below) e Long-term Captal Gans on assets at 7 above n case of NON-REESIDENT (7c 7d) B7e For NON-RESIDENTS - From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 8a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) b A Cost of acquston A B If the long term captal asset was acqured before , lower of B1 and B2 B 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total deductons (b + b +b) bv c Balance (8a bv) 8c d Less- LTCG exempt as per secton 112A (8c Rs. 1 lakh) 8d e Deducton under sectons 54F (Specfy detals n tem D below) 8e f Long-term Captal Gans on sale of captal assets at B8 above (8d 8e) 9 From sale of assets where B1 to B8 above are not applcable a a b b b bv 7d B8f

98 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 347 a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted a shares b Far market value of unquoted shares determned n the prescrbed manner b c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of mprovement wth ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (a bv) 9c d Deducton under secton 54D//54G/54GA (Specfy detals n tem D below) e Long-term Captal Gans on assets at B9 above (9c- 9d) 10 Amount deemed to be long-term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA New asset acqured/constructed Year n whch asset acqured/constructed b Amount deemed to be long-term captal gans, other than at a Amount deemed to be long-term captal gans (X + b) Amount utlsed out of Captal Gans account c a a 9d Amount not used for new asset or remaned unutlzed n Captal gans account (X) 11 Pass Through Income n the nature of Long Term Captal Gan, (Fll up schedule PTI) (B11a + B11b) B11 12 a b Pass Through Income n the nature of Long Term Captal Gan, 10% Pass Through Income n the nature of Long Term Captal Gan, 20% Amount of LTCG ncluded n tems B1 to B11 but not chargeable to tax or chargeable at specal rates n Inda as per DTAA Sl. No. Amount of ncome Item No. B1 to B11 above n whch ncluded Country Artcle of name & DTAA Code Rate as per Treaty (enter NIL, f not Whether TRC obtaned (Y/N) Secton of I.T. Act B11a B11b Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I B9e B10 II 13 a Total amount of LTCG not chargeable to tax n Inda as per DTAA b Total amount of LTCG chargeable to tax at specal rates n Inda as per DTAA Total long term captal gan] [B1e + B2e + B3e + B4e + B5f + B6c + B7e + B8f + B9f+ B10+B11-B12a] (In case of loss take the fgure to 9x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A9 + B13) (take B13 as nl, f loss) D Informaton about deducton clamed aganst Captal Gans 1 In case of deducton u/s 54B/54D/54EC /54G/54GA gve followng detals a b Deducton clamed u/s 54B Date of transfer of orgnal asset a dd/mm/yyyy Cost of new agrcultural land Date of purchase of new agrcultural land a dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54D Date of acquston of orgnal asset b dd/mm/yyyy a av av B12a B12b B12 C

99 348 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c d e Cost of purchase/ constructon of new land or buldng for ndustral undertakng Date of purchase of new land or buldng b dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54EC Date of transfer of orgnal asset c dd/mm/yyyy Amount nvested n specfed/notfed bonds Date of nvestment c dd/mm/yyyy v Amount of deducton clamed Deducton clamed u/s 54G Date of transfer of orgnal asset d dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new asset Date of purchase/constructon of new asset n an area other than urban area v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54GA b bv bv c cv d d dv dv dd/mm/yyyy Date of transfer of orgnal asset from urban area e dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new asset Date of purchase/constructon of new asset n SEZ e dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed f Total deducton clamed (1a + 1b + 1c + 1d + 1e ) e ev ev f E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A8 & B10 whch s chargeable under DTAA) Sl. Type of Captal Gan Captal Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss Long term captal loss Current year s captal gans remanng after set off 15% 30% applcable rate DTAA rates 10% 20% DTAA rates (9= ) Captal Loss to be set off (Fll ths row only, f computed fgure s negatve) (A3e*+ A4a*+ A8a*) (A5e*+ A8b*) (A1e*+ A2c*+ A4b*+ A6g* + A7+A8c*) A9b (B4e*+B5f* +B7e*+B8f *+B9f+ B12a*) B1e*+ B2e*+ B6c*+ B9f*+ B10e*+ B11*+B12b*) B12b 15% (A3e+A4a+A8a*) Short term captal gan 30% (A5e+ A8b*) (A1e*+ A2c*+ v applcable rate A4b*+ A6g* + A7+A8c*) v DTAA rates A9b v 10% Long term captal gan v 20% (B4e*+B5f*+B7e *+B8f*+B9f B12a*) B1e*+ B2e*+ B6c*+ B9f*+ B10e*+ B11* B12b*) v DTAA rates B12b x Total loss set off ( + + v + v + v+v+v) x Loss remanng after set off ( x) The fgures of STCG n ths table (A1e* etc.) are the amounts of STCG computed n respectve column (A1-A8) as reduced by the amount of STCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. The fgures of LTCG n ths table (B1e* etc.) are the amounts of LTCG computed n respectve column (B1-B11) as reduced by the amount of LTCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. F Informaton about accrual/recept of captal gan

100 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 349 Type of Captal gan / Date 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) NOTE Short-term captal gans taxable at the rate of 15% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at the rate of 30% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at applcable rates Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at DTAA rates Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% Enter value from tem 5x of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% Enter value from tem 5x of schedule BFLA, f any. Long- term captal gans taxable at the rate DTAA rates Enter value from tem 5x of schedule BFLA, f any. Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head Schedule OS OTHER SOURCESxx Income from other sources 1 Gross Income chargeable to tax at normal applcable rates (1a+ 1b+ 1c+ 1d + 1e) 1 a Dvdends, Gross b Interest, Gross (b + b + b + bv) From Savngs Bank From Deposts (Bank/ Post Offce/ Co-operatve) Socety/) From Income-tax Refund v In the nature of Pass through ncome v Others c Rental ncome from machnery, plants, buldngs, etc., Gross d Income of the nature referred to n secton 56(2)(x) whch s chargeable to tax (d + d + d + dv + dv) Aggregate value of sum of money receved wthout consderaton v v In case mmovable property s receved wthout consderaton, stamp duty value of property In case mmovable property s receved for nadequate consderaton, stamp duty value of property n excess of such consderaton In case any other property s receved wthout consderaton, far market value of property In case any other property s receved for nadequate consderaton, far market value of property n excess of such consderaton e Any other ncome (please specfy nature) 2 Income chargeable at specal rates (2a+ 2b+ 2c+ 2d + 2e) 2 a Income by way of wnnngs from lotteres, crossword puzzles etc. chargeable u/s 115BB b Income chargeable u/s 115BBE (b + b + b + bv+ bv + bv) Cash credts u/s 68 Unexplaned nvestments u/s 69 Unexplaned money etc. u/s 69A v Undsclosed nvestments etc. u/s 69B v Unexplaned expendture etc. u/s 69C v Amount borrowed or repad on hund u/s 69D c Accumulated balance of recognsed provdent fund taxable u/s 111 S.No. Assessment Year Income beneft Tax beneft () () () (v) 1a 1b b b b bv bv 1c 1d d d d dv dv 1e 2a 2b b b b bv bv bv 2c d Any other ncome chargeable at specal rate (total of d to dxx) Dvdends receved by non-resdent (not beng company) or foregn company chargeable u/s 115A(1)(a)() d 2d Interest receved from Government or Indan concern on foregn currency debts chargeable u/s 115A(1)(a)() d Interest receved from Infrastructure Debt Fund chargeable u/s 115A(1)(a)(a) d

101 350 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v v v v v x x Interest referred to n secton 194LC - chargeable u/s 115A(1)(a)(aa) Interest referred to n secton 194LD - chargeable u/s 115A(1)(a)(ab) Dstrbuted ncome beng nterest referred to n secton 194LBA - chargeable u/s 115A(1)(a)(ac) Income from unts of UTI or other Mutual Funds specfed n secton 10(23D), purchased n Foregn Currency - chargeable u/s 115A(1)(a)() dv dv dv dv Income from royalty or fees for techncal servces receved dv from Government or Indan concern - chargeable u/s 115A(1)(b) Income by way of nterest or dvdends from bonds or GDRs purchased n foregn currency by non-resdents - chargeable u/s 115AC Income by way of dvdends from GDRs purchased n foregn currency by resdents - chargeable u/s 115ACA dx dx x x Income (other than dvdend) receved by an FII n respect of securtes (other than unts referred to n secton 115AB) - chargeable u/s 115AD(1)() Income by way of nterest receved by an FII on bonds or Government securtes referred to n secton 194LD chargeable as per provso to secton 115AD(1)() dx dx e f x xv xv xv xv xv Tax on non-resdents sportsmen or sports assocatons chargeable u/s 115BBA Anonymous Donatons n certan cases chargeable u/s 115BBC Income by way of dvdend receved by specfed assessee, beng resdent, from domestc company exceedng rupees ten lakh chargeable u/s 115BBDA Income by way of royalty from patent developed and regstered n Inda - chargeable u/s 115BBF Income by way of transfer of carbon credts - chargeable u/s 115BBG Investment Income of a Non-Resdent Indan - chargeable u/s 115E xx Any other ncome (Please specfy) Pass through ncome n the nature of ncome from other sources chargeable at specal rates (drop down to be provded) Amount ncluded n 1 and 2 above, whch s chargeable at specal rates n Inda as per DTAA (total of column (2) of table below) Sl. No. Amount of ncome Item No.2a to 2e n whch Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not dx dxv dxv dxv dxv dv dxx Whether TRC obtaned (Y/N) Secton of I.T. Act Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II 2e 2f 3 Deductons under secton 57 (other than those relatng to ncome chargeable at specal rates under 2a, 2b & 2d) a Expenses / Deductons b Deprecaton c Total 4 Amounts not deductble u/s 58 5 Profts chargeable to tax u/s Net Income from other sources chargeable at normal applcable rates ( ) (If negatve take the fgure to 4 of schedule CYLA) 7 Income from other sources (other than from ownng and mantanng race horses) (2 + 6) (enter 6 as nl, f negatve) 7 3a 3b 3c 6 8 Income from the actvty of ownng race horses a Recepts b Deductons under secton 57 n relaton to recepts at 8a only c Amounts not deductble u/s 58 d Profts chargeable to tax u/s 59 8a 8b 8c 8d

102 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 351 e Balance (8a - 8b + 8c + 8d) (f negatve take the fgure to 10x of Schedule CFL) 9 Income under the head Income from other sources (7+ 8e) (take 8e as nl f negatve) 9 10 Informaton about accrual/recept of ncome from Other Sources S.No. Other Source Income Upto 15/6 From 16/6 to 15/9 From 16/9 to 15/12 1 Dvdend Income u/s 115BBDA From 16/12 to 15/3 From 16/3 to 31/3 () () () (v) (v) 8e 2 Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. referred to n secton 2(24)(x) NOTE Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head. Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Sl.No Head/ Source of Income Detals of Income after Set off of current year losses Loss to be set off (Fll ths row only, f computed fgure s negatve) Income of current year (Fll ths column only f ncome s zero or postve) House property (4 of Schedule HP) v Busness (excludng speculaton ncome and ncome from specfed busness) Proft and gans from lfe nsurance busness u/s 115B House property loss of the current year set off Busness Loss (other than speculaton or specfed busness loss) of the current year set off Other sources loss (other than loss from race horses and amount chargeable to specal rate of tax) of the current year set off Current year s Income remanng after set off = (A38 of Schedule BP) (3v of tem E of Sch. BP) v Speculaton 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 captal gan 15% v Short-term captal gan 30% x Short-term captal gan taxable at applcable rates x Short-term captal gan taxable at specal rates n Inda as per DTAA (9 of tem E of schedule CG) (9 of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) x Long term captal gan (9v of tem E of schedule 10% CG) x Long term captal gan (9v of tem E of 20% schedule CG) x Long term captal gans taxable at (9v of tem E of specal rates n Inda as per DTAA schedule CG) xv Net ncome from other sources chargeable at normal applcable (6 of schedule OS) rates xv Proft from the actvty of ownng and mantanng race horses (8e of schedule OS) xv Income from other sources taxable at specal rates n Inda as per DTAA (2f of schedule OS) xv Total loss set off xv Loss remanng after set-off ( xv) (4 of Schedule HP) (2v of tem E of Schedule BP) (6 of Schedule-OS) Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years

103 352 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] BROUGHT FORWARD LOSS ADJUSTMENT Sl. No. Head/ Source of Income Income after set off, f any, of current year s losses as per 5 of Schedule CYLA) Brought forward loss set off House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculaton ncome and ncome from specfed busness) Proft and gans from lfe nsurance busness u/s 115B v Speculaton Income Brought forward deprecaton set off Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5 of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) v Specfed Busness Income (5v of schedule CYLA) (B/f busness loss, other than speculaton or specfed busness loss) (B/f busness loss, other than speculaton or specfed busness loss) (B/f normal busness or speculaton loss) (B/f normal busness or specfed busness loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term or longterm captal loss) (B/f short-term or long- v Short-term captal gan (5v of schedule CYLA) 15% v Short-term captal gan ( 5v of schedule CYLA) 30% Short-term captal gan taxable at v ( 5x of schedule CYLA) applcable rates x Short-term captal gan taxable at specal rates n Inda as per DTAA (5x of schedule CYLA) x Long-term captal gan 10% (5x of schedule CYLA) x Long term captal gan ( 5x of schedule CYLA) 20% term captal loss) x Long term captal gans taxable at (B/f short-term or longterm captal loss) (5x of schedule CYLA) specal rates n Inda as per DTAA Net ncome from other sources x chargeable at normal applcable (5xv of schedule CYLA) rates Proft from ownng and mantanng xv race horses (5xv of schedule CYLA) (B/f loss from horse races) Income from other sources ncome xv taxable at specal rates n Inda as (5xv of schedule CYLA) per DTAA xv Total of brought forward loss set off xv Current year s ncome remanng after set off Total of ( v+ 5v + 5v + 5v + 5v + 5x + 5x + 5x +5x +5x+ 5xv + 5xv) Schedule CFL CARRY FORWARD OF LOSS Sl. No. Assessment Year Detals of Losses to be carred forward to future years Date of Flng (DD/MM/ YYYY) House property loss Loss from busness other than loss from speculatve busness and specfed busness Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses v v v v v x x x x Total of earler year losses b/f Adjustment of above losses n Schedule BFLA (Current year losses to be carred forward) Total loss Carred forward to future years (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) (2x+3x+4x+5x of tem E of schedule CG) (6x+7x+8x) of tem E of schedule CG) (2xv of schedule BFLA) (8e of schedule OS, f ve)

104 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 353 Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought Amount of deprecaton Balance carred Amount of brought Amount of allowance Balance forward unabsorbed set-off aganst the current forward to the forward unabsorbed set-off aganst the Carred deprecaton year ncome next year allowance current year ncome forward to the next year (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Year v v Total (3xv of BFLA) (4xv of BFLA) Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X 11a. 11b. Accountng Polces Valuaton of Inventores (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Constructon Contracts Revenue Recognton Tangble Fxed Assets Changes n Foregn Exchange Rates Government Grants Securtes (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Borrowng Costs Provsons, Contngent Labltes and Contngent Assets Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negatve) Schedule 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone DEDUCTION U/S 10AA Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce/provde servces c Total deducton under secton 10AA (a + b + c + d) Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G DETAILS OF DONATIONS A B C Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total Donaton n cash Donaton n other mode Total Donaton Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt Donaton n cash Donaton n other mode Total Donaton

105 354 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] D Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total Donaton n cash Donaton n other mode Total Donaton Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total E Total donatons (A + B + C + D) Donaton n cash Donaton n other mode Total Donaton Schedule 80GGA S. No. Detals of donatons for scentfc research or rural development Relevant clause under whch deducton s clamed (drop down to be provded) Total donaton Name and address of donee PAN of Donee Donaton n cash Amount of donaton Donaton n other mode Total Donaton Elgble Amount of donaton Schedule RA Detals of donatons to research assocatons etc. [deducton under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA)] Name and address of donee PAN of Donee Amount of donaton Total Donaton n cash Donaton n other mode Total Donaton Elgble Amount of donaton Schedule 80-IA a b c d Deductons under secton 80-IA Deducton n respect of profts of an enterprse referred to n secton 80-IA(4)() [Infrastructure faclty] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] a1 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) a2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) b1 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) b2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) c1 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) c2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) d1 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) d2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) e Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Crosscountry natural gas dstrbuton network] f Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2 + e1 + e2) e1 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) e2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) f Schedule 80-IB a b Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng)

106 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 355 c Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] d Deducton n the case of multplex theatre [Secton 80-IB(7A)] e Deducton n the case of conventon centre [Secton 80-IB(7B)] f g h j k l Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] Deducton n the case of an undertakng developng and buldng housng projects [Secton 80-IB(10)] Deducton n the case of an undertakng operatng a cold chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n ntegrated busness of handlng, storage and transportaton of food grans [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n operatng and mantanng a rural hosptal [Secton 80-IB(11B)] Deducton n the case of an undertakng engaged n operatng and mantanng a hosptal n any area, other than excluded area [Secton 80-IB(11C) m Total deducton under secton 80-IB (Total of a1 to l2) c1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) c2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) d1 Undertakng no. 1 (10(v) of Form 10CCBA of the undertakng) d2 Undertakng no. 2 (10(v) of Form 10CCBA of the undertakng) e1 Undertakng no. 1 (10(v) of Form 10CCBB of the undertakng) e2 Undertakng no. 2 (10(v) of Form 10CCBB of the undertakng) f1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) f2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) g1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) g2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) h1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) h2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) 1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) 2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) j1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) j2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) k1 Undertakng no. 1 (11(v) of From 10CCBC) k2 Undertakng no. 2 (11(v) of From 10CCBC) l1 Undertakng no. 1 (11(d) of From 10CCBD) l2 Undertakng 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 a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East da Assam db Arunachal Pradesh dc Manpur dd Mzoram de Meghalaya df Nagaland dg Trpura da1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) da2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) db1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) db2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dc1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dc2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dd1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dd2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) de1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) de2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) df1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) df2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dg1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c1 Undertakng no. 2 dh e (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng)

107 356 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule 80P Deductons under secton 80P 1 Sec.80P(2)(a)() Bankng/Credt Facltes to ts members 2 Sec.80P(2)(a)() Cottage Industry 3 Sec.80P(2)(a)() Marketng of Agrcultural produce grown by ts members 4 Sec.80P(2)(a)(v) Purchase of Agrcultural Implements, seeds, lvestocks or other artcles ntended for agrculture for the purpose of supplyng to ts members. 5 Sec.80P(2)(a)(v) Processng, wthout the ad of power, of the agrcultural Produce of ts members. 6 Sec.80P(2)(a)(v) Collectve dsposal of Labour of ts members 7 Sec.80P(2)(a)(v) Fshng or alled actvtes for the purpose of supplyng to ts members. 8 Sec.80P(2)(b)Prmary cooperatve socety enagaged n supplyng Mlk, olseeds, fruts or vegetables rased or grown by ts members to Federal cooperatve socety enagaged n supplyng Mlk, olseeds, fruts or vegetables/government or local authorty/government Company / corporaton establshed by or under a Central, State or Provncal Act 9 Sec.80P(2)(c)()Consumer Cooperatve Socety Other than specfed n 80P(2a) or 80P(2b) 10 Sec.80P(2)(c)()Other Cooperatve Socety engaged n actvtes Other than specfed n 80P(2a) or 80P(2b) 11 Sec.80P(2)(d)Interest/Dvdend from Investment n other co-operatve socety 12 Sec.80P(2)(e)Income from Lettng of godowns / warehouses for storage, processng / facltatng the marketng of commodtes 13 Sec.80P(2)(f)Others 14 Total Income Amount elgble for deducton Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80G b 80GGA c 80GGC Total Deducton under Part B (a + b + c) 1 TOTAL DEDUCTIONS 2 Part C- Deducton n respect of certan ncomes d 80-IA (f of Schedule 80-IA) e 80-IAB f 80-IAC g 80-IB (m of Schedule 80-IB) h 80-IBA 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) j 80JJA k 80JJAA l 80LA (9 of Annexure to Form 10CCF) m 80P Total Deducton under Part C (total of c to m ) 2 3 Total deductons under Chapter VI-A (1 + 2) 3 Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 13 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) a Deducton Clamed under any secton ncluded n Chapter VI-A under the headng C. Deductons n respect of certan ncomes b Deducton Clamed u/s 10AA c Deducton clamed u/s 35AD as reduced by the amount of deprecaton on assets on whch such deducton s clamed d Total Adjustment (2a+ 2b+ 2c) 3 Adjusted Total Income under secton 115JC(1) (1+2d) 3 4 Tax payable under secton 115JC(1) [18.5% or 9% as the case may be of (3)] (In the case of AOP, BOI, AJP ths s applcable f 3 s greater than Rs. 20 lakhs) 2a 2b 2d 4 Schedule AMTC Computaton of tax credt under secton 115JD

108 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2g of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse enter 0] 3 4 Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of AMT Credt Brought Forward) S.No Assessment Year (AY) (A) v v v v v Current AY (enter 1-2, f 1>2 else enter 0) Total Gross (B1) AMT Credt Set-off n earler assessment years (B2) Balance brought forward to the current assessment year (B3) = (B1) (B2) 5 Amount of tax credt under secton 115JD utlsed durng the year [total of tem No. 4 (C)] 5 6 Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4 (D)] 6 AMT Credt Utlsed durng the Current Assessment Year (C) Balance AMT Credt Carred Forward (D)= (B3) (C) Schedule SI SPECIAL RATE] Sl No Income chargeable to tax at specal rates [Please see nstructon Number-7() for secton and rate of tax] Secton/Descrpton Specal rate (%) Income () 1 111A (STCG on shares/equty orented MF on whch STT pad) 15 (part of 5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (part of 5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 5x of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5xof schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (part of 5x of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5x of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (part of 5x of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) 9 112A (LTCG on sale of shares or unts on whch STT s pad) 10 (B5f and B8f of schedule CG) 10 STCG chargeable at specal rates n Inda as per DTAA (part of 5x of schedule BFLA) 11 LTCG Chargeable at specal rates n Inda as per DTAA (part of 5x of schedule BFLA) B (Profts and gans of lfe nsurance busness) (part of 4b of schedule BP) AC (Income of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (2a of schedule OS) BBDA (Dvdend ncome from domestc company exceedng Rs.10 lakh) 10 (2dxv of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (2b of schedule OS) BBF (Tax on ncome from patent) a Income under head busness or professon 10 (3d of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) BBG (Tax on ncome from transfer of carbon credts) a Income under head busness or professon 10 (8e of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) A(1)(b) (Income of a non-resdent from Royalty) 25 (part of 2dv of schedule OS) 20 Income from other sources chargeable at specal rates n Inda as per DTAA (part of 2f of schedule OS) 21 Pass Through Income n the nature of Short Term Captal Gan 15% (part of 5v of schedule BFLA) Pass Through Income n the nature of Short Term Captal Gan chargeable (part of 5v of schedule BFLA) 30% Pass Through Income n the nature of Long Term Captal Gan chargeable (part of 5x of schedule BFLA) 10% Pass Through Income n the nature of Long Term Captal Gan chargeable (part of 5x of schedule BFLA) 20% Tax thereon ()

109 358 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 25 Pass through ncome n the nature of ncome from other source chargeable at specal rates Total (2e of schedule OS) Schedule IF Informaton regardng partnershp frms n whch you are partner FIRMS IN WHICH PARTNER Number of frms n whch you are partner Sl. No Name of the Frm PAN of the frm Whether the frm s lable for audt? (Yes/No) Whether secton 92E s applcable to frm? (Yes/ No) Percentage Share n the proft of the frm Amount of share n the proft Captal balance on 31 st March n the frm 4 Total Schedule EI EXEMPT INCOME Detals of Exempt Income (Income not to be ncluded n Total Income or not chargeable to tax) 1 Interest ncome 1 2 Dvdend ncome 2 3 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years v Agrcultural ncome porton relatng to Rule 7, 7A, 7B(1), 7B(1A) and 8 (from Sl. No. 40 of Sch. BP) v Net Agrcultural ncome for the year ( + v) (enter nl f loss) 3 v In case the net agrcultural ncome for the year exceeds Rs.5 lakh, please furnsh the followng detals (Fll up detals separately for each agrcultural land) a Name of dstrct along wth pn code n whch agrcultural land s located b Measurement of agrcultural land n Acre c Whether the agrcultural land s owned or held on lease (drop down to be provded) d Whether the agrcultural land s rrgated or ran-fed (drop down to be provded) 4 Other exempt ncome ncludng exempt ncome of mnor chld (please specfy) 4 5 Income not chargeable to tax as per DTAA Sl. No. Amount of ncome Nature of ncome I II Country name & Code Artcle of DTAA v Head of Income Whether TRC obtaned (Y/N) III Total Income from DTAA not chargeable to tax 5 6 Pass through ncome not chargeable to tax (Schedule PTI) 6 7 Total ( ) 7 Schedule PTI Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Sl. Name of busness trust/ PAN of the busness Sl. Head of ncome Amount of ncome TDS on such nvestment fund trust/ nvestment fund amount, f any 1. House property Captal Gans a Short term b Long term Other Sources v Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s 2. House property Captal Gans a Short term b Long term Other Sources v Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s NOTE Please refer to the nstructons for fllng out ths schedule. PASS THROUGH INCOME

110 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 359 Schedule FSI INCOME FROM OUTSIDE INDIA AND TAX RELIEF Sl. Country Code 1 2 NOTE Taxpayer Identfcaton Number Detals of Income from outsde Inda and tax relef Sl. Head of ncome Income from outsde Inda (ncluded n PART B- TI) House Property Busness or Professon Captal Gans v Other sources House Property Busness or Professon Captal Gans v Other sources Tax pad outsde Inda Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Total Total Please refer to the nstructons for fllng out ths schedule. Schedule TR TAX RELIEF FOR TAX PAID OUTSIDE INDIA Detals Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Identfcaton Number Total taxes pad outsde Inda (total of (c) of Schedule FSI n respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total 2 Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of total of 1(d)) 2 3 Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total of 1(d)) 3 4 NOTE Schedule FA DETAILS OF FOREIGN ASSETS Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below a Amount of tax refunded Please refer to the nstructons for fllng out ths schedule. Detals of Foregn Assets and Income from any source outsde Inda b Assessment year n whch tax relef allowed n Inda 4 Yes/No A1 Detals of Foregn Depostory Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod) Sl No Country name Country code ZIP code Account number Status Account openng date Closng balance Name of fnancal nsttuton Address of fnancal nsttuton Peak balance durng the perod Gross nterest pad/credted to the account durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A2 Detals of Foregn Custodal Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country name Country code ZIP code Account number Status Closng balance Name of fnancal nsttuton Address of fnancal nsttuton Account openng date Peak balance durng the perod Gross amount pad/credted to the account durng the perod (drop down to be provded specfyng nature of amount vz. nterest/dvdend/proceeds from sale or redempton of fnancal assets/ other ncome) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A3 Detals of Foregn Equty and Debt Interest held (ncludng any benefcal nterest) n any entty at any tme durng the relevant accountng perod

111 360 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Sl No Country name Country code Name of entty Address of entty ZIP code Nature of entty Date of acqurng the nterest Intal value of the nvestment Peak value of nvestment durng the perod Closng value Total gross amount pad/credted wth respect to the holdng durng the perod Total gross proceeds from sale or redempton of nvestment durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) () () A4 Detals of Foregn Cash Value Insurance Contract or Annuty Contract held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Country code Sl No Country name Name of fnancal nsttuton n whch nsurance contract held Address of fnancal nsttuton ZIP code Date of contract The cash value or surrender value of the contract Total gross amount pad/credted wth respect to the contract durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Nature of Name and Date snce Income Nature of Income taxable and offered n ths return Name and entty Address of held accrued from Income code the Entty such Interest Nature of Interest- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Address of Ownershp- Date of Total Investment Income Nature of Income taxable and offered n ths return Name and the Property Drect/ acquston (at cost) (n derved from Income Amount Schedule where Item number of code Benefcal rupees) the property offered schedule owner/ Benefcary (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Nature of Ownershp- Date of Total Investment Income Nature of Income taxable and offered n ths return Name and code Asset Drect/ Benefcal acquston (at cost) (n rupees) derved from the asset Income Amount Schedule where offered Item number of schedule owner/ Benefcary (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detals of account(s) n whch you have sgnng authorty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod and whch has not been ncluded n A to D above. Sl No Name of the Address of Name of Account Peak Balance/ Whether ncome If (7) s If (7) s yes, Income offered n ths return Insttuton n the the account Number Investment accrued s yes, whch the account Insttuton s held holder durng the year (n rupees) taxable n your hands? Income accrued n the account Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl No Country Name and Name and Name and Name and Date Whether If (8) s yes, If (8) s yes, Income offered n ths return Name and address of address of address of address of snce ncome Income Amount Schedule Item number of code the trust trustees Settlor Benefcares poston derved s derved from where offered schedule held taxable n the trust your hands? (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () ()

112 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 361 Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head G busness or professon If (6) s yes, Income offered n ths return Country Name Name and address of the Whether taxable Sl No Income derved Nature of ncome and code person from whom derved n your hands? Amount Schedule Item number of where offered schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule. Schedule GST DETAILS OF GST INFORMATION REGARDING TURNOVER/GROSS RECEIPT REPORTED FOR GST Sl. No. GSTIN No(s). Annual value of outward supples as per the GST return(s) fled (1) (2) (3) NOTE Please furnsh the nformaton above for each GSTIN No. separately PART-B Part B - TI Computaton of total ncome 1 Income from house property ( 4 of Schedule-HP) (enter nl f loss) 1 2 Profts and gans from busness or professon Profts and gans from busness other than speculatve busness and 2 specfed busness (A38 of Schedule BP)(enter nl f loss) Profts and gans from speculatve busness (B43 of Schedule BP) (enter 2 nl f loss and carry ths fgure to Schedule CFL) Profts and gans from specfed busness (C49 of Schedule BP) (enter nl 2 f loss and carry ths fgure to Schedule CFL) v Income chargeable to tax at specal rate (3d and 3e of Schedule BP) 2v v Total ( v) (enter nl, f loss and carry ths fgure of loss to Schedule CYLA) 2v 3 Captal gans a Short term Short-term 15% (9 of tem E of schedule CG) a Short-term 30% (9 of tem E of schedule CG) a Short-term chargeable at applcable rate (9v of tem E of schedule CG) a Short-term chargeable at specal rates n Inda as per DTAA (9v v of tem E of Schedule CG) av v Total Short-term (a + a + a + av) (enter nl f loss) 3av b Long-term Long-term 10% (9v of tem E of Schedule CG) b Long-term 20% (9v of tem E of Schedule CG) b Long-term chargeable at specal rates n Inda as per DTAA (9v of tem E of schedule CG) b v Total Long-term (b + b + b) (enter nl f loss) bv c Total captal gans (3av + 3bv) (enter nl f loss) 3c 4 Income from other sources a Net ncome from other sources chargeable to tax at normal 4a applcable rates ( 6 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate (2 of Schedule OS) 4b c Income from the actvty of ownng and mantanng race horses (8e 4c of Schedule OS) (enter nl f loss) d Total (4a + 4b + 4c) 4d 5 Total of head wse ncome (1 + 2v + 3c +4d) 5 6 Losses of current year to be set off aganst 5 (total of 2xv, 3xv and 4xv of Schedule CYLA) 6 7 Balance after set off of current year losses (5 6) (total of column 5 of schedule CYLA + 4b + 2v) 7 8 Brought forward losses to be set off aganst 7 (total of 2xv, 3xv and 4xv of Schedule BFLA) 8 9 Gross Total ncome (7 8)(also 5xv of Schedule BFLA + 4b + 2v) 9 10 Income chargeable to tax at specal rate under secton 111A, 112, 112A etc. ncluded n Deductons under Chapter VI-A TOTAL INCOME a Part-B of Chapter VI-A [1 of Schedule VI-A and lmted upto (9-10)] 11a b Part-C of Chapter VI-A [2 of Schedule VI-A and lmted upto (9-10-2)] 11b c Total (11a + 11b) [lmted upto (9-10)] 11c 12 Incomes not formng part of total ncome (12a + 12b+ 12c) 12 a Deducton u/s 10AA (c of Sch. 10AA) 12a b Income of nvestment fund referred to n secton 10(23FB) or 10(23FBA) 12b c Income of a busness trust referred to n secton 10(23FC) or 10(23FCA) 12c 13 Total ncome (9-11c - 12) 13

113 362 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 14 Income chargeable to tax at specal rates (total of () of schedule SI) Net agrcultural ncome/ any other ncome for rate purpose (3 of Schedule EI) Aggregate ncome ( ) [applcable f (13-14) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of x of Schedule CFL) Deemed total ncome under secton 115JC (3 of Schedule AMT) 18 Part B - TTI Computaton of tax lablty on total ncome 1 1a a Tax payable on deemed total ncome under secton 115JC (4 of Schedule AMT) COMPUTATION OF TAX LIABILITY TAXES PAID AND BANK DETAILS BANK ACCOUNT b Surcharge on (a) above (f applcable) 1b c Health and Educaton 4% on 1a+1b above 1c d Total Tax Payable on deemed total ncome (1a+1b+1c) 1d 2 Tax payable on total ncome a Tax at normal rates on 16 of Part B-TI 2a b Tax at specal rates (total of col. () of Schedule-SI) 2b c Rebate on agrcultural ncome [applcable f (13-14) of Part B- 2c TI exceeds maxmum amount not chargeable to tax] d Tax Payable on total ncome (2a+2b -2c)) 2d e Surcharge 25% of 12() of Schedule SI 2e 2g() On [(2d) (12() of Schedule SI)] 2e Total ( + ) 2e f Health and Educaton 4% on 2d+2e 2f g Gross tax lablty (2d + 2e + 2f) 2g 3 Gross tax payable (hgher of 1d or 2g) 3 4 Credt under secton 115JD of tax pad n earler years (applcable f 2g s more than 1d) (5 of Schedule AMTC) 4 5 Tax payable after credt under secton 115JD (3-4) 5 6 Tax relef a Secton 90/90A (2 of Schedule TR) 6a b Secton 91(3 of Schedule TR) 6b c Total (6a + 6b) 6c 7 Net tax lablty (5 6c) (enter zero, f negatve) 7 8 Interest and fee payable a Interest for default n furnshng the return (secton 234A) 8a b Interest for default n payment of advance tax (secton 234B) 8b c Interest for deferment of advance tax (secton 234C) 8c d Fee for default n furnshng return of ncome (secton 234F) 8d e Total Interest and Fee Payable (8a+8b+8c+8d) 8e 9 Aggregate lablty (7 + 8e) 9 10 Taxes Pad a Advance Tax (from column 5 of 115A) 10a b TDS (total of column 9 of15b) 10b c TCS (total of column 7 of 15C) 10c d Self-Assessment Tax (from column 5 of 15A) 10d e Total Taxes Pad (10a+10b+10c+10d) 10e 11 Amount payable (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (refund, f any, wll be drectly credted nto the bank account) 12 Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) (In case of non-resdents, detals of any 13 one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bank n case of Bank Accounts Name of the Bank Account Number Indcate the account n held n Inda (SWIFT Code n case of foregn (IBAN n case of foregn Bank whch you prefer to get your Bank Account) Accounts) refund credted, f any (tck one account ) 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or Yes No () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] 15 TAX PAYMENTS

114 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 363 A ADVANCE/ SELF ASSESSMENT TAX Detals of payments of Advance Tax and Self-Assessment Tax Sl No BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) (1) (2) (3) (4) (5) NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI B Sl No Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued or Form 16B/16C furnshed by Deductor(s)] TDS credt relatng to self Unclamed TDS of the current TDS credt beng clamed ths /other person [spouse as TDS brought Fn. Year Year (only f correspondng per secton 5A/other person forward (b/f) ncome s beng offered for tax as per rule 37BA(2)] ths year) PAN of Other Person (f TDS credt related to other person) TAN of the Deductor/ PAN of Tenant/ Buyer Fn. TDS Year n b/f whch deducted Deducted n own hands Deducted n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) VERIFICATION Clamed n own hands Clamed n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) Correspondng Income offered Gross Amount Head of Income TDS credt beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Income TDS Income TDS PAN NOTE Please enter total of column 9 n10b of Part B- TTI C Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Name of the Collector Unclamed TCS brought Tax Collecton forward (b/f) Account Number of Amount the Collector b/f TCS ON INCOME Fn. Year n whch collected TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) n 10c of Part B-TTI Amount out of (5) or (6) beng carred forward I, (full name n block letters), son/ daughter of, solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and the schedules thereto s correct and complete s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng ths return n my capacty as (drop down to be provded) and I am also competent to make ths return and verfy t. I am holdng permanent account number (f allotted) (Please see nstructon) I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Date Sgn here

115 364 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-6 INDIAN INCOME TAX RETURN [For Companes other than companes clamng exempton under secton 11] (Please see rule 12 of the Income-tax Rules,1962) (Please refer nstructons) Assessment Year Part A-GEN Name GENERAL PAN Is there any change n the company s name? If yes, please furnsh the old name Corporate Identty Number (CIN) ssued by MCA PERSONAL INFORMATION Flat/Door/Block No Name of Premses/Buldng/Vllage Date of ncorporaton (DD/MM/YYYY) Date of commencement of busness (DD/MM/YYYY) / / / / Road/Street/Post Offce Area/Localty Type of company (Tck any one) () Domestc Company () Foregn Company Town/Cty/Dstrct State Pn code/zp code If a publc company wrte 6, and f prvate company wrte 7 (as Country defned n secton 3 of The Companes Act) Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Emal Address-1 Emal Address-2 (a) Fled u/s (Tck)[Please see nstructon ] (b) (c) Or fled n response to notce u/s If revsed/ defectve/modfed, then enter Recept No and Date of flng orgnal return (DD/MM/YYYY) 139(1)- On or Before due date, 139(4)- After due date, 139(5)- Revsed Return, 92CD-Modfed return, 119(2)(b)- after condonaton of delay 139(9), 142(1), 148, 153A, 153C If fled, n response to notce u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b), enter date of such notce/order, or f fled u/s 92CD enter date of advance prcng agreement (d) Resdental Status (Tck) Resdent Non-Resdent / / / / FILING STATUS (e) (f) (g) Whether optng for secton 115BA? (Yes/No) (applcable on Domestc Company) Whether total turnover/ gross recepts n the prevous year exceeds 250 crore rupees? Domestc Company) (Yes/No) (applcable for Whether assessee s a resdent of a country or specfed terrtory wth whch Inda has an agreement referred to n sec 90 (1) or Central Government has adopted any agreement under sec 90A(1)? (h) In the case of non-resdent, s there a Permanent Establshment (PE) n Inda (Tck) Yes No () (j) (k) Whether assessee s requred to seek regstraton under any law for the tme beng n force relatng to companes? Whether the fnancal statements of the company are drawn up n complance to the Indan Accountng Standards specfed n Annexure to the companes (Indan Accountng Standards) Rules, 2015 (Tck) Yes No Whether assessee s located n an Internatonal Fnancal Servces Centre and derves ncome solely n convertble foregn exchange? (Tck) Yes No (l) Whether the assessee company s under lqudaton (Tck) Yes No (m) Whether you are an FII / FPI? Yes/No (n) (o) If yes, please provde SEBI Regn. No. Whether the company s a producer company as defned n Sec.581A of Companes Act, 1956? No Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve assessee Yes

116 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 365 (2) Capacty of the Representatve (drop down to be provded) (3) Address of the representatve assessee AUDIT INFORMATION (4) Permanent Account Number (PAN) of the representatve assessee (p) Whether you are recognzed as start up by DPIIT Yes No 1 If yes, please provde start up recognton number allotted by the DPIIT 2 Whether certfcate from nter-mnsteral board for certfcaton s receved? Yes No 3 If yes provde the certfcaton number 4 Whether declaraton n Form-2 n accordance wth para 5 of DPIIT notfcaton dated 19/02/2019 has been fled before flng of the return? 5 If yes, provde date of flng Form-2 (a) Whether lable to mantan accounts as per secton 44AA? (Tck) Yes No (b) Whether lable for audt under secton 44AB? (Tck) Yes No (c) Yes If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton below (1) Menton the date of furnshng of audt report (DD/MM/YYYY) (2) Name of the audtor sgnng the tax audt report (3) Membershp No. of the audtor (4) Name of the audtor (propretorshp/ frm) (5) Propretorshp/frm regstraton number (6) Permanent Account Number (PAN) of the audtor (propretorshp/ frm) (7) Date of audt report No (d) Are you lable for Audt u/s 92E? Yes No Date of furnshng audt report? DD/MM/YYYY (d) If lable to furnsh other audt report under the Income-tax Act, menton the date of furnshng the audt report? (DD/MM/YY) (Please see Instructon 5()) Sl. No. Secton Code Date (DD/MM/YYYY) HOLDING STATUS (e) (a) (b) (c) Menton the Act, secton and date of furnshng the audt report under any Act other than the Income-tax Act Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) Nature of company (select 1 f holdng company, select 2 f a subsdary company, select 3 f both, select 4 f any other) If subsdary company, menton the detals of the Holdng Company PAN Name of Holdng Company Address of Holdng Company Percentage of Shares held If holdng company, menton the detals of the subsdary companes PAN Name of Subsdary Company Address of Subsdary Company Percentage of Shares held (a) In case of amalgamatng company, menton the detals of amalgamated company BUSINESS ORGANISATION (b) PAN Name of Amalgamated Company Address of Amalgamated Company In case of amalgamated company, menton the detals of amalgamatng company PAN Name of Amalgamatng Company Address of Amalgamatng Company Date of Amalgamaton Date of Amalgamaton

117 366 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] (c) In case of demerged company, menton the detals of resultng company Address of Resultng Company PAN Name of Resultng Company Date of Demerger (d) In case of resultng company, menton the detals of demerged company Address of Demerged Company PAN Name of Demerged Company Date of Demerger K E Y Partculars of Managng Drector, Drectors, Secretary and Prncpal offcer(s) who have held the offce durng the prevous year S.No. Name Desgnaton Resdental Address PAN Drector Identfcaton Number (DIN) ssued by MCA, n case of Drector SHAREHOLDERS INFORMATION Partculars of persons who were benefcal owners of shares holdng not less than 10% of the votng power at any tme of the prevous year S.No. Name and Address Percentage of shares held PAN (f allotted) In case of unlsted company, partculars of natural persons who were the ultmate benefcal owners, drectly or ndrectly, of shares holdng not less than 10% of the votng power at any tme of the prevous year S.No. Name Address Percentage of shares held PAN (f allotted) OWNERSHIP INFORMATION In case of Foregn company, please furnsh the detals of mmedate parent company. S.No Name Address Country of resdence In case of foregn company, please furnsh the detals of ultmate parent company S.No Name Address Country of resdence PAN (f allotted) PAN (f allotted) Taxpayer s regstraton number or any unque dentfcaton number allotted n the country of resdence Taxpayer s regstraton number or any unque dentfcaton number allotted n the country of resdence NATURE OF COMPANY AND ITS BUSINESS Nature of company (Tck) 1 Whether a publc sector company as defned n secton 2(36A) of the Income-tax Act Yes No 2 Whether a company owned by the Reserve Bank of Inda Yes No Whether a company n whch not less than forty percent of the shares are held (whether sngly or taken together) by the Government or the Reserve Bank of Inda or a corporaton owned by that Bank Whether a bankng company as defned n clause (c) of secton 5 of the Bankng Regulaton Act,1949 Whether a scheduled Bank beng a bank ncluded n the Second Schedule to the Reserve Bank of Inda Act Yes Yes Yes No No No

118 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Whether a company regstered wth Insurance Regulatory and Development Authorty (establshed under sub-secton (1) of secton 3 of the Insurance Regulatory and Development Authorty Act, 1999) Yes No 7 Whether a company beng a non-bankng Fnancal Insttuton Yes No 8 Whether the company s unlsted? If yes, please ensure to fll up the Schedule SH-1 and Schedule AL-1 Yes No Nature of busness or professon, f more than one busness or professon ndcate the three man actvtes/ products (Other than those declarng ncome under secton 44AE) S.No. Code [Please see nstructon No.7()] Descrpton () () () I Part A-BS EQUITY AND LIABILITIES Equty and Labltes 1 Shareholder s fund A B Share captal BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2019 OR AS ON THE DATE OF AMALGAMATION Authorsed A Issued, Subscrbed and fully Pad up Subscrbed but not fully pad v Total (A + A) Reserves and Surplus Captal Reserve B Captal Redempton Reserve Securtes Premum Reserve v Debenture Redempton Reserve v Revaluaton Reserve v Share optons outstandng amount v v Other reserve (specfy nature and amount) a b c Total (va + vb) A A B B Bv Bv Bv va vb Bv Surplus.e. Balance n proft and loss account (Debt balance Bv to be shown as ve fgure) x Total (B + B + B + Bv + Bv + Bv + Bv + Bv) (Debt balance to be shown as ve fgure) C Money receved aganst share warrants D Total Shareholder s fund (Av + Bx + 1C) 2 Share applcaton money pendng allotment Pendng for less than one year Pendng for more than one year Total ( + ) 2 3 Non-current labltes A Long-term borrowngs Bonds/ debentures a Foregn currency a b Rupee b c Total (a + b) c Term loans a Foregn currency a Av Bx 1C 1D

119 368 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b Rupee loans 1 From Banks b1 2 From others b2 3 Total (b1 + b2) b3 c Total Term loans (a + b3) c Deferred payment labltes v Deposts from related partes (see nstructons) v v Other deposts v v Loans and advances from related partes (see nstructons) v v Other loans and advances v v Long term maturtes of fnance lease oblgatons v x Total Long term borrowngs (c + c + + v + v + v + v + v) 3A B Deferred tax labltes (net) 3B C Other long-term labltes Trade payables Others Total Other long-term labltes ( + ) 3C D Long-term provsons Provson for employee benefts Others Total ( + ) 3D E Total Non-current labltes (3A + 3B + 3C + 3D) 3E 4 Current labltes A Short-term borrowngs Loans repayable on demand a From Banks a b From Non-Bankng Fnance Companes b c From other fnancal nsttutons c d From others d e Total Loans repayable on demand (a + b + c + d) Deposts from related partes (see nstructons) Loans and advances from related partes (see nstructons) v Other loans and advances v Other deposts v Total Short-term borrowngs (e v + v) B Trade payables Outstandng for more than 1 year Others Total Trade payables ( + ) e v v 4A 4B C Other current labltes Current maturtes of long-term debt Current maturtes of fnance lease oblgatons Interest accrued but not due on borrowngs v Interest accrued and due on borrowngs v v Income receved n advance v v Unpad dvdends v

120 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 369 D v Applcaton money receved for allotment of securtes and due for refund and nterest accrued v Unpad matured deposts and nterest accrued thereon x Unpad matured debentures and nterest accrued thereon x Other payables x Total Other current labltes ( v + v + v + v + v + x + x) Short-term provsons Provson for employee beneft Provson for Income-tax Proposed Dvdend v Tax on dvdend v Other v Total Short-term provsons ( v + v) E Total Current labltes (4A + 4B + 4C + 4D) Total Equty and labltes (1D E + 4E) v v x x v v 4C 4D 4E I II ASSETS 1 Non-current assets A Fxed assets Tangble assets a Gross block a b Deprecaton b c Imparment losses c d Net block (a b - c) d Intangble assets a Gross block a b Amortzaton b c Imparment losses c d Net block (a b - c) d Captal work-n-progress v Intangble assets under development v v Total Fxed assets (d + d + + v) Av B Non-current nvestments Investment n property Investments n Equty nstruments a Lsted equtes a b Unlsted equtes b c Total (a + b) c Investments n Preference shares v Investments n Government or trust securtes v v Investments n Debenture or bonds v v Investments n Mutual funds v v Investments n Partnershp frms v v Others Investments v x Total Non-current nvestments ( + c + + v + v + v + v + v) Bx C Deferred tax assets (Net) C

121 370 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] D Long-term loans and advances Captal advances Securty deposts Loans and advances to related partes (see nstructons) v Other Loans and advances v v Total Long-term loans and advances ( v) v Long-term loans and advances ncluded n Dv whch s Dv a for the purpose of busness or professon va b c not for the purpose of busness or professon gven to shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act E Other non-current assets Long-term trade recevables Others a Secured, consdered good b Unsecured, consdered good c Doubtful d Total Other non-current assets (a + b + c) Total (d + ) v Non-current assets ncluded n E whch s due from shareholder, beng the benefcal owner of share, or from any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act F Total Non-current assets (Av + Bx + C + Dv + E) 2 Current assets A B C Current nvestments Investment n Equty nstruments a Lsted equtes b Unlsted equtes c Total (a + b) Investment n Preference shares Investment n government or trust securtes v Investment n debentures or bonds v Investment n Mutual funds v Investment n partnershp frms v Other nvestment v Total Current nvestments (c v + v + v + v) Inventores Raw materals Work-n-progress Fnshed goods v Stock-n-trade (n respect of goods acqured for tradng) v v Stores and spares v v Loose tools v v Others v Total Inventores ( v + v + v + v) Trade recevables vb vc a b c d v a b c v v v v v E 1F Av Bv

122 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 371 D E Outstandng for more than 6 months Others Total Trade recevables ( + + ) C Cash and cash equvalents Balances wth Banks Cheques, drafts n hand Cash n hand v Others v v Total Cash and cash equvalents ( v) Dv Short-term loans and advances Loans and advances to related partes (see nstructons) Others Total Short-term loans and advances ( + ) E v Short-term loans and advances ncluded n E whch s a for the purpose of busness or professon va b not for the purpose of busness or professon vb c gven to a shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act vc F Other current assets F G Total Current assets (Av + Bv + C + Dv + E + F) 2G Total Assets (1F + 2G) II Part A-BS Ind AS I Equty and Labltes 1 Equty BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2019 OR AS ON THE DATE OF BUSINESS COMBINATION [applcable for a company whose fnancal statements are drawn up n complance to the Indan Accountng Standards specfed n Annexure to the companes (Indan Accountng Standards) Rules, 2015] (fll tems below n a case where regular books of accounts are mantaned, otherwse fll tem III) A Equty share captal Authorsed A Issued, Subscrbed and fully pad up Subscrbed but not fully pad v Total (A + A) B Other Equty Other Reserves a Captal Redempton Reserve b Debenture Redempton Reserve c Share Optons Outstandng account d Other (specfy nature and amount) e Total other reserves (a + b + c + d) Retaned earnngs (Debt balance of statement of P&L to be shown as ve fgure) Total (Be + ) (Debt balance to be shown as ve fgure) C Total Equty (Av + B) 2 Labltes A Non-current labltes I Fnancal Labltes Borrowngs A A a b c d e Av B 1C

123 372 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] a Bonds or debentures 1 Foregn currency a1 2 Rupee a2 3 Total (1 + 2) a3 b Term loans 1 Foregn currency b1 2 Rupee loans From Banks From other partes Total ( + ) b2 3 Total Term loans (b1 + b2) b3 c Deferred payment labltes c d Deposts d e Loans from related partes (see nstructons) e f Long term maturtes of fnance lease oblgatons f g Lablty component of compound fnancal nstruments g h Other loans h Total borrowngs (a3 + b3 + c + d + e + f + g + h) j Trade Payables j k Other fnancal labltes (Other than those specfed n II under provsons) k II Provsons a Provson for employee benefts a b Others (specfy nature) b c Total Provsons IIc III Deferred tax labltes (net) III IV Other non-current labltes a Advances a b Others (specfy nature) b c Total Other non-current labltes IVc Total Non-Current Labltes (I + Ij + Ik + IIC + III + IVc) 2A B Current labltes I Fnancal Labltes Borrowngs a Loans repayable on demand 1 From Banks 1 2 From Other partes 2 3 Total Loans repayable on demand (1 + 2) 3 b Loans from related partes b c Deposts c d Other loans (specfy nature) d Total Borrowngs (a3 + b + c + d) I Trade payables I Other fnancal labltes a Current maturtes of long-term debt a b Current maturtes of fnance lease oblgatons b c Interest accrued c d Unpad dvdends d

124 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 373 II e Applcaton money receved for allotment of securtes to the extent refundable and nterest accrued thereon f Unpad matured deposts and nterest accrued thereon g Unpad matured debentures and nterest accrued thereon h Others (specfy nature) Total Other fnancal labltes (a + b +c +d +e +f +g+ h) v Total Fnancal Labltes (I + I + I) II Other Current labltes III Provsons a Revenue receved n advance b Other advances (specfy nature) c Others (specfy nature) d Total Other current labltes (a + b+ c) a Provson for employee benefts b Others (specfy nature) c Total provsons (a + b) IV Current Tax Labltes (Net) Total Current labltes (Iv + IId + IIIc+ IV) Total Equty and labltes (1C + 2A +2B) ASSETS 1 Non-current assets A Property, Plant and Equpment a Gross block b Deprecaton c Imparment losses d Net block (a b - c) B Captal work-n-progress C Investment Property a Gross block b Deprecaton e f g h a b c a b a b c a b I Iv IId IIIc IV 2B I Ad B c Imparment losses c d Net block (a b - c) D Goodwll a Gross block b Imparment losses c Net block (a b ) E Other Intangble Assets a Gross block b Amortsaton c Imparment losses d Net block (a b - c) F Intangble assets under development G Bologcal assets other than bearer plants a Gross block b Imparment losses a b a b c a b Cd Dc Ed F

125 374 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c Net block (a b ) H Fnancal Assets I Investments Investments n Equty nstruments a Lsted equtes b Unlsted equtes c Total (a + b) Investments n Preference shares Investments n Government or trust securtes v Investments n Debenture or bonds v Investments n Mutual funds v Investments n Partnershp frms v Others Investments (specfy nature) v Total non-current nvestments (c v + v + v + v) II Trade Recevables III Loans IV a Secured, consdered good b Unsecured, consdered good c Doubtful d Total Trade recevables Securty deposts Loans to related partes (see nstructons) Other loans (specfy nature) v Total Loans ( + + ) v Loans ncluded n HIII above whch s- a for the purpose of busness or professon b not for the purpose of busness or professon c gven to shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act Other Fnancal Assets Bank Deposts wth more than 12 months maturty Others Total of Other Fnancal Assets ( + ) I Deferred Tax Assets (Net) J Other non-current Assets Captal Advances Advances other than captal advances Others (specfy nature) v Total non-current assets ( + + ) v Non-current assets ncluded n J above whch s due from shareholder, beng the benefcal owner of share, or from any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act Total Non-current assets (Ad + B + Cd + Dc + Ed + F + Gc + HI + HII + HIII + HIV + I + J) 1 2 Current assets A Inventores Raw materals Work-n-progress a b v v v v a b c va vb vc v Gc c HI HII HIII HIV I J

126 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 375 B I II Fnshed goods v Stock-n-trade (n respect of goods acqured for tradng) v v Stores and spares v v Loose tools v v Others v Total Inventores ( v + v + v + v) Fnancal Assets Investments Investment n Equty nstruments a Lsted equtes b Unlsted equtes c Total (a + b) Investment n Preference shares Investment n government or trust securtes v Investment n debentures or bonds v Investment n Mutual funds v Investment n partnershp frms v Other Investments v Total Current nvestments (c v + v + v + v) Trade recevables Secured, consdered good Unsecured, consdered good Doubtful v Total Trade recevables ( + + ) II III Cash and cash equvalents Balances wth Banks (of the nature of cash and cash equvalents) Cheques, drafts n hand Cash on hand v Others (specfy nature) v v Total Cash and cash equvalents ( v) III IV Bank Balances other than III above V Loans Securty Deposts Loans to related partes (see nstructons) Others(specfy nature) v Total loans ( + + ) V v Loans and advances ncluded n V above whch s- a for the purpose of busness or professon b not for the purpose of busness or professon c VI Other Fnancal Assets gven to a shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act Total Fnancal Assets (I + II + III + IV + V + VI) C Current Tax Assets (Net) 2C D Other current assets Advances other than captal advances v va vb vc a b c v v v v 2A I IV VI 2B

127 376 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] III NO ACCOUNT CASE Others(specfy nature) Total Total Current assets (2A + 2B + 2C + 2D) 2 Total Assets (1 + 2) In a case where regular books of account of busness or professon are not mantaned - (furnsh the followng nformaton as on 31 st day of March, 2019, n respect of busness or professon) a Amount of total sundry debtors b Amount of total sundry credtors c Amount of total stock-n-trade d Amount of the cash balance 2D II IIIa IIIb IIIc IIId Part A- Manufacturng Account 1 Openng Inventory A Manufacturng Account for the fnancal year (fll tems 1 to 3 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) Openng stock of raw-materal Openng stock of Work n progress Total ( + ) B Purchases (net of refunds and duty or tax, f any) C Drect wages D Drect expenses (D + D + D) Carrage nward Power and fuel Other drect expenses E Factory Overheads I Indrect wages I Factory rent and rates I Factory Insurance Iv Factory fuel and power V Factory general expenses V Deprecaton of factory machnery V Total (+++v+v+v) F Total of Debts to Manufacturng Account (A+B+C+D+Ev) 2 Closng Stock Raw materal Work-n-progress Total (2 +2) 2 3 Cost of Goods Produced transferred to Tradng Account (1F - 2) 3 v v v 2 2 A B C D Ev 1F Part A-Tradng Account CREDITS TO TRADING ACCOUNT Tradng Account for the fnancal year (fll tems 4 to 12 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 4 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a a

128 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 377 DEBITS TO TRADING ACCOUNT b c Total (a + b) v Total ( + + c) B Gross recepts from Professon C Dutes, taxes and cess receved or recevable n respect of goods and servces sold or suppled Unon Excse dutes Servce tax VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) v Integrated Goods & Servces Tax (IGST) v Unon Terrtory Goods & Servces Tax (UTGST) v Any other duty, tax and cess x Total ( v +v+ v+v+v) D Total Revenue from operatons (Av + B +Cx) 5 Closng Stock of Fnshed Stocks 5 6 Total of credts to Tradng Account (4D + 5v ) 6 7 Openng Stock of Fnshed Goods 7 8 Purchases (net of refunds and duty or tax, f any) 8 9 Drect Expenses ( ) 9 Carrage nward Power and fuel Other drect expenses Note: Row can be added as per the nature of Drect Expenses 10 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty v Unon excse duty v Servce tax v VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) x Integrated Goods & Servces Tax (IGST) x Unon Terrtory Goods & Servces Tax (UTGST) x Any other tax, pad or payable b c v v v v v v 10v 10v 10v 10v x Total ( v + 10v + 10v + 10v + 10v + 10x + 10x + 10x) 11 Cost of goods produced Transferred from Manufacturng Account Gross Proft from Busness/Professon - transferred to Proft and Loss account ( x- 11) 12a Turnover from Intraday Tradng 12b Income from Intraday Tradng 10x 10x 10x Av B Cx 4D 10x 12 12a 12b

129 378 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Part A-P& L CREDITS TO PROFIT AND LOSS ACCOUNT DEBITS TO PROFIT AND LOSS ACCOUNT Proft and Loss Account for the fnancal year (fll tems 13 to 60 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 13 Gross proft transferred from Tradng Account Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sale of fxed assets v v Proft on sale of nvestment beng securtes chargeable to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Gan (loss) on account of foregn exchange fluctuaton u/s 43AA x Proft on converson of nventory nto captal asset u/s 28(va) (Far Market Value of nventory as on the date of converson) x Agrcultural ncome x x Any other ncome (specfy nature and amount) a b c Total (xa + xb) xc x Total of other ncome ( v + v + v + v + v + x + x + xc) 14x 15 Total of credts to proft and loss account (13+14x) Freght outward Consumpton of stores and spare parts Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages 22 Bonus 22 Rembursement of medcal expenses 22 v Leave encashment 22v v Leave travel benefts 22v v Contrbuton to approved superannuaton fund 22v v Contrbuton to recognsed provdent fund 22v v Contrbuton to recognsed gratuty fund 22v x Contrbuton to any other fund 22x x Any other beneft to employees n respect of whch an expendture has been ncurred x Total compensaton to employees (total of 22 to 22x) 22x xa Whether any compensaton, ncluded n 22x, pad to non-resdents xa Yes / No xb If Yes, amount pad to non-resdents 23 Insurance Medcal Insurance 23 Lfe Insurance 23 Keyman s Insurance 23 v Other Insurance ncludng factory, offce, car, goods, etc. 23v v Total expendture on nsurance ( v) 23v v v x xa xb 22x xb

130 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson 31 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 30 Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty 44 Servce tax 44 VAT/ Sales tax 44 v Cess 44v v Central Goods & Servce Tax (CGST) 44v v State Goods & Servces Tax (SGST) 44v v Integrated Goods & Servces Tax (IGST) 44v v Unon Terrtory Goods & Servces Tax (UTGST) 44v x Any other rate, tax, duty or cess ncl STT and CTT 44x x Total rates and taxes pad or payable ( v + 44v + 44v + 44v + 44v +44x) 44x 45 Audt fee Other expenses (specfy nature and amount) Total ( + ) 46

131 380 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 47 Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s clamed and amount) v Rows can be added as requred 47v v Others (more than Rs. 1 lakh) where PAN s not avalable (provde name and complete address) 47v v Others (amounts less than Rs. 1 lakh) 47v v Total Bad Debt ( v + 47v+ 47v) 47v 48 Provson for bad and doubtful debts Other provsons Proft before nterest, deprecaton and taxes [15 (16 to x + 23v + 24 to to x v )] 51 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 52 Deprecaton and amortsaton Net proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Appropratons PROVISIONS PROVISION FOR TAX AND APPROPRIATIONS Transfer to reserves and surplus 59 Proposed dvdend/ Interm dvdend Tax on dvdend/ Tax on dvdend for earler years v Appropraton towards Corporate Socal Responsblty (CSR) actvtes (n case of companes covered under secton 135 of Companes Act, 2013) v Any other appropraton v Total ( v+59v) 60 Balance carred to balance sheet (58-59v) COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE SR. NO. Regstraton No. of goods carrage Name of Busness Busness code Descrpton Whether owned/leased/ hred Tonnage capacty of goods carrage (n MT) v 59v 59v Number of months for whch goods carrage was owned/leased/hred by assessee Presumptve ncome u/s 44AE for the goods carrage Rs.1000 per ton per month n case tonnage exceeds 12MT, or Rs.7500 per month) or the amount clamed to have been actually earned, whchever s hgher () (1) (2) (3) (4) (5) (a) (b)

132 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 381 NO ACCOUNT CASE Add row optons as necessary (upto maxmum 10) () Total presumptve ncome from goods carrage u/s 44AE [total of column (5) of table 61()] NOTE If the profts are lower than prescrbed under S.44AE or the number of goods carrage owned / leased / hred at any tme durng the year exceeds 10, then, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 62 In case of Foregn Company whose total ncome comprses solely of profts and gans from busness referred to n sectons 44B, 44BB, 44BBA or 44BBB, furnsh the followng nformaton a Gross recepts / Turnover b Net proft 61() 62a 62b Part A- Manufacturng Account Ind-AS 1 Openng Inventory A Manufacturng Account for the fnancal year [applcable for a company whose fnancal statements are drawn up n complance to the Indan Accountng Standards specfed n Annexure to the companes (Indan Accountng Standards) Rules, 2015] (fll tems 1 to 3 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) Openng stock of raw-materal Openng stock of Work n progress Total ( + ) B Purchases (net of refunds and duty or tax, f any) C Drect wages D Drect expenses Carrage nward Power and fuel Other drect expenses E Factory Overheads I Indrect wages I Factory rent and rates I Factory Insurance Iv Factory fuel and power V Factory general expenses V Deprecaton of factory machnery V Total (+++v+v+v) F Total of Debts to Manufacturng Account (A+B+C+D+Ev) 2 Closng Stock Raw materal Work-n-progress Total (2 +2) 2 3 Cost of Goods Produced transferred to Tradng Account (1F - 2) A B C D Ev 1F Part A-Tradng Account Ind-AS CREDITS TO TRADING ACCOUNT Tradng Account for the fnancal year [applcable for a company whose fnancal statements are drawn up n complance to the Indan Accountng Standards specfed n Annexure to the companes (Indan Accountng Standards) Rules, 2015] (fll tems 4 to 12 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 4 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a b c Total (a + b) a b c

133 382 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] DEBITS TO TRADING ACCOUNT v Total ( + + c) B Gross recepts from Professon C Dutes, taxes and cess receved or recevable n respect of goods and servces sold or suppled Unon Excse dutes Servce tax VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) v Integrated Goods & Servces Tax (IGST) v Unon Terrtory Goods & Servces Tax (UTGST) v Any other duty, tax and cess x Total ( v +v+ v+v+v) D Total Revenue from operatons (Av + B +Cx) 5 Closng Stock of Fnshed Stocks 5 6 Total of credts to Tradng Account (4D + 5v ) 6 7 Openng Stock of Fnshed Goods 7 8 Purchases (net of refunds and duty or tax, f any) 8 9 Drect Expenses ( ) 9 Carrage nward Power and fuel Other drect expenses Note: Row can be added as per the nature of Drect Expenses 10 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty v Unon excse duty v Servce tax v VAT/ Sales tax v Central Goods & Servce Tax (CGST) v State Goods & Servces Tax (SGST) x Integrated Goods & Servces Tax (IGST) x Unon Terrtory Goods & Servces Tax (UTGST) x Any other tax, pad or payable v v v v v v 10v 10v 10v 10v x Total ( v + 10v + 10v + 10v + 10v + 10x + 10x + 10x) 11 Cost of goods produced Transferred from Manufacturng Account Gross Proft from Busness/Professon - transferred to Proft and Loss account ( x- 11) 12a Turnover from Intraday Tradng 12b Income from Intraday Tradng 10x 10x 10x Av B Cx 4D 10x 12 12a 12b

134 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 383 Part A-P& L Ind-AS CREDITS TO PROFIT AND LOSS ACCOUNT Proft and Loss Account for the fnancal year [applcable for a company whose fnancal statements are drawn up n complance to the Indan Accountng Standards specfed n Annexure to the companes (Indan Accountng Standards) Rules, 2015] (fll tems 13 to 60 n a case where regular books of accounts are mantaned, otherwse fll tems 61 to 64 as applcable) 13 Gross proft transferred from Tradng Account 14 Other ncome Rent Commsson Dvdend ncome v Interest ncome v v Proft on sale of fxed assets v v Proft on sale of nvestment beng securtes chargeable to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Gan (loss) on account of foregn exchange fluctuaton u/s 43AA x Proft on converson of nventory nto captal asset u/s 28(va) (Far Market Value of nventory as on the date of converson) x Agrcultural ncome x x Any other ncome (specfy nature and amount) a b c Total (xa + xb) xc x Total of other ncome ( v + v + v + v + v + x + x + xc) 14x 15 Total of credts to proft and loss account (13+14x) Freght outward Consumpton of stores and spare parts Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages 22 Bonus 22 Rembursement of medcal expenses 22 v Leave encashment 22v v Leave travel benefts 22v v Contrbuton to approved superannuaton fund 22v v Contrbuton to recognsed provdent fund 22v v Contrbuton to recognsed gratuty fund 22v x Contrbuton to any other fund 22x x Any other beneft to employees n respect of whch an expendture has been ncurred x Total compensaton to employees (total of 22 to 22x) 22x x Whether any compensaton, ncluded n 22x, pad to non-resdents xa Yes / No 23 Insurance If Yes, amount pad to non-resdents Medcal Insurance 23 Lfe Insurance 23 Keyman s Insurance 23 v Other Insurance ncludng factory, offce, car, goods, etc. 23v v v x xa xb 22x xb

135 384 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Total expendture on nsurance ( v) 23v 24 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson 31 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 30 Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty 44 Servce tax 44 VAT/ Sales tax 44 v Cess 44v v Central Goods & Servce Tax (CGST) 44v v State Goods & Servces Tax (SGST) 44v v Integrated Goods & Servces Tax (IGST) 44v v Unon Terrtory Goods & Servces Tax (UTGST) 44v x Any other rate, tax, duty or cess ncl STT and CTT 44x x Total rates and taxes pad or payable ( v + 44v + 44v + 44v + 44v +44x) 44x 45 Audt fee Other expenses (specfy nature and amount) Total ( + ) 46

136 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s clamed and amount) v Rows can be added as requred 47v v Others (more than Rs. 1 lakh) where PAN s not avalable (provde name and complete address) 47v v Others (amounts less than Rs. 1 lakh) 47v v Total Bad Debt ( v + 47v+47v) 47v 48 Provson for bad and doubtful debts Other provsons Proft before nterest, deprecaton and taxes [15 (16 to x + 23v + 24 to to x v )] 51 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 52 Deprecaton and amortsaton Net proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Appropratons Transfer to reserves and surplus 59 PROVISIONS PROVISION FOR TAX AND APPROPRIATIONS Proposed dvdend/ Interm dvdend Tax on dvdend/ Tax on dvdend for earler years v Appropraton towards Corporate Socal Responsblty (CSR) actvtes (n case of companes covered under secton 135 of Companes Act, 2013) v Any other appropraton v Total ( v+59v) 60 Balance carred to balance sheet (58-59v) A Items that wll not be reclassfed to P&L Changes n revaluaton surplus Re-measurements of the defned beneft plans Equty nstruments through OCI v v Far value Changes relatng to own credt rsk of fnancal labltes desgnated at FVTPL Share of Other comprehensve ncome n assocates and jont ventures, to the extent not to be classfed to P&L v Others (Specfy nature) v Income tax relatng to tems that wll not be reclassfed to P&L v Total B Items that wll be reclassfed to P&L Exchange dfferences n translatng the fnancal statements of a foregn operaton v 59v 59v v v v v 61A

137 386 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Debt nstruments through OCI v The effectve porton of gans and loss on hedgng nstruments n a cash flow hedge Share of OCI n assocates and jont ventures to the extent to be classfed nto P&L v Others (Specfy nature) v Income tax relatng to tems that wll be reclassfed to P&L v Total 62 Total Comprehensve Income ( A + 61B) COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE SR. NO. Name of Busness Busness code Descrpton v v v 61B NO ACCOUNT CASE Regstraton No. of goods carrage Whether owned/leased/ hred Tonnage capacty of goods carrage (n MT) Number of months for whch goods carrage was owned/leased/hred by assessee Presumptve ncome u/s 44AE for the goods carrage Rs.1000 per ton per month n case tonnage exceeds 12MT, or Rs.7500 per month) or the amount clamed to have been actually earned, whchever s hgher () (1) (2) (3) (4) (5) (a) (b) Add row optons as necessary (upto maxmum 10) () Total presumptve ncome from goods carrage u/s 44AE [total of column (5) of table 63()] NOTE If the profts are lower than prescrbed under S.44AE or the number of goods carrage owned /leased / hred at any tme durng the year exceeds 10, then, t s mandatory to mantan books of accounts and have a tax audt under secton 44AB 64 IF REGULAR BOOKS OF ACCOUNT OF BUSINESS OR PROFESSION ARE NOT MAINTAINED, furnsh the followng nformaton for prevous year n respect of busness or professon (OTHER THAN COVERED U/S 44AE) () For assessee carryng on Busness a Gross recepts / Turnover (a1 + a2) 1 Through a/c payee cheque or a/c payee bank draft or bank electronc clearng system receved before specfed date 2 Any other mode a2 b Gross proft c Expenses d Net proft () For assessee carryng on Professon a Gross recepts (a1 + a2) 1 Through a/c payee cheque or a/c payee bank draft or bank electronc clearng system receved before specfed date 2 Any other mode a2 b Gross proft c Expenses d Net proft () Total proft ( ) a a1 b c a a1 b c 63()

138 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 387 OTHER INFORMATION Part A- OI Other Informaton (mandatory, f lable for audt under secton 44AB, for other fll, f applcable) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No 3a Increase n the proft or decrease n loss because of devaton, f any, as per Income Computaton Dsclosure Standards notfed under secton 145(2) [column 11a() of Schedule ICDS] Decrease n the proft or ncrease n loss because of devaton, f any, as per Income Computaton 3b 3b Dsclosure Standards notfed under secton 145(2) [column 11b() of Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year (optonal n case of professonals) a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Increase n the proft or decrease n loss because of devaton, f any, from the method of valuaton specfed under secton 145A e Decrease n the proft or ncrease n loss because of devaton, f any, from the method of valuaton specfed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value added tax, or refund of GST, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year d any other tem of ncome e captal recept, f any f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to nonfulflment of condton specfed n relevant clauses- a b c d Premum pad for nsurance aganst rsk of damage or destructon of stocks or store [36(1)()] Premum pad for nsurance on the health of employees [36(1)(b)] Any sum pad to an employee as bonus or commsson for servces rendered, where such sum was otherwse payable to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed captal [36(1)()] e Amount of dscount on a zero-coupon bond [36(1)(a)] f g h Amount of contrbutons to a recognsed provdent fund [36(1)(v)] Amount of contrbutons to an approved superannuaton fund [36(1)(v)] Amount of contrbuton to a penson scheme referred to n secton 80CCD [36(1)(va)] Amount of contrbutons to an approved gratuty fund [36(1)(v)] j Amount of contrbutons to any other fund k Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up under ESI Act or any other fund for the welfare of employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] o p Expendture for the purposes of promotng famly plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of transacton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] 5a 5b 5c 5d 5e 6a 6b 6c 6d 6e 6f 6g 6h 6 6j 6k 6l 6m 6n 6o 6p 3a 4d 4e 5f

139 388 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] q Marked to market loss or other expected loss as computed n accordance wth the ICDS notfed u/s 145(2) [36(1)(xv)] r Any other dsallowance s Total amount dsallowable under secton 36 (total of 6a to 6r) t Total number of employees employed by the company (mandatory n case company has recognzed Provdent Fund) deployed n Inda deployed outsde Inda Total 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] b Expendture of personal nature [37(1)] c d e Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] Expendture on advertsement n any souvenr, brochure, tract, pamphlet or the lke, publshed by a poltcal party [37(2B)] Expendture by way of penalty or fne for volaton of any law for the tme beng n force f Any other penalty or fne g Expendture ncurred for any purpose whch s an offence or whch s prohbted by law h Expendture ncurred on corporate socal responsblty (CSR) Amount of any lablty of a contngent nature j Any other amount not allowable under secton 37 k Total amount dsallowable under secton 37 (total of 7a to 7j) 8 A. Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 B. a b c d Amount dsallowable under secton 40 (a)(), on account of non-complance wth the provsons of Chapter XVII-B Amount dsallowable under secton 40(a)(a) on account of non-complance wth the provsons of Chapter XVII-B Amount dsallowable under secton 40(a)(b) on account of non-complance wth the provsons of Chapter VIII of the Fnance Act, 2016 Amount dsallowable under secton 40(a)() on account of non-complance wth the provsons of Chapter XVII-B e Amount of tax or rate leved or assessed on the bass of profts [40(a)()] f Amount pad as wealth tax [40(a)(a)] g Amount pad by way of royalty, lcense fee, servce fee etc. as per secton 40(a)(b) h Amount of nterest, salary, bonus, commsson or remuneraton pad to any partner or member [40(b)] Any other dsallowance j Total amount dsallowable under secton 40(total of Aa to A ) Any amount dsallowed under secton 40 n any precedng prevous year but allowable durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A a Amounts pad to persons specfed n secton 40A(2)(b) b Amount pad otherwse than by account payee cheque or account payee bank draft or use of electronc clearng system through a bank account, dsallowable under secton 40A(3) c Provson for payment of gratuty [40A(7)] d any sum pad by the assessee as an employer for settng up or as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance f Total amount dsallowable under secton 40A (Total of 9a to 9e) 6q 6r Aa Ab Ac Ad Ae Af Ag Ah A 9a 9b 9c 9d 9e 7a 7b 7c 7d 7e 7f 7g 7h 7 7j 6s 7k Aj 8B 9f

140 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng the prevous year a Any sum n the nature of tax, duty, cess or fee under any law b c d e Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other fund for the welfare of employees Any sum payable to an employee as bonus or commsson for servces rendered Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal corporaton or a State Industral nvestment corporaton Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other than a prmary agrcultural credt socety or a prmary co-operatve agrcultural and rural development bank f Any sum payable towards leave encashment g Any sum payable to the Indan Ralways for the use of ralway assets h Total amount allowable under secton 43B (total of 10a to 10g ) 11 Any amount debted to proft and loss account of the prevous year but dsallowable under secton 43B a Any sum n the nature of tax, duty, cess or fee under any law b Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other fund for the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered d Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank or a co-operatve bank other than a prmary agrcultural credt socety or a prmary co-operatve agrcultural and rural development bank f Any sum payable towards leave encashment g Any sum payable to the Indan Ralways for the use of ralway assets h Total amount dsallowable under Secton 43B(total of 11a to 11g) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Central Goods & Servce Tax (CGST) e State Goods & Servces Tax (SGST) f Integrated Goods & Servces Tax (IGST) g Unon Terrtory Goods & Servces Tax (UTGST) h Any other tax Total amount outstandng (total of 12a to 12h) 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA or 33AC Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss account (net) Amount of expendture dsallowed u/s 14A 16 10a 10b 10c 10d 10e 10f 10g 11a 11b 11c 11d 11e 11f 11g 12a 12b 12c 12d 12e 12f 12g 12h 10h 11h 12

141 390 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Part A QD Quanttatve detals (mandatory, f lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern 6 Raw materals QUANTITATIVE DETAILS a Openng stock 6a b Purchases durng the prevous year 6b c Consumpton durng the prevous year 6c d Sales durng the prevous year 6d e Closng stock 6e f Yeld fnshed products 6f g Percentage of yeld 6g h Shortage/ excess, f any 6h 7 Fnshed products/ By-products a openng stock 7a b purchase durng the prevous year 7b c quantty manufactured durng the prevous year 7c d sales durng the prevous year 7d e closng stock 7e f shortage/ excess, f any 7f Part A OL Recept and payment account of company under lqudaton 1 Openng balance Cash n hand 1 Bank 1 Recept and payment account of company under lqudaton Total openng balance 1 2 Recepts Interest 2 Dvdend 2 Sale of assets (pls. specfy nature and amount) a 2a b 2b c 2c d Total (a + b + c) 2d v Realsaton of dues/debtors 2v v Others (pls. specfy nature and amount) a 2va b 2vb c Total of other recepts (va + vb) 2vc v Total recepts ( d+ 2v + 2vc) 2v 3 Total of openng balance and recepts 3 4 Payments Repayment of secured loan 4

142 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 391 Repayment of unsecured loan 4 Repayment to credtors 4 v Commsson 4v v Others (pls. specfy) a 4va b 4vb c Total of other payments (4va + 4vb) 4vc v Total payments ( v + 4vc) 4v 5 Closng balance Cash n hand 5 Bank 5 Total of closng balance (5 + 5) 5 6 Total of closng balance and payments (4v + 5) 6 Schedule HP 1 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Detals of Income from House Property (Please refer nstructons) (Drop down to be provded ndcatng ownershp of property) Address of property 1 Town/ Cty State PIN Code / Zp Code Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II HOUSE PROPERTY 2 [Tck the applcable opton] Let out Deemed let out Name(s) of Tenant PAN of Tenant(s) (f avalable) (f let out) I II a Gross rent receved or recevable or letable value 1a b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2) of the Act) 1e f Annual value of the property owned (own percentage share x 1e) 1f g 30% of 1f 1g h Interest payable on borrowed captal 1h Total (1g + 1h) 1 j Arrears/Unrealsed rent receved durng the year less 30% 1j k Income from house property 1 (1f 1+1j) 1k PAN/TAN of Tenant(s) (f TDS credt s clamed) Address of property 2 Town/ Cty State PIN Code/Zp code Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II [Tck the applcable opton] Name(s) of Tenant PAN of Tenant(s) (Please see note) (f let out) PAN/TAN of Tenant(s) (Please see note)

143 392 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Let out Deemed let out I II a Gross rent receved or recevable/ letable value (hgher of the two, f let out for whole of the year, lower of the two, f let out for part of the year) 2a b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) 2e f Annual value of the property owned (own percentage share x 2e) 2f g 30% of 2f 2g h Interest payable on borrowed captal 2h Total (2g + 2h) 2 j Arrears/Unrealsed rent receved durng the year less 30% 2j k Income from house property 2 (2e 2h + 2j) 2k 3 Pass through ncome f any * 3 4 Income under the head Income from house property (1k + 2k + 3) (f negatve take the fgure to 2 of schedule CYLA) 4 Furnshng of PAN of tenant s mandatory, f tax s deducted under secton 194-IB. NOTE Furnshng of TAN of tenant s mandatory, f tax s deducted under secton 194-I. Schedule BP INCOME FROM BUSINESS OR Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 53 and 61() of Part A-P&L) / (tem 55 and 63() of Part A-P&L Ind AS) (as applcable) Net proft or loss from speculatve busness ncluded n 1 (enter 2a 2a ve sgn n case of loss) 2b 3 4a 4b 4c Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) Income/ recepts credted to proft and loss account consdered under other heads of ncome/chargeable u/s 115BBF/ chargeable u/s 115BBG a House property b Captal gans c Other sources d u/s 115BBF e u/s 115BBG Proft or loss ncluded n 1, whch s referred to n secton 44B/44BB/44BBA/44BBB/ 44D/44DA/ Chapter-XII-G/ Frst 4a Schedule of Income-tax Act (other than 115B) (Dropdown to be provded) Proft and gans from lfe nsurance busness referred to n secton 115B Proft from actvtes covered under rule 7, 7A, 7B(1), 7B(1A) and 8 (Dropdown to be provded) 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) b Share of ncome from AOP/ BOI c Any other exempt ncome (specfy nature and amount) Total (c + c) d Total exempt ncome (5a + 5b + 5c) 6 Balance (1 2a 2b 3a - 3b 3c 3d 3e 4 5d) 6 7 Expenses debted to proft and loss account consdered under other heads of ncome/related to ncome chargeable u/s 115BBF or u/s 115BBG 5a 5b c c 5c a House property b Captal gans 2b 3a 3b 3c 3d 3e 4b 4c 5d 7a 7b c Other sources 7c d u/s 115BBF 7d 1

144 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 393 e u/s 115BBG 8a Expenses debted to proft and loss account whch relate to 8a 8b Expenses debted to proft and loss account whch relate to 8b exempt ncome and dsallowed u/s 14A (16 of Part A-OI) 9 Total (7a + 7b + 7c + 7d + 7e + 8) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortzaton debted to proft and loss account Deprecaton allowable under Income-tax Act Deprecaton allowable under secton 32(1)() and 32(1)(a) (tem 6 of Schedule-DEP) Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 (6r of Part A-OI) 15 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 (7k of Part A-OI) 16 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 (8Aj of Part A-OI) 17 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A (9f of Part A-OI) 18 Any amount debted to proft and loss account of the prevous year but dsallowable under secton 43B (11h of Part A-OI) Interest dsallowable under secton 23 of the Mcro, Small and 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/ 22 Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DA Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch company s Increase n proft or decrease n loss on account of ICDS adjustments and devaton n method of valuaton of stock (Column Total (14 3a d + 16 of + Part 17 + A- 18 OI) ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD Amount allowable as deducton under secton 32AC 29 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem x(4) 30 of Schedule ESR) (f amount deductble under secton 35 or 35CCC or 30 35CCD s lower than amount debted to P&L account, t wll go to tem 24) 31 Any amount dsallowed under secton 40 n any precedng prevous year but allowable durng the prevous year(8b of Part A-OI) 31 Any amount dsallowed under secton 43B n any precedng 32 prevous year but allowable durng the prevous year (10g of Part 32 A-OI) 33 Any other amount allowable as deducton Decrease n proft or ncrease n loss on account of ICDS adjustments and devaton n method of valuaton of stock (Column 3b + 4e of Part A- OI) 35 Total ( ) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AE (62() of schedule P&L or 64() of Ind As P&L) Secton 44B Secton 44BB v Secton 44BBA v Secton 44BBB v 37v 7e

145 394 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 38 v Secton 44D v Secton 44DA 37v (tem 4 of Form 3CE) v Chapter-XII-G (tonnage) x Frst Schedule of Income-tax Act (other than 115B) x Total (37 to 37x) 37v 37v (total of col. 7 of tem 10 of Form 66) 37x Net proft or loss from busness or professon other than speculatve and specfed busness (34+37x) 38 37x Net Proft or loss from busness or professon other than speculatve busness and specfed busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same fgure as n 38) (If loss take the fgure to 2 of tem E) (39a+ 39b + 39c + 39d + 39e + 39f) a Income chargeable under Rule 7 b Deemed ncome chargeable under Rule 7A c Deemed ncome chargeable under Rule 7B(1) d Deemed ncome chargeable under Rule 7B(1A) e Deemed ncome chargeable under Rule 8 f Income other than Rule 7A, 7B & 8 (Item No. 38) 39a 39b 39c 39d 39e Balance of ncome deemed to be from agrculture, after applyng Rule 7, 7A, 7B(1), 7B(1A) and Rule 8 for the purpose of aggregaton of ncome as per Fnance Act [4b- (39a+39b+39c+39d+39e)] B Computaton of ncome from speculatve busness 41 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Income from speculatve busness ) ( ) (f loss, take the fgure to 6x of schedule CFL) C Computaton of ncome from specfed busness under secton 35AD 45 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 48 Proft or loss from specfed busness ) ( ) Deductons n accordance wth secton 35AD(1) Income from Specfed Busness) (48-49 )(f loss, take the fgure to 7x of schedule CFL) C50 39f A39 40 B Relevant clause of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from drop down menu) C51 D Income chargeable under the head Profts and gans from busness or professon (A38+B44+C50) D E Intra head set off of busness loss of current year Sl. Type of Busness ncome Income of current year (Fll ths column only f fgure s zero or postve) Busness loss set off Busness ncome remanng after set off (1) (2) (3) = (1) (2) Loss to be set off (Fll ths row only f fgure s negatve) (A39) Income from speculatve busness Income from specfed busness v Total loss set off ( + ) (B44) (C50) v Loss remanng after set off ( v)

146 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 395 DEPRECIATION ON PLANT AND MACHINERY Schedule DPM Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton under any other secton) 1 Block of assets Plant and machnery 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7 8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Addtonal deprecaton relatng to mmedately precedng year on asset put to use for less than 180 days 15 Total deprecaton ( ) 16 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 15) 17 Net aggregate deprecaton (15-16) 18 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 17) 19 Expendture ncurred n connecton wth transfer of asset/ assets 20 Captal gans/ loss under secton 50 ( ) (enter negatve only, f block ceases to exst) 21 Wrtten down value on the last day of prevous year* ( ) (enter 0, f result s negatve) () () () DEPRECIATION ON OTHER ASSETS Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Land Buldng (not ncludng land) Furnture and fttngs Intangble assets 2 Rate (%) Nl Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) Shps () () () (v) (v) (v) (v)

147 396 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Total deprecaton (10+11) 13 Deprecaton dsallowed under secton 38(2) of the I.T. Act (out of column 12) 14 Net aggregate deprecaton (12-13) 15 Proportonate aggregate deprecaton allowable n the event of successon, amalgamaton, demerger etc. (out of column 14) 16 Expendture ncurred n connecton wth transfer of asset/ assets 17 Captal gans/ loss under secton 50* ( ) (enter negatve only f block ceases to exst) 18 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) SUMMARY OF DEPRECIATION ON ASSETS Schedule DEP 1 Plant and machnery a b c Summary of deprecaton on assets (Other than on assets on whch full captal expendture s allowable as deducton under any other secton) Block enttled for 15 per cent ( Schedule DPM - 17 or 18 as applcable) Block enttled for 30 per cent ( Schedule DPM - 17 or 18 as applcable) Block enttled for 40 per cent ( Schedule DPM - 17 or 18 as applcable) d Total deprecaton on plant and machnery ( 1a + 1b + 1c) 2 Buldng (not ncludng land) a Block enttled for 5 per cent (Schedule DOA- 14 or 15 as applcable) b Block enttled for 10 per cent (Schedule DOA- 14 or 15 as applcable) c Block enttled for 40 per cent (Schedule DOA- 14v or 15v as applcable) d Total deprecaton on buldng (2a+2b+2c) 3 Furnture and fttngs(schedule DOA- 14v or 15v as applcable) 3 4 Intangble assets (Schedule DOA- 14v or 15v as applcable) 4 5 Shps (Schedule DOA- 14v or 15v as applcable) 5 6 Total deprecaton ( 1d+2d+3+4+5) 6 1a 1b 1c 2a 2b 2c 1d 2d Schedule DCG Deemed Captal Gans on sale of deprecable assets 1Plant and machnery a Block enttled for 15 per cent 1a (Schedule DPM - 20) bblock enttled for 30 per cent 1b (Schedule DPM 20)

148 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 397 c Block enttled for 40 per cent (Schedule DPM - 20) dtotal ( 1a +1b + 1c) 2Buldng (not ncludng land) a Block enttled for 5 per cent (Schedule DOA- 17) bblock enttled for 10 per cent (Schedule DOA- 17) c Block enttled for 40 per cent (Schedule DOA- 17v) dtotal ( 2a + 2b + 2c) 1c 2a 2b 2c 1d 2d 3Furnture and fttngs ( Schedule DOA- 17v) 3 4Intangble assets (Schedule DOA- 17v) 4 5Shps (Schedule DOA- 17v) 5 6Total ( 1d+2d+3+4+5) 6 Schedule ESR Sl No Expendture of the nature referred to n secton v v v v v x x NOTE Expendture on scentfc Research etc. (Deducton under secton 35 or 35CCC or 35CCD) (1) 35(1)() 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) In case any deducton s clamed under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA), please provde the detals as per Schedule RA. Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Sub-tems 4 & 5 are not applcable for resdents) 1 From sale of land or buldng or both (fll up detals separately for each property) a Full value of consderaton receved/recevable a CAPITAL GAINS Short-term Captal Gans Value of property as per stamp valuaton authorty Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed 1.05 a tmes (a), take ths fgure as (a), or else take (a)] b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer a b b b

149 398 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Total (b + b + b) c Balance (a bv) bv 1c d Deducton under secton 54D/ 54G/54GA (Specfy detals n tem D below) e Short-term Captal Gans on Immovable property (1c - 1d) f In case of transfer of mmovable property, please furnsh the followng detals (see note) S.N o. Name of buyer(s) PAN of buyer(s) Percentage share Amoun t 1d Address of property Pn code A1 e NOTE 2 From slump sale Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. In case of more than one buyer, please ndcate the respectve percentage share and amount. a Full value of consderaton 2a (5 of Form b Net worth of the under takng or dvson 2b (6(e) 3CEA) of Form c Short term captal gans from slump sale (2a-2b) 3CEA) From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (3a bv) d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and 3d dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) STCG on transactons on whch securtes transacton tax (STT) s pad a A4 b STCG on transactons on whch securtes transacton tax (STT) s not pad A4 For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 115AD 3a b b b bv 3c A2 c A3 e a b a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans Full value of consderaton n respect of securtes other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton a b c a a b b

150 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 399 Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (5a bv) d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) b bv 5c 5d e Short-term captal gan on securtes (other than those at A3 above) by an FII (5c +5d) A5 e 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n a respect of unquoted shares bfar market value of unquoted shares determned n the prescrbed manner b c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA c Full value of consderaton n respect of assets a other Total than (c + ) unquoted shares a b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of Improvement wthout ndexaton Expendture wholly and exclusvely n connecton wth v Total transfer ( + + ) c Balance (6a bv) d e In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) Deemed short term captal gans on deprecable assets (6 of schedule- DCG) f Deducton under secton 54D/54G/54GA g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e 6f) 7 Amount deemed to be short-term captal gans b b b bv 6c 6d 6e 6f A6 g a b Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year 54D/54G/54 GA New asset acqured/constructed Year n whch asset acqured/construc ted Amount utlsed out of Captal Gans account Amount deemed to be short-term captal gans u/s 54D/54G/54GA, other than at a Amount not used for new asset or remaned unutlzed n Captal gans account (X) Total Amount deemed to be short-term captal gans u/s 54D/54G/54GA (ax + b) A7 8 Pass Through Income n the nature of Short Term Captal Gan, (Fll up schedule PTI) (A8a + A8b + A8c) A8 a b Pass Through Income n the nature of Short Term Captal Gan, 15% Pass Through Income n the nature of Short Term Captal Gan, 30% A8 a A8 b

151 400 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] c Pass Through Income n the nature of Short Term Captal Gan, chargeable at applcable rates A8 c 9 Amount of STCG ncluded n A1 A8 but not chargeable to tax or chargeable at specal rates n Inda as per DTAA Sl. No. Amount of ncome Item No. A1 to A8 above n whch nclude d Countr y name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whethe r TRC obtaned (Y/N) Secto n of I.T. Act Rate as per I.T. Act Applcab le rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I 10 B Long-term captal gan (LTCG) (Sub-tems 5, 6, 7, 8 & 9 are not applcable for resdents) II a b Total amount of STCG not chargeable to tax n Inda as per DTAA Total amount of STCG chargeable to tax at specal rates n Inda as per DTAA Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7 + A8 A9a) A9 A9 b A1 0 1 From sale of land or buldng or both (fll up detals separately for each property) a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty a Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans [n case (a) does not exceed a 1.05 tmes (a), take ths fgure as (a), or else take (a)] Long-term Captal Gans b Deductons under secton 48 Cost of acquston wth ndexaton Cost of Improvement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b + b) c Balance (a bv) d Deducton under secton 54D/54EC /54G/54GA (Specfy detals n tem D below) e Long-term Captal Gans on Immovable property (1c - 1d) f In case of transfer of mmovable property, please furnsh the followng detals (see note) Address S.N PAN of Percentage Amou Pn Name of buyer(s) of o. buyer(s) share nt code property NOTE 2 From slump sale 3 Furnshng of PAN s mandatory, f the tax s deduced under secton 194-IA or s quoted by buyer n the documents. b b b b 1c v In case of more than one buyer, please ndcate the respectve percentage share and amount. a Full value of consderaton b Net worth of the under takng or dvson 2b c Balance (2a 2b) d Deducton u/s e Long term captal gans from slump sale (2c-2d) 2a 2c 2d 1d (5 of Form 3CEA) (6(e) of Form 3CEA) From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) B1 e B2 e

152 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 401 a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (3a bv) 3c d Deducton under sectons (Specfy detals n tem D below) 3d 4 e LTCG on bonds or debenture (3c 3d) From sale of lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b B3 e Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer Total (b + b +b) bv c Balance v (4a bv) 4c d Deducton under sectons (Specfy detals n tem D below) e Long-term Captal Gans on assets at B4 above (4c 4d) 5 From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) ACost of acquston b b 4d 5a b A B4 e If the long term captal asset was acqured B before , lower of B1 and B2 B 1 Far Market Value of captal asset as per secton 55(2)(ac) B1 2 Full value of consderaton B2 Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total deductons (b + b +b) bv c Balance (5a bv) d Less- LTCG threshold lmt as per secton 112A (5c Rs. 1 lakh) e Deducton under sectons 54F (Specfy detals n tem D below) 5c 5d 5e f Long-term Captal Gans on sale of captal assets at B5 above (5d 5e) B5f 6 For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 6a b Deducton under sectons (Specfy detals n tem D below) c LTCG on share or debenture (6a 6b) 6b

153 402 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 7 For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () unts referred n sec. 115AB, () bonds or GDR as referred n sec. 115AC, (v) securtes by FII as referred to n sec. 115AD (other than securtes referred to n secton 112A for whch column B8 s to be flled up) a In case securtes sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of securtes other than unquoted shares a b c a Total (c + ) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (a bv) 7c d Deducton under sectons (Specfy detals n tem D below) 7d e Long-term Captal Gans on assets at 7 above n case of NON-REESIDENT (7 7d) B7e 8 For NON-RESIDENTS - From sale of equty share n a company or unt of equty orented fund or unt of a busness trust on whch STT s pad under secton 112A a Full value of consderaton 8a b Deductons under secton 48 Cost of acquston wthout ndexaton (hgher of A and B) A Cost of acquston B If the long term captal asset was acqured before , lower of B1 and B2 1 Far Market Value of captal asset as per secton 55(2)(ac) 2 Full value of consderaton B2 b A B B1 Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer b b v Total deductons (b + b +b) c Balance (8a bv) 8c d Less- LTCG threshold lmt as per secton 112A (8c Rs. 1 lakh) e Deducton under sectons 54F (Specfy detals n tem D below) f Long-term Captal Gans on sale of captal assets at B8 above (8d 8e) B8f 9 From sale of assets where B1 to B8 above are not applcable a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals bv 8d 8e a Full value of consderaton receved/recevable n respect of unquoted shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) c

154 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 403 Full value of consderaton n respect of assets other than unquoted shares Total (c + ) a b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of mprovement wth ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (a bv) 7c d Deducton under secton 54D/54G/54GA (Specfy detals n tem D below) 7d e Long-term Captal Gans on assets at B9 above (9c- 9d) B9e 10 Amount deemed to be long-term captal gans Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown a below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA New asset acqured/constructed Amount Year n whch asset 403tlzed out of acqured/constructedcaptal Gans account b Amount deemed to be long-term captal gans, other than at a Amount not used for new asset or remaned unutlzed n Captal gans account (X) Total amount deemed to be long-term captal gans (ax + b) B10 11 Pass Through Income n the nature of Long Term Captal Gan, (Fll up schedule PTI) (B12a + B12b) B11 a b Pass Through Income n the nature of Long Term Captal Gan, 10% Pass Through Income n the nature of Long Term Captal Gan, 20% B11a B11b 13 Amount of LTCG ncluded n tems B1 to B8 but not chargeable to tax or chargeable at specal rates n 12 Inda as per DTAA Amount Sl. of No. ncome Item No. B1 to B11 above n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II a Total amount of LTCG not chargeable to tax n Inda as per DTAA b Total amount of LTCG chargeable to tax at specal rates n Inda as per DTAA Total long term captal gan (B1e+ B2e+ B3e+ B4e+ B5f+ B6c+ B7e + B8f + B9e+ B10 + B11 B12a) (In case of loss take the fgure to 9x of schedule CFL) B13 B12a B12b C Income chargeable under the head CAPITAL GAINS (A10 + B13) (take B10 as nl, f loss) C D Informaton about deducton clamed aganst Captal Gans 1 In case of deducton u/s 54D/54EC/54G/54GA gve followng detals a Deducton clamed u/s 54D Date of acquston of orgnal asset a dd/mm/yyyy Cost of purchase/ constructon of new land or buldng for ndustral undertakng a Date of purchase of new land or buldng a dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed av av

155 404 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] b c Deducton clamed u/s 54EC Date of transfer of orgnal asset b dd/mm/yyyy Amount nvested n specfed/notfed bonds b Date of nvestment b dd/mm/yyyy v Amount of deducton clamed bv Deducton clamed u/s 54G Date of transfer of orgnal asset from urban area c dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new asset Date of purchase/constructon of new asset n an area other than urban area c c dd/mm/yyyy d v Amount deposted n Captal Gans Accounts Scheme before due date v Amount of deducton clamed Deducton clamed u/s 54GA Date of transfer of orgnal asset from urban area d dd/mm/yyyy Cost and expenses ncurred for purchase or constructon of new d asset Date of purchase/constructon of new asset n SEZ d dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due dv date v Amount of deducton clamed dv e Total deducton clamed (1a + 1b + 1c + 1d) cv cv 1e E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A7 & B9 whch s chargeable under DTAA) Sl. Type of Captal Gan Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss set off Long term captal loss set off Current year s captal gans 15% 30% applcable rate DTAA rates 10% 20% DTAA rates remanng after set off Loss to be set off (Fll ths row f fgure computed s negatve) (A3e*+ (A1e*+ (A5e*+ A4a*+ A2c*+A4b*+A6g* A8b*) A8a*) +A7*+A8c* ) A9b (B4e*+ B5f*+ B7e*+ B8f*+ B9e* B11a* ) (B1e*+ B2e*+B3e*+B6c*+B9e*+ B10*+ B11b*) B12b 15% (A3e*+ A4a*+ A8a*) Short term 30% (A5e*+ A8b*) captal v gan v applcable rate DTAA rates v 10% Long term captal v gan 20% (A1e*+ A2c*+A4b*+A6g* +A7*+A8c* ) A9b (B4e*+ B5f*+ B7e*+ B8f*+ B9e* B11a* ) (B1e*+ B2e*+B3e*+B6c*+B9e*+ B10*+ B11b*) v DTAA B12b rates x Total loss set off ( + + v + v + v + v + v) x Loss remanng after set off (-x) The fgures of STCG n ths table (A1e* etc.) are the amounts of STCG computed n respectve column (A1-A8) as reduced by the amount of STCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any.

156 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 405 The fgures of LTCG n ths table (B1e* etc.) are the amounts of LTCG computed n respectve column (B1-B11) as reduced by the amount of LTCG not chargeable to tax or chargeable at specal rates as per DTAA, whch s ncluded theren, f any. F Informaton about accrual/recept of captal gan 1 Type of Captal gan / Date Short-term captal gans taxable at the rate of 15% Enter value from tem 5v of schedule BFLA, f any. 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) 2 Short-term captal gans taxable at the rate of 30% Enter value from tem 5v of schedule BFLA, f any. 3 Short-term captal gans taxable at applcable rates Enter value from tem 5v of schedule BFLA, f any. 4 Short-term captal gans taxable at DTAA rates Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% 5 Enter value from tem 5x of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% 6 Enter value from tem 5x of schedule BFLA, f any. Long- term captal gans taxable at the rate DTAA rates 7 Enter value from tem 5x of schedule BFLA, f any. Schedule OS OTHER SOURCES Income from other sources 1 Gross ncome chargeable to tax at normal applcable rates (1a+ 1b+ 1c+ 1d + 1e) 1 a Dvdends, Gross b Interest, Gross (b + b + b + bv) From Savngs Bank From Deposts (Bank/ Post Offce/ Co-operatve) Socety) From Income-tax Refund v In the nature of Pass through ncome v Others c Rental ncome from machnery, plants, buldngs, etc., Gross b b b bv bv 1a 1b 1c d Income of the nature referred to n secton 56(2)(x) whch s chargeable to tax (d + d + d + dv + dv) Aggregate value of sum of money receved wthout consderaton 1d d In case mmovable property s receved wthout consderaton, stamp duty value of property d In case mmovable property s receved for nadequate consderaton, stamp duty value of property n excess of such consderaton d v v In case any other property s receved wthout consderaton, far market value of property In case any other property s receved for nadequate consderaton, far market value of property n excess of such consderaton dv dv 2 Income chargeable at specal rates (2a+ 2b+ 2c+ 2d + 2e) 2 a Income by way of wnnngs from lotteres, crossword puzzles etc. b Income chargeable u/s 115BBE (b + b + b + bv+ bv + bv) Cash credts u/s 68 Unexplaned nvestments u/s 69 Unexplaned money etc. u/s 69A v Undsclosed nvestments etc. u/s 69B v Unexplaned expendture etc. u/s 69C 2a 2b b b b bv bv

157 406 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Amount borrowed or repad on hund u/s 69D c Accumulated balance of recognsed provdent fund taxable u/s 111 S.No. Assessment Year Income beneft Tax beneft () () () (v) d Any other ncome chargeable at specal rate (total of d to dxx) Dvdends receved by non-resdent (not beng company) or foregn company chargeable u/s 115A(1)(a)() Interest receved from Government or Indan concern on foregn currency debts chargeable u/s 115A(1)(a)() Interest receved from Infrastructure Debt Fund chargeable u/s 115A(1)(a)(a) d d d bv 2c 2d v v v v Interest referred to n secton 194LC - chargeable u/s 115A(1)(a)(aa) Interest referred to n secton 115A(1)(a)(ab) 194LD - chargeable u/s Dstrbuted ncome beng nterest referred to n secton 194LBA - chargeable u/s 115A(1)(a)(ac) Income from unts of UTI or other Mutual Funds specfed n dv secton 10(23D), purchased n Foregn Currency - chargeable u/s 115A(1)(a)() Income from royalty or fees for techncal servces receved dv v from Government or Indan concern - chargeable u/s 115A(1)(b) Income by way of nterest or dvdends from bonds or GDRs dx x purchased n foregn currency by non-resdents - chargeable u/s 115AC dv dv dv x Income by way of dvdends from GDRs purchased n foregn currency by resdents - chargeable u/s 115ACA dx e f x x Income (other than dvdend) receved by an FII n respect of dx securtes (other than unts referred to n secton 115AB) - chargeable u/s 115AD(1)() Income by way of nterest receved by an FII on bonds or dx Government securtes referred to n secton 194LD chargeable as per provso to secton 115AD(1)() Tax on non-resdents sportsmen or sports x assocatons chargeable u/s 115BBA dx xv Anonymous Donatons n certan cases chargeable u/s 115BBC dxv xv xv xv Income by way of dvdend receved by specfed assessee, beng dxv resdent, from domestc company exceedng rupees ten lakh chargeable u/s 115BBDA Income by way of royalty from patent developed and regstered dxv n Inda - chargeable u/s 115BBF Income by way of transfer of carbon credts - chargeable u/s dxv 115BBG Investment Income of a Non-Resdent Indan - chargeable u/s dv xv 115E xx Any other ncome (Please specfy) Pass through ncome n the nature of ncome from other sources chargeable at specal rates (drop down to be provded) Amount ncluded n 1 and 2 above, whch s chargeable at specal rates n Inda as per DTAA (total of column (2) of table below) Amount of Item No.2a Country Artcle of Rate as Whether Secton of Rate as Applcable Sl. No. ncome to 2e n name & DTAA per Treaty TRC I.T. Act per I.T. rate [lower whch Code (enter obtaned Act of (6) or (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II dxx 2e 2f

158 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Deductons under secton 57 (other than those relatng to ncome chargeable at specal rates under 2a, 2b & 2d ) a Expenses / Deductons b Deprecaton c Total 4 Amounts not deductble u/s Profts chargeable to tax u/s Net Income from other sources chargeable at normal applcable rates ( ) (If negatve take the fgure to 4 of schedule CYLA) 7 Income from other sources (other than from ownng and mantanng race horses) (2 +6 )) (enter 6 as nl, f negatve) 7 3a 3b 3c 6 8 Income from the actvty of ownng race horses a Recepts b Deductons under secton 57 n relaton to recepts at 8a only c Amounts not deductble u/s 58 d Profts chargeable to tax u/s 59 8a 8b 8c 8d e Balance (8a - 8b + 8c + 8d) (f negatve take the fgure to 10x of Schedule CFL) 8e NOTE 9 Income under the head Income from other sources (7 + 8e) (take 8e e as nl f negatve) 9 10 Informaton about accrual/recept of ncome from Other Sources S. No. Other Source Income Upto 15/6 From 16/6 to 15/9 1 2 Dvdend Income u/s 115BBDA Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. referred to n secton 2(24)(x) From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3 () () () (v) (v) Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head. Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Sl.No Head/ Source of Income Loss to be set off Detals of Income after Set off of current year losses (Fll ths row only, f computed fgure s negatve) Income of current year (Fll ths column only f ncome s zero or postve) House property ( 4 of Schedule HP) v v v Busness (excludng speculaton ncome and ncome from specfed busness) Proft and gans from lfe nsurance busness u/s 115B Speculaton ncome Specfed busness ncome u/s 35AD House property loss of the current year set off Busness Loss (other than speculaton or specfed busness loss) of the current year set off Other sources loss (other than loss from race horses and amount chargeable to specal rate of tax) of the current year set off Current year s Income remanng after set off = (A39 of Schedule BP) (3v of tem E of Sch. BP) (3 of tem E of Sch. BP) (3 of tem E of Sch. BP) (4 of Schedule HP) (2v of tem E of Schedule BP) (6 of Schedule-OS)

159 408 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v v x x x x x xv xv xv Short-term captal gan 15% Short-term captal gan 30% Short-term captal gan taxable at applcable rates Short-term captal gan taxable at specal rates n Inda as per DTAA Long term captal gan 10% Long term captal gan 20% Long term captal gans taxable at specal rates n Inda as per DTAA Net ncome from other sources chargeable at normal applcable rates Proft from the actvty of ownng and mantanng race horses Income from other sources taxable at specal rates n Inda as per DTAA xv Total loss set off xv Loss remanng after set-off ( xv) (9 of tem E of schedule CG) ( 9 of tem E of schedule CG) ( 9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) (9v of tem E of schedule CG) ( 6 of schedule OS) ( 8e of schedule OS) (2f of schedule OS) Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT Sl. No. Detals of Income after Set off of Brought Forward Losses of earler years Head/ Source of Income Income after set off, f any, of current year s losses as per 5 of Schedule CYLA) House property (5 of schedule CYLA) Busness (excludng speculaton ncome and ncome from specfed busness) Proft and gans from lfe nsurance busness u/s 115B v Speculaton Income v Specfed Busness Income v v v x x x x Short-term captal gan 15% Short-term captal gan 30% Short-term captal gan taxable at applcable rates Brought forward loss set off Brought forward deprecaton set off Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5 of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) ( 5v of schedule CYLA) (5x of schedule CYLA) Short-term captal gan taxable at specal rates n Inda as per (5x of schedule CYLA) DTAA Long-term captal gan 10% Long term captal gan 20% Long term captal gans taxable at specal rates n Inda as per DTAA (5x of schedule CYLA) ( 5x of schedule CYLA) (5x of schedule CYLA) (B/f house property loss) (B/f busness loss, other than speculaton or specfed busness loss) (B/f busness loss, other than speculaton or specfed busness loss) (B/f normal busness or speculaton loss) (B/f normal busness or specfed busness loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term or longterm captal loss) (B/f short-term or longterm captal loss) (B/f short-term or longterm captal loss)

160 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 409 x xv xv Net ncome from other sources chargeable at normal applcable rates Proft from ownng and mantanng race horses Income from other sources ncome taxable at specal rates n Inda as per DTAA xv Total of brought forward loss set off xv (5xv of schedule CYLA) (5xv of schedule CYLA) (5xv of schedule CYLA) (B/f loss from horse races) Current year s ncome remanng after set off Total of v+ 5v + 5v + 5v + 5v + 5x + 5x + 5x +5x+5x+ 5xv + 5xv) Schedule CFL Detals of Losses to be carred forward to future years Sl. No. Assessment Year Date of Flng (DD/MM/YYYY) House property loss Loss from busness other than loss from speculatve busness and specfed busness Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses CARRY FORWARD OF LOSS v v v v v x x x x Total of earler year losses b/f Adjustment of above losses n Schedule BFLA (Current year losses to be carred forward) Total loss Carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2 of schedule BFLA) (B44 of schedule BP, f ve) (2v of schedule BFLA) (C50 of schedule BP, f ve) (2x+3x+4x+5x) of tem E of schedule CG) 6x+7x+8x) of tem E of schedule CG) (2xv of schedule BFLA) ( 8e of schedule OS, f ve) Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought forward unabsorbed deprecaton Amount of deprecaton set-off aganst the current year ncome Balance carred forward to the next year Amount of brought forward unabsorbed allowance Amount of allowance set-off aganst the current year ncome Balance Carred forward to the next year (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Year v Total (3xv of BFLA) ( 4xv of BFLA)

161 410 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount (+) or (-) () () () I II III IV V VI VII VIII IX X 11a. 11b. Accountng Polces Valuaton of Inventores (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Constructon Contracts Revenue Recognton Tangble Fxed Assets Changes n Foregn Exchange Rates Government Grants Securtes (other than the effect of change n method of valuaton u/s 145A, f the same s separately reported at col. 4d or 4e of Part A-OI) Borrowng Costs Provsons, Contngent Labltes and Contngent Assets Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f postve) Total effect of ICDS adjustments on proft (I+II+III+IV+V+VI+VII+VIII+IX+X) (f negatve) Schedule 10AA DEDUCTION U/S 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 c Total deducton under secton 10AA (a + b) Assessment year n whch unt begns to manufacture/produce/provde servces Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G DETAILS OF DONATIONS A B Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee v Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee v Total C Donatons enttled for 100% deducton subject to qualfyng lmt PAN of Donee Amount of donaton Elgble Amount of donaton Donaton n cash Donaton n Total other mode Donaton PAN of Donee Amount of donaton Elgble Amount of donaton Donaton n cash Donaton n Total other mode Donaton

162 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 411 Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton v Total D Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee v Total E Total donatons (Av + Bv + Cv + Dv) PAN of Donee Donaton n cash Donaton n cash Donaton n Total other mode Donaton Amount of donaton Donaton n Total other mode Donaton Elgble Amount of donaton Schedule 80GGA S. No. Detals of donatons for scentfc research or rural development Relevant clause under whch deducton s clamed (drop down to be provded) Total donaton Name and address of donee PAN of Donee Donaton n cash Amount of donaton Donaton n other mode Total Donaton Elgble Amount of donaton Schedule RA Detals of donatons to research assocatons etc. [deducton under sectons 35(1)() or 35(1)(a) or 35(1)() or 35(2AA)] Name and address of donee PAN of Donee Amount of donaton Total Donaton n cash Donaton n other mode Total Donaton Elgble Amount of donaton DEDUCTION U/S 80-IA Schedule 80-IA a b c d Deductons under secton 80-IA Deducton n respect of profts of an enterprse referred to n secton 80-IA(4)() [Infrastructure faclty] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] a1 a2 b1 b2 c1 c2 d1 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng)

163 412 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Cross-country natural gas dstrbuton network] d2 e1 e2 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 f Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2+ e1 + e2) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) f Schedule 80-IB a b c d e f g h j k l m Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] Deducton n the case of multplex theatre [Secton 80- IB(7A)] Deducton n the case of conventon centre [Secton 80- IB(7B)] Deducton n the case of company carryng on scentfc research [Secton 80-IB(8A)] Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] Deducton n the case of an undertakng developng and buldng housng projects [Secton 80-IB(10)] Deducton n the case of an undertakng operatng a cold chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n ntegrated busness of handlng, storage and transportaton of food grans [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n operatng and mantanng a rural hosptal [Secton 80- IB(11B)] Deducton n the case of an undertakng engaged n operatng and mantanng a hosptal n any area, other than m1 a1 a2 b1 b2 c1 c2 d1 d2 e1 e2 f1 f2 g1 g2 h1 h2 1 2 j1 j2 k1 k2 l1 l2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 Undertakng no. 2 Undertakng no. 1 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBB of the undertakng) (10(v) of Form 10CCBB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (11(v) of From 10CCBC) (11(v) of From 10CCBC) (11(d) of From 10CCBD)

164 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 413 excluded area [Secton 80-IB(11C) m2 Undertakng no. 2 (11(d) of From 10CCBD) n Total deducton under secton 80-IB (Total of a1 to m2) n DEDUCTION U/S 80-IC Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East da Assam db Arunachal Pradesh da1 Undertakng no. 1 (30 of Form 10CCB of the da2 Undertakng no. 2 (30 of Form 10CCB of the db1 Undertakng no. 1 (30 of Form 10CCB of the db2 Undertakng no. 2 (30 of Form undertakng) 10CCB of the dc Manpur dc1 Undertakng no. 1 (30 of Form 10CCB of the dc2 Undertakng no. 2 (30 of Form undertakng) 10CCB of the dd Mzoram dd1 Undertakng no. 1 (30 of Form 10CCB of the dd2 Undertakng no. 2 (30 of Form undertakng) 10CCB of the de Meghalaya de1 Undertakng no. 1 (30 of Form 10CCB of the de2 Undertakng no. 2 (30 of Form 10CCB of the df Nagaland df1 Undertakng no. 1 (30 of Form undertakng) 10CCB of the df2 Undertakng no. 2 (30 of Form 10CCB of the dg Trpura dg1 Undertakng no. 1 (30 of Form undertakng) 10CCB of the dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) a1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) a2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) b1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) b2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) c1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the c1 Undertakng no. 2 undertakng) dh e Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80G b 80GGB c 80GGA d 80GGC Total Deducton under Part B (a + b + c +d) 1 TOTAL DEDUCTIONS 2 Part C- Deducton n respect of certan 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) Total Deducton under Part C (total of e to m) 2 3 Total deductons under Chapter VI-A (1 + 2) 3

165 414 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule SI Income chargeable to tax at specal rates [Please see nstructon Number-7() for secton and rate of tax] Sl No Secton/Descrpton Specal rate (%) 1 111A (STCG on shares/equty orented MF on whch STT pad) 15 Income () (5v of schedule BFLA) Tax thereon () 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (part of 5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 5xof schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5x of schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (part of 5x of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5x of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (part of 5x of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) 9 112A (LTCG on sale of shares or unts on whch STT s pad) 10 STCG chargeable at specal rates n Inda as per DTAA 10 (B5f and B8f of schedule CG) (part of 5x of schedule BFLA) 11 LTCG Chargeable at specal rates n Inda as per DTAA (part of 5x of schedule B (Profts and gans of lfe nsurance busness) BFLA) (part of 4b of schedule BP) AC (Income of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) SPECIAL RATE BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (2a of schedule OS) BBD (Dvdend receved from specfed foregn company) 15 (part of 2dxv of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 60 (2b of schedule OS) A(1)(b) (Income of a foregn company from Royalty) 25 (part of 2dv of schedule OS) BBF (Tax on ncome from patent) a Income under head busness or professon 10 (3d of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) BBG (Tax on ncome from transfer of carbon credts) a Income under head busness or professon 10 (8e of schedule BP) b Income under head other sources 10 (2dxv of schedule OS) 20 Income from other sources chargeable at specal rates n Inda as per DTAA (part of 2f of schedule OS) 21 Pass Through Income n the nature of Short Term Captal Gan 15% Pass Through Income n the nature of Short Term Captal Gan 30% Pass Through Income n the nature of Long Term Captal Gan 10% Pass Through Income n the nature of Long Term Captal Gan 20% (part of 5v of schedule BFLA) (part of 5v of schedule BFLA) (part of 5x of schedule BFLA) (part of 5x of schedule BFLA) 25 Pass through ncome n the nature of ncome from other source chargeable at specal rates (2e of schedule OS) Total

166 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 415 Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income or not chargeable to tax) 1 Interest ncome 1 2 Dvdend ncome 2 3 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years v Agrcultural ncome porton relatng to Rule 7, 7A, 7B(1), 7B(1A) and 8 (from Sl. No. 40 of Sch. BP) v v Net Agrcultural ncome for the year ( + v) (enter nl f loss) 3 EXEMPT INCOME v In case the net agrcultural ncome for the year exceeds Rs.5 lakh, please furnsh the followng detals (Fll up detals separately for each agrcultural land) a Name of dstrct along wth pn code n whch agrcultural land s located b Measurement of agrcultural land n Acre c Whether the agrcultural land s owned or held on lease (drop down to be provded) d Whether the agrcultural land s rrgated or ran-fed (drop down to be provded) 4 Other exempt ncome ncludng exempt ncome of mnor chld (please specfy) 4 5 Income not chargeable to tax as per DTAA Sl. No. Amount of ncome Nature of ncome Country name & Code Artcle of DTAA Head of Income Whether TRC obtaned (Y/N) 6 Pass through ncome not chargeable to tax (Schedule PTI) 6 7 Total ( ) 7 Schedule PTI PASS THROUGH INCOME Sl. NOTE Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Name of busness trust/ nvestment fund PAN of the busness trust/ nvestment fund 1. House property Sl. Head of ncome Amount of ncome TDS on such amount, f any v Captal Gans a b Short term Long term Other Sources Income clamed to be exempt a b c u/s 10(23FBB) u/s.. u/s 2. House property Please refer to the nstructons for fllng out ths schedule. v Captal Gans a b Short term Long term Other Sources Income clamed to be exempt a b c u/s 10(23FBB) u/s.. u/s

167 416 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule MAT MINIMUM ALTERNATE TAX Computaton of Mnmum Alternate Tax payable under secton 115JB 1 Whether the Proft and Loss Account s prepared n accordance wth the provsons of Parts II of Schedule III to the Companes Act, 2013 (If yes, wrte Y, f no wrte N ) 2 If 1 s no, whether proft and loss account s prepared n accordance wth the provsons of the Act governng such company (If yes, wrte Y, f no wrte N ) 3 Whether, for the Proft and Loss Account referred to n tem 1 above, the same accountng polces, accountng standards and same method and rates for calculatng deprecaton have been followed as have been adopted for preparng accounts lad before the company at ts annual general body meetng? (If yes, wrte Y, f no wrte N ) 4 Proft after tax as shown n the Proft and Loss Account (enter tem 56 of Part A-P&L) )/ (enter tem 56 of Part A- P&L Ind AS) (as applcable) 5 Addtons (f debted n proft and loss account) a Income-tax pad or payable or ts provson ncludng the amount of deferred tax and the provson thereof b Reserve (except reserve under secton 33AC) c Provsons for unascertaned lablty d Provsons for losses of subsdary companes e Dvdend pad or proposed f Expendture related to exempt ncome under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] g Expendture related to share n ncome of AOP/ BOI on whch no ncome-tax s payable as per secton 86 h Expendture n case of foregn company referred to n clause (fb) of explanaton 1 to secton 115JB Notonal loss on transfer of certan captal assets or unts referred to n clause (fc) of explanaton 1 to secton 115JB j Expendture relatable to ncome by way of royalty n respect of patent chargeable to tax u/s 115BBF k Deprecaton attrbutable to revaluaton of assets l m Gan on transfer of unts referred to n clause (k) of explanaton 1 to secton 115JB Others (ncludng resdual unadjusted tems and provson for dmnuton n the value of any asset) n Total addtons (5a+5b+5c+5d+5e+5f+5g+5h+5+5j+5k+5l+5m) 5a 5b 5c 5d 5e 5f 5g 5h 5 5j 5k 5l 5m 4 5n 6 Deductons a Amount wthdrawn from reserve or provsons f credted to Proft and Loss account b Income exempt under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] c Amount wthdrawn from revaluaton reserve and 6c credted to proft and loss account to the extent t does not exceed the amount of deprecaton attrbutable to revaluaton of asset d Share n ncome of AOP/ BOI on whch no ncome-tax s payable as per secton 86 credted to Proft and Loss account e Income n case of foregn company referred to n clause (d) of explanaton 1 to secton 115JB f Notonal gan on transfer of certan captal assets or unts referred to n clause (e) of explanaton 1 to secton 115JB g Loss on transfer of unts referred to n clause (f) of explanaton 1 to secton 115JB h Income by way of royalty referred to n clause (g) of explanaton 1 to secton 115JB Loss brought forward or unabsorbed deprecaton whchever s less or both as may be applcable j Proft of sck ndustral company tll net worth s equal to or exceeds accumulated losses 6a 6b 6d 6e 6f 6g 6h 6 6j

168 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 417 k Others (ncludng resdual unadjusted tems and the amount of deferred tax credted to P&L A/c) l Total deductons (6a+6b+6c+6d+6e+6f+6g+6h+6+6j+6k) 6k 6l 7 Book proft under secton 115JB (4+ 5n 6l) 7 8 Whether the fnancal statements of the company are drawn up n complance to the Indan Accountng Standards (Ind-AS) specfed n Annexure to the companes (Indan Accountng Standards) Rules, If yes, furnsh the detals below:- A. Addtons to book proft under sub-sectons (2A) to (2C) of secton 115JB a b Amounts credted to other comprehensve ncome n statement of proft & loss under the head tems that wll not be reclassfed to proft & loss Amounts debted to the statement of proft & loss on dstrbuton of non-cash assets to shareholders n a demerger c One ffth of the transton amount as referred to n secton 115JB (2C) (f applcable) d Others (ncludng resdual adjustment) e Total addtons (8a + 8b + 8c + 8d) B. Deductons from book proft under sub-sectons (2A) to (2C) of secton 115JB f g Amounts debted to other comprehensve ncome n statement of proft & loss under the head tems that wll not be reclassfed to proft & loss Amounts credted to the statement of proft & loss on dstrbuton of non-cash assets to shareholders n a demerger h One ffth of the transton amount as referred to n secton 115JB (2C) (f applcable) Others (ncludng resdual adjustment) j Total deductons (8f + 8g + 8h + 8) 9 Deemed total ncome under secton 115JB (7 + 8e 8j) 9 10 Tax payable under secton 115JB 10 8a 8b 8c 8d 8e 8f 8g 8h 8 8j Yes No MAT CREDIT Schedule MATC Computaton of tax credt under secton 115JAA 1 Tax under secton 115JB n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2f of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse enter 0] 3 4 Utlsaton of MAT credt Avalable [Sum of MAT credt utlsed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of MAT Credt Brought Forward ] S.No Assessment Year v v v v v x x x (A) x (enter 1-2, f 1>2 else enter 0) x Total Gross (B1) MAT Credt Set-off n earler years (B2) Balance Brought forward (B3)=(B2)-(B1) MAT Credt Utlsed durng the Current Year 5 Amount of tax credt under secton 115JAA utlsed durng the year [enter 4(C)x] 5 6 Amount of MAT lablty avalable for credt n subsequent assessment years [enter 4(D)x] 6 (C) Balance MAT Credt Carred Forward (D)= (B3) (C)

169 418 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule- DDT DIVIDEND DISTRIBUTION TAX Detals of tax on dstrbuted profts of domestc companes and ts payment Sl Descrpton Detals of 1 st dvdend Detals of 2 nd dvdend Detals of 3 rd dvdend () () () (v) (v) Secton Under whch dvdend s beng declared Date of declaraton or dstrbuton or payment, whchever s earlest, of dvdend by domestc company Rate of dvdend, declared, dstrbuted or pad Amount of dvdend declared, dstrbuted or pad Amount of reducton as per secton 115-O(1A) Tax payable on dvdend declared, dstrbut ed or pad a b c d Addto nal or 30% as applcab le payable under secton 115-O on (4-5) Surchar ge on a Health & Educat on cess on (a+b) Total tax payable (a+b+c) Interest payable under secton 115P Addtonal ncome-tax and nterest payable (6d+7) 9 Tax and nterest pad Net payable/refundable (8-9) Date(s) of depost of dvdend dstrbuton tax Name of Bank and Branch 13 BSR Code 14 Seral number of challan 15 Amount deposted (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) Date 1 Date 2 Date 1 Date 2 Date 1 Date 2 (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY)

170 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 419 TAX ON BUY BACK OF SHARES Schedule- BBS Detals of tax on dstrbuted ncome of a domestc company on buy back of shares, not lsted on stock exchange Sl Descrpton Detals of 1 st buy-back Detals of 2 nd buy- back Detals of 3 rd buy- back () () () (v) (v) Date of payments of any consderaton to the shareholder on buy back of share Amount of consderaton pad by the company on buy-back of shares Amount receved by the company for ssue of such shares Dstrbuted Income of the company (2 3) Tax payable on dstrbute d ncome a b c d Addton al payable under secton 115QA on 4 Surchar ge on a Health & Educat on cess on (a+b) Total tax payable (a+b+c) Interest payable under secton 115QB Addtonal ncome-tax and nterest payable (5d + 6) 8 Tax and nterest pad Net payable/refundable (7-8) Date(s) of depost of tax on dstrbuton ncome Name of Bank and Branch 12 BSR Code 13 Seral number of challan 14 Amount deposted (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) Date 1 Date 2 Date 1 Date 2 Date 1 Date 2 (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) (DD/MM/YY YY) Schedule FSI INCOME FROM OUTSIDE INDIA AND TAX RELIEF Sl. Country Code Taxpayer Identfcaton Number 1 House Property Detals of Income from outsde Inda and tax relef Sl. Head of ncome Income from outsde Inda Busness or Professon (ncluded n PART B-TI) Tax pad outsde Inda Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f)

171 420 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Captal Gans v Other sources Total 2 House Property Busness or Professon Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR TAX RELIEF FOR TAX PAID OUTSIDE INDIA 1 Detals of Tax relef clamed Country Code Summary of tax relef clamed for taxes pad outsde Inda Taxpayer Identfcaton Number Total taxes pad outsde Inda (total of (c) of Schedule FSI n respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of total of 1(d)) Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total of 1(d)) Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below NOTE a Amount of tax refunded Please refer to the nstructons for fllng out ths schedule. b Assessment year n whch tax relef allowed n Inda Yes/No Schedule FA DETAILS OF FOREIGN ASSETS Detals of Foregn Assets and Income from any source outsde Inda A1 Detals of Foregn Depostory Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod) Sl No Country name Country code Name of fnancal nsttuton Address of fnancal nsttuton ZIP code Account number Status Account openng date Peak balance durng the perod Closng balance Gross nterest pad/credted to the account durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A2 Detals of Foregn Custodal Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country name Country code Name of fnancal nsttuton Address of fnancal nsttuton ZIP code Account number Status Account openng date Peak balance durng the perod Closng balance Gross amount pad/credted to the account durng the perod (drop down to be provded specfyng nature of amount vz. nterest/dvdend/proceeds from sale or redempton of fnancal assets/ other ncome) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

172 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 421 () () A3 Sl No Detals of Foregn Equty and Debt Interest held (ncludng any benefcal nterest) n any entty at any tme durng the relevant accountng perod Country name Country code Name of entty Address of entty ZIP code Nature of entty Date of acqurng the nterest Intal value of the nvestment Peak value Closng of value nvestment durng the perod Total gross amount pad/credted wth respect to the holdng durng the perod Total gross proceeds from sale or redempton of nvestment durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) () () A4 Sl No Detals of Foregn Cash Value Insurance Contract or Annuty Contract held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Country name Country code Name of fnancal nsttuton n whch nsurance contract held Address of fnancal nsttuton ZIP code Date of contract The cash value or surrender value of the contract Total gross amount pad/credted wth respect to the contract durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Nature of entty Name and Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Investment (at cost) (n rupees) Income accrued from such Interest Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Address of the Property Ownershp- Date of Total Drect/ acquston Investment (at Benefcal cost) (n rupees) owner/ Benefcary Income derved from the property Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl No Country Name and code Nature of Asset Ownershp- Drect/ Benefcal owner/ Benefcary Date of acquston Total Investment (at cost) (n rupees) Income derved from the asset Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detals of account(s) n whch you have sgnng authorty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod and whch has not been ncluded n A to D above. Sl Name of the Address of Name of Account Peak Balance/ Whether If (7) s If (7) s yes, Income offered n ths return

173 422 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] No Insttuton n the whch the Insttuton account s held the account holder Number Investment durng the year (n rupees) ncome accrued s taxable n your hands? yes, Income accrued n the account Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl No Country Name and code Name and address of the trust Name and address of trustees Name and address of Settlor Name and address of Benefcares Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust If (8) 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) (12) () () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon Country Name and code Name and address of the person from whom derved Income derved Nature of ncome Whether taxable n your hands? If (6) s yes, Income offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () NOTE Please refer to nstructons for fllng out ths schedule SCHEDULE SH-1 SHAREHOLDING OF UNLISTED COMPANY (other than a start-up for whch Schedule SH-2 s to be flled up) If you are an unlsted company, please furnsh the followng detals;- Detals of shareholdng at the end of the prevous year Name of the shareholder Resdental status n Inda Type of share PAN Date of allotment Number of shares held Face value per share Issue Prce per share Amount receved Detals of equty share applcaton money pendng allotment at the end of the prevous year Name of the applcant Resdental status n Inda Type of share PAN Date of applcaton Number of shares appled for Applcaton money receved Face value per share Proposed ssue prce Detals of shareholders who s not a shareholder at the end of the prevous year but was a shareholder at any tme durng the prevous year Name of the shareholder Resdental status n Inda Type of share PAN Number of shares held Face value per share Issue Prce per share Amount receved Date of allotment Date on whch cease to be shareholder Mode of cessaton In case of transfer, PAN of the new shareholder SCHEDULE SH-2 SHAREHOLDING OF START-UPS If you are a start-up whch has fled declaraton n Form-2 under para 5 of DPIIT notfcaton dated , please furnsh the followng detals of shareholdng;- Detals of shareholdng as at the end of the prevous year Name of the shareholder Category of shareholder (drop down to be provdednon-resdent/ venture captal company/ venture captal fund/ specfed company/ any other person) Type of share PAN Date of allotment Number of shares held Face value per share Issue Prce per share Pad up value per share Share premum

174 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 423 Detals of share applcaton money pendng allotment as at the end of the prevous year Name of the applcant Category of applcant (drop down to be provded- nonresdent/ venture captal company/ venture captal fund/ specfed company/ any other person) Type of share PAN Date of applcaton Total Number of shares appled for Face value per share Proposed ssue prce per share Share applcaton money Share applcaton premum Detals of shareholder who s not a shareholder at the end of the prevous year but was a shareholder at any tme durng the prevous year Name of the shareholder Category of shareholder (drop down to be provdednonresdent/ venture captal company/ venture captal fund/ specfed company/ any other person) Type of share PAN Date of allotment Number of shares held Face value per share Issue Prce per share Total Pad up value per share Date on whch ceased to be shareholder Mode of cessaton In case of transfer, PAN of the new shareholder NOTE For defnton of expressons venture captal company, venture captal fund and specfed company, please refer DPIIT notfcaton dated Schedule AL-1 DETAILS OF ASSETS AND LIABILITIES Assets and labltes as at the end of the year (mandatorly requred to be flled up by an unlsted company) (other than a start-up for whch Schedule AL-2 s to be flled up) A Detals of buldng or land appurtenant there to, or both, beng a resdental house Sl. No. Address Pn code Date of acquston Cost of acquston Rs. Purpose for whch used (dropdown to be provded) (1) (2) (3) (4) (5) (6) () () B Detals of land or buldng or both not beng n the nature of resdental house Sl. No. Address Pn code Date of acquston Cost of acquston Rs. Purpose for whch used (dropdown to be provded) (1) (2) (3) (4) (5) (6) () C Detals of lsted equty shares No. of shares Openng balance Type of shares Cost of acquston Shares acqured durng the year No. of shares Type of shares Cost of acquston Shares transferred durng the year No. of shares Type of share s Sale consderato n No. of shares Closng balance Type of shares Cost of acquston D Detals of unlsted equty shares Name of company PAN Openng balance Shares acqured durng the year Shares transferred durng the year Closng balance

175 424 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] No. of share s Cost of acquston No. of shares Date of subscrpto n / purchase Face value per share Issue prce per share (n case of fresh ssue) Purchase prce per share (n case of purchase from exstng shareholder ) No. of shares Sale consderat on No. of shares Cost of acqust on E Detals of other securtes Type of securte s Whethe r lsted or unlste d Openng balance No. of securte s Cost of acqust on No. of securte s Securtes acqured durng the year Date of subscrpto n/ purchase Face value per share Issue prce of securt y (n case of fresh ssue) Purchase prce per securty (n case of purchase from exstng holder) Securtes transferred durng the year No. of securte s Sale consderaton Closng balance No. of securt es Cost of acqust on F Detals of captal contrbuton to other entty Name of entty PAN Openng balance Amount contrbuted durng the year Amount wthdrawn durng the year Amount of proft/loss/ dvdend/ nterest debted or credted durng the year Closng balance G Detals of Loans & Advances to any other concern (If money lendng s not assessee s substantal busness ) Name of the person PAN Openng Balance Amount receved Amoun t pad Interest debted, f any Closng balance Rate of nterest (%) H Detals of motor vehcle, arcraft, yacht or other mode of transport Partculars of asset Regstraton number of vehcle Cost of acquston Date of acquston Purpose for whch used (dropdown to be provded) I Detals of Jewellery, archaeologcal collectons, drawngs, pantngs, sculptures, any work of art or bullon Partculars of asset Quantty Cost of acquston Date of acquston Purpose of use (dropdown to be provded) J Detals of labltes Detals of loans, deposts and advances taken from a person other than fnancal nsttuton Name of the person PAN Openng Balance Amount receved Amount pad Interest credted, f any Closng balance Rate of nterest (%) NOTE Please refer to nstructons for fllng out ths schedule.

176 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 425 Schedule AL- 2 Assets and labltes as at the end of the year (applcable for start-ups only) If you are a start-up whch has fled declaraton n Form-2 under para 5 of DPIIT notfcaton dated , please furnsh the followng nformaton for the perod from the date of ncorporaton upto end of the year;- A Detals of buldng or land appurtenant there to, or both, beng a resdental house acqured snce ncorporaton Sl. No. Address Pn code Date of acquston Cost of acquston Rs. Purpose for whch used (dropdown to be provded) Whether transferred on or before the end of the prevous year, f Yes date of transfer (1) (2) (3) (4) (5) (6) (7) () DETAILS OF ASSETS AND LIABILITIES () B Detals of land or buldng or both not beng a resdental house acqured snce ncorporaton Sl. No. Address Pn code Date of acquston Cost of acquston Rs. Purpose for whch used (dropdown to be provded) Whether transferred on or before the end of the prevous year, f Yes date of transfer (1) (2) (3) (4) (5) (6) (7) () C Detals of Loans & Advances made snce ncorporaton (If lendng of money s not assessee s substantal busness) Name of person PAN Date on whch Amount of loans loans and advances and advances has been made Amount Whether loans and advances has been repad, f Yes date of such repayment Closng balance as at the end of the prevous year, f any Rate of nterest, f any D Detals of captal contrbuton made to any other entty snce ncorporaton Name of entty PAN Date on whch captal contrbuton has been made Amount of contrbuton Amount wthdrawn, f any Amount of proft/loss/ dvdend/ nterest debted or credted Closng balance as at the end of the prevous year, f any E Detals of acquston of shares and securtes Name of company/entty PAN Type of shares/securtes Number of shares/securtes acqured Cost of acquston Date of acquston Whether transferred, f Yes date of transfer Closng balance as at the end of the prevous year, f any F Detals of motor vehcle, arcraft, yacht or other mode of transport, the actual cost of whch exceeds ten lakh rupees acqured snce ncorporaton Partculars of asset Regstraton number of vehcle Cost of acquston Date of acquston Purpose for whch used (dropdown to be provded) Whether transferred, f Yes date of transfer G Detals of Jewellery acqured snce ncorporaton Partculars of asset Quantty Cost of acquston Date of acquston Purpose for whch used (dropdown to be provded) Whether Closng transferred, balance as at f Yes date the end of the of transfer prevous year, f any

177 426 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] H Detals of archaeologcal collectons, drawngs, pantngs, sculptures, any work of art or bullon acqured snce ncorporaton Partculars of asset Quantty Cost of acquston Date of acquston Purpose for whch used (dropdown to be provded) Whether Closng transferred, balance as at f Yes date the end of the of transfer prevous year, f any I Detals of labltes Detals of loans, deposts and advances taken from a person other than fnancal nsttuton Name of the person PAN Openng Balance Amount receved Amount pad Interest credted, f any Closng balance Rate of nterest (%) NOTE Please refer to nstructons for fllng out ths schedule. Schedule GST DETAILS OF GST INFORMATION REGARDING TURNOVER/GROSS RECEIPT REPORTED FOR GST Sl. No. GSTIN No(s). Annual value of outward supples as per the GST return(s) fled (1) (2) (3) NOTE Please furnsh the nformaton above for each GSTIN No. separately Schedule FD Foregn Currency Transacton S. No. Break-up of payments/recepts n Foregn currency (to be flled up by the assessee who s not lable to get accounts audted u/s 44AB) Payments made durng the year on captal account Payments made durng the year on revenue account Recepts durng the year on captal account v Recepts durng the year on revenue account NOTE Please refer to nstructons for fllng out ths schedule. Amount (n Rs.) Part B - TI Computaton of total ncome Part B 1 Income from house property ( 4 of Schedule-HP) (enter nl f loss) 1 2 Profts and gans from busness or professon Profts and gans from busness other than speculatve busness and specfed busness (A39 of Schedule BP) (enter nl f loss) 2 TOTAL INCOME Profts and gans from speculatve busness (B44 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) Profts and gans from specfed busness ( C50 of Schedule BP)(enter nl f loss and take the fgure to schedule CFL) v Income chargeable to tax at specal rates (3d and 3e of Schedule BP) v Total ( v ) 3 Captal gans a Short term Short-term 15% (9 of tem E of schedule CG) Short-term 30% (9 of tem E of schedule CG) a 2 2 2v a 2v

178 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 427 v Short-term chargeable at applcable rate ( 9v of tem E of schedule CG) Short-term chargeable at specal rates n Inda as per DTAA (9v of tem E of Schedule CG) v Total Short-term (a + a + a + av) (enter nl f loss) b Long-term Long-term 10% (9v of tem E of schedule CG) b Long-term 20% (9v of tem E of schedule CG) b Long-term chargeable at specal rates n Inda as per DTAA (9v of tem E of schedule CG) v Total Long-term (b + b + b) (enter nl f loss) c Total captal gans (3av + 3bv) (enter nl f loss) 4 Income from other sources a Net ncome from other sources chargeable to tax at normal applcable rates ( 6 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate ( 2 of Schedule OS) c Income from the actvty of ownng and mantanng race horses ( 8e of Schedule OS) (enter nl f loss) d Total (4a + 4b + 4c) 5 Total of head wse ncome (1 + 2v + 3c + 4d) 5 6 Losses of current year to be set off aganst 5 (total of 2xv, 3xv and 4xv of Schedule CYLA) 6 7 Balance after set off current year losses (5 6) (total of column 5 of schedule CYLA + 4b + 2v) 7 8 Brought forward losses to be set off aganst 7 (total of 2xv, 3xv and 4xv of Schedule BFLA) 8 9 Gross Total ncome (7 8) ( 5xv of Schedule BFLA + 4b + 2v) 9 10 Income chargeable to tax at specal rate under secton 111A, 112, 112A etc. ncluded n Deductons under Chapter VI-A a Part-B of Chapter VI-A [1 of Schedule VI-A and lmted upto (9-10)] b Part-C of Chapter VI-A [2 of Schedule VI-A and lmted upto (9-10-2)] c Total (11a + 11b) [lmted upto (9-10)] 12 Deducton u/s 10AA (c of Sch. 10AA) Total ncome (9-11c - 12) Income chargeable to tax at specal rates (total of () of schedule SI) Income chargeable to tax at normal rates (13-14) Net agrcultural ncome( 3 of Schedule EI) Losses of current year to be carred forward (total of x of Schedule CFL) Deemed total ncome under secton 115JB (9 of Schedule MAT) 18 4a 4b 4c a av 3av b bv 3c 4d 11a 11b 11c Part B - TTI Computaton of tax lablty on total ncome 1 a Tax Payable on deemed total Income under secton 115JB (10 of Schedule MAT) 1a COMPUTATION OF TAX LIABILITY b Surcharge on (a) above (f applcable) 1b c Health and Educaton 4%on (1a+1b) above 1c d Total Tax Payable u/s 115JB (1a+1b+1c) 1d 2 Tax payable on total ncome a Tax at normal rates on 15 of Part B-TI 2a b Tax at specal rates (total of col. () of Schedule-SI) 2b c Tax Payable on Total Income (2a + 2b) 2c d Surcharge 25% of 12() of Schedule SI 2d On [(2c) (12() of Schedule SI)] 2d Total ( + ) 2d

179 428 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] e Health and Educaton 4% on (2c+2d) f Gross tax lablty (2c+2d+2e) 3 Gross tax payable (hgher of 1d and 2f) 3 4 Credt under secton 115JAA of tax pad n earler years (f 2f s more than 1d) ( 5 of Schedule MATC) 4 5 Tax payable after credt under secton 115JAA [ (3-4)] 5 6 Tax relef a Secton 90/90A(2 of Schedule TR) b Secton 91(3 of Schedule TR) c Total (6a + 6b) 7 Net tax lablty (5 6c) (enter zero f negatve) 7 8 Interest and fee payable a Interest for default n furnshng the return (secton 234A) b Interest for default n payment of advance tax (secton 234B) c Interest for deferment of advance tax (secton 234C) 6a 6b 8a 8b 8c 2e 2f 6c d Fee for default n furnshng return of ncome (secton 234F) 8d TAXES PAID e Total Interest and Fee Payable (8a+8b+8c+8d) 8e 9 Aggregate lablty (7 + 8e) 9 10 Taxes Pad a Advance Tax (from column 5 of 15A) 10a b TDS (total of column 9 of 15B) 10b c TCS (total of column 7 of 15C) 10c d Self-Assessment Tax (from column 5 of 15A) 10d e Total Taxes Pad (10a+10b+10c + 10d) 10e 11 Amount payable (9-10e) (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (Refund, f any, wll be drectly credted nto the bank account) 12 BANK ACCOUNT 13 Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) (In case of non-resdents, detals of any one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bank n case of Bank Accounts held n Inda (SWIFT Code n case of foregn Bank Account) Name of the Bank Account Number (IBAN n case of foregn Bank Accounts) Indcate the account n whch you prefer to get your refund credted, f any (tck one account ) 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? Yes No A 15 TAX PAYMENTS ADVANCE/ SELF ASSESSMENT TAX Detals of payments of Advance Tax and Self-Assessment Tax Sl No BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) (1) (2) (3) (4) (5) NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI

180 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 429 B Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued or Form 16B/16C furnshed by Deductor(s)] Sl No TDS credt relatng to self /other person [spouse as per secton 5A/other person as per rule 37BA(2)] PAN of Other Person (f TDS credt related to other person) TAN of the Deductor/ PAN of Tenant/ Buyer Unclamed TDS brought forward (b/f) Fn. TDS Year n b/f whch deducted TDS of the current Fn. Year Deducted n own hands Deducted n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) TDS credt beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Clamed n own hands Clamed n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) Correspondng Income offered Gross Amount Head of Income (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Income TDS Income TDS PAN TDS credt beng carred forward NOTE Please enter total of column 9 n10b of Part B- TTI C TCS ON INCOME Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Tax Collecton Account Number of the Collector Name of the Collector Unclamed TCS brought forward (b/f) Fn. Year n whch collected Amount b/f TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (5) or (6) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) n 10c of Part B-TTI VERIFICATION I, son/ daughter of, solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and the schedules thereto s correct and complete s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng ths return n my capacty as (drop down to be provded and I am also competent to make ths return and verfy t. I am holdng permanent account number (f allotted) (Please see nstructon). I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Date Sgn here

181 430 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] FORM ITR-7 INDIAN INCOME TAX RETURN [For persons ncludng companes requred to furnsh return under sectons 139(4A) or 139(4B) or 139(4C) or 139(4D) only] (Please see rule 12 of the Income-tax Rules, 1962) (Please refer nstructons for gudance) Assessment Year Part A-GEN Name (as mentoned n deed of creaton/ establshng/ ncorporaton/ formaton) PAN PERSONAL INFORMATION Flat/Door/Block No Name Of Premses/Buldng/Vllage Date of formaton/ncorporaton (DD/MM/YYYY) Road/Street/Post Offce Area/Localty Status (see nstructons Town/Cty/Dstrct State Pn code/zp code para 11b) Offce Phone Number wth STD code/moble No. 1 Fax Number/Moble No. 2 Emal Address 1 / / Sub Status (see nstructons para 11b) Emal Address 2 Whether any project/nsttuton s run by the assessee? (Yes/No) If Yes, then please furnsh the detals: Detals of the projects/nsttutons run by you Sl. Name of the project/nsttuton (see nstructon para 11ca) Nature of actvty (see nstructon para 11d) Classfcaton (see nstructons para 11d) Detals of regstraton or approval under the Income-tax Act (Mandatory, f requred to be regstered) Sl Secton under whch regstered or approved Date of regstraton or approval Approval/ Notfcaton/ Regstraton No. Approvng/ regsterng Authorty Detals of regstraton or approval under any law other than Income-tax Act Sl. Law under whch regstered Date of regstraton or approval Approval/ Notfcaton/ Regstraton No. Approvng/ regsterng Authorty For Offce Use Only For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal

182 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 431 FILING see nstructon ] Or fled n response to notce u/s STATUS (a) Return fled u/s (Tck) [Please 139(1)-On or before due date, 139(4)-After due date, 139(5)-Revsed Return, 92CD-Modfed return, 119(2)(b)- after condonaton of delay. 139(9), 142(1), 148, 153A 153C (b) Return furnshed under secton 139(4A) 139(4B) 139(4C) 139(4D) Others (c) (d) Please specfy the secton under whch the exempton s clamed (dropdown to be provded) If revsed/ defectve/modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b), enter date of such notce/order, or f fled u/s 92CD enter date of advance prcng agreement (e) Resdental status? (Tck) Resdent Non-resdent (f) / / Whether any ncome ncluded n total ncome for whch clam under secton 90/90A/91 has been made? Yes No [applcable n the case of resdent] [f yes, ensure to fll Schedule FSI and Schedule TR] / / (g) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Capacty of the Representatve (drop down to be provded) (3) Address of the representatve (4) Permanent Account Number (PAN) of the representatve (h) Whether you are Partner n a frm? (Tck) Yes No Name of Frm If yes, please furnsh followng nformaton PAN () Whether you have held unlsted equty shares at any tme durng the prevous year? (Tck) Yes No If yes, please furnsh followng nformaton n respect of equty shares Name of company PAN Openng balance Shares acqured durng the year Shares transferred durng the year Closng balance No. of shares Cost of acquston No. of shares Date of subscrpton / purchase Face value per share Issue prce per share (n case of fresh ssue) Purchase prce per share (n case of purchase from exstng shareholder) No. of shares Sale consderaton No. of shares Cost of acquston A Where, n any of the projects/nsttutons run by you, one of the chartable purposes s advancement of any other object of general publc utlty then,- a Whether there s any actvty n the nature of trade, commerce or busness referred to n provso to secton 2(15)? Yes No If yes, then percentage of recept from such actvty vs-à-vs total recepts % OTHER DETAILS b Whether there s any actvty of renderng any servce n relaton to any trade, commerce or busness for any consderaton as referred to n provso to secton 2(15)? Yes If yes, then percentage of recept from such actvty vs-à-vs total recepts % If a or b s YES, the aggregate annual recepts from such actvtes n respect of that nsttuton No Sl. Name of the project/insttuton a Amount of aggregate annual recepts from such actvtes b B Whether approval obtaned u/s 80G? Yes No

183 432 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] C D If yes, then enter Approval No. Date of Approval (DD/MM/YYYY) / / Is there any change n the objects/actvtes durng the Year on the bass of whch approval/regstraton was granted? Yes No If yes, please furnsh followng nformaton:- a date of such change (DD/MM/YYYY) b Whether an applcaton for fresh regstraton has been made n the prescrbed form and manner wthn the stpulated perod of thrty days as per Clause (ab) of sub-secton (1) of secton 12A / / Yes No c Whether fresh regstraton has been granted under secton 12AA Yes No d date of such fresh regstraton (DD/MM/YYYY) Whether regstered under Foregn Contrbuton (Regulaton) Act, 2010 / / (FCRA)? Yes No If yes, then enter Regstraton No. Date of Regstraton (DD/MM/YYYY) / / v a Total amount of foregn contrbuton receved durng the year, f any b Specfy the purpose for whch the above contrbuton s receved Rs. E Whether a busness trust regstered wth SEBI? Yes No F If yes, then enter Regstraton No. Date of Regstraton (DD/MM/YYYY) / / Whether lable to tax at maxmum margnal rate under secton 164? (If dsallowable u/s 13(1)(c) and/or 13(1)(d))? Yes No G Is ths your frst return? Yes No Are you lable for audt under the Income-tax Act?(Tck) Yes No, If yes, furnsh followng H nformaton- Secton under whch you are lable for audt (specfy secton). Please menton date of audt report. (DD/MM/YY) (see Instructon 6()) AUDIT INFORMATION MEMBER S INFORMATION 12A I J a b c d e Name of the audtor sgnng the tax audt report Membershp No. of the audtor Name of the audtor (propretorshp/ frm) Permanent Account Number (PAN) of the propretorshp/ frm Date of audt report f Date of furnshng of the audt report / / (DD/MM/YYYY). If lable to audt under any Act other than the Income-tax Act, menton the Act, secton and date of furnshng the audt report? Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) Partculars of persons who were members n the AOP on 31 st day of March, 2019 (to be flled by venture captal fund/nvestment fund) Percentage of Aadhaar Number/ Status S.No Name and Address share (f PAN Enrolment Id (f elgble for determnate) Aadhaar) (1) (2) (3) (4) (5) (6)

184 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 433 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule I Year of accumulaton (F.Yr.) Detals of amounts accumulated / set apart wthn the meanng of secton 11(2)) or n terms of thrd provso to secton 10(23C) Amount Purpose of accumulated accumulaton n the year of accumulaton Amount appled for chartable/ relgous purposes upto the begnnng of the prevous year Amount nvested or deposted n the modes specfed n secton 11(5) Amounts appled for chartable or relgous purpose durng the prevous year Balance amount avalable for applcaton (7) = (2) - (4) (6) (1) (2) (3) (4) (5) (6) (7) (8) Total Amount deemed to be ncome wthn meanng of sub-secton (3) of secton 11 Statement showng the funds and nvestments as on the last day of the prevous year [to be flled f Schedule J regstered under secton 12A/12AA or approved under secton 10(23C)(v)/10(23C)(v)/ 10(23C)(v)/10(23C)(va)/10(21)] A Balance n the corpus fund as on the last day of the prevous year Rs. Balance n the non-corpus fund as on the last day of the prevous year B Detals of nvestment/deposts made under secton 11(5) Sl. No. Mode of nvestment as per secton 11(5) Date of nvestment Date of maturty Rs. Amount of nvestment Maturty amount DETAILS OF INVESTMENT OF FUNDS (1) (2) (3) (4) (5) (6) Investment n Government Savng Scheme Post Offce Savng Bank Depost n Schedule Bank or co-operatve socetes as per secton 11(5)() v Investment n UTI v Any Other v TOTAL C Investment held at any tme durng the prevous year (s) n concern (s) n whch persons referred to n secton 13(3) have a substantal nterest Sl. Name and address Where the Number of Class of Nomnal Income from Whether the amount n col No. of the concern concern s a shares held shares value of the (6) exceeds 5 percent of the company held the nvestment captal of the concern (tck as applcable nvestment durng the prevous year (tck as applcable ) (1) (2) (3) (4) (5) (6) (7) (8) Yes No Yes No Yes No Yes No

185 434 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Yes No Yes No v Yes No Yes No v Yes No Yes No TOTAL D Other nvestments as on the last day of the prevous year Sl. No. Name and address of the concern Whether the concern s a company (tck as applcable ) Class of shares held Number of shares held Nomnal value of nvestment (1) (2) (3) (4) (5) (6) Yes No Yes No Yes No v Yes No v TOTAL E Voluntary contrbutons/donatons receved n knd but not converted nto nvestments n the specfed modes u/s 11(5) wthn the tme provded Sl.. No. Name and address of the donor Value of contrbuton/ donaton Value of contrbuton appled towards objectve Amount out of (3) nvested n modes prescrbed under secton 11(5) Balance to be treated as ncome under secton 11(3) (1) (2) (3) (4) (5) (6) v TOTAL Schedule K Statement of partculars regardng the Author(s) / Founder(s) / Trustee(s) / Manager(s), etc., of the Trust or Insttuton (to be mandatorly flled n by all persons flng ITR-7) A Name(s) of author(s) / founder(s) / Settlor(s) and address(es), f alve Sl. Name and address PAN Aadhaar Number/ Enrolment Id (f avalable) B Name(s) of the person(s) who was / were trustee(s) / manager(s) durng the prevous year(s) Sl. Name and address PAN Aadhaar Number/ Enrolment Id (f avalable) C Name(s) of the person(s) who has / have made substantal contrbuton to the trust / nsttuton n terms of secton 13(3)(b) Sl. Name and address PAN Aadhaar Number/ Enrolment Id (f avalable)

186 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 435 Name(s) of relatve(s) of author(s), founder(s), trustee(s), manager(s), and substantal contrbutor(s) and where D any such author, founder, trustee, manager or substantal contrbutor s a Hndu undvded famly, also the names of the members of the famly and ther relatves Sl. Name and address PAN Aadhaar Number/ Enrolment Id (f avalable) Schedule LA POLITICAL PARTY Poltcal Party 1 Whether books of account were mantaned? (tck as applcable ) Yes No 2 Whether any voluntary contrbuton from any person n excess of twenty a thousand rupees was receved durng the year? (tck as applcable ) Yes No If yes, whether record of each voluntary contrbuton (other than contrbutons b by way of electoral bonds) n excess of twenty thousand rupees (ncludng name and address of the person who has made such contrbuton) were mantaned? (tck as applcable ) Yes No 3 Whether the accounts have been audted? (tck as applcable ) Yes No If yes, furnsh the followng nformaton:- a Date of furnshng of the audt report (DD/MM/YYYY) / / b c d e f Name of the audtor sgnng the audt report Membershp No. of the audtor Name of the audtor (propretorshp/ frm) Propretorshp/frm regstraton No. Permanent Account Number (PAN) of the audtor (propretorshp/ frm) g Date of audt report 4 Whether any donaton exceedng two thousand rupees was receved otherwse than by an account payee cheque or account payee bank draft or use of electronc clearng system through a bank account or through electoral bond? (tck as applcable ) 5 Whether the report under sub-secton (3) of secton 29C of the Representaton of the People Act, 1951 for the fnancal year has been submtted?(tck as applcable ) 6 If yes, then date of submsson of the report (DD/MM/YYYY) Yes Yes No No / / Schedule ET ELECTORAL TRUST Electoral Trust 1 Whether books of account were mantaned? (tck as applcable ) Yes No 2 Whether record of each voluntary contrbuton (ncludng name, address and PAN of the person who has made such contrbuton along wth the mode of contrbuton) Yes No were mantaned? (tck as applcable ) 3 Whether record of each elgble poltcal party to whom the dstrbutable contrbutons have been dstrbuted (ncludng name, address, PAN and regstraton Yes No number of elgble poltcal party) was mantaned? (tck as applcable ) 4 Whether the accounts have been audted as per rule 17CA(12)? (tck as applcable ) Yes No If yes, date of audt report n Form No.10BC (DD/MM/YYYY ) 5 Whether the report as per rule 17CA(14) furnshed to the Commssoner of Incometax or Drector of Income-tax?(tck as applcable ) 6 Detals of voluntary contrbutons receved and amounts dstrbuted durng the year Openng balance as on 1 st Aprl Voluntary contrbuton receved durng the year Total ( + ) v Amount dstrbuted to Poltcal partes v v Amount spent on admnstratve and management functons of the Trust v v Total (v + v) v v Total amount elgble for exempton under secton 13B v / / Yes No

187 436 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule VC A B v Closng balance as on 31 st March ( v) v Local Voluntary Contrbutons (to be mandatorly flled n by all persons flng ITR-7) Corpus fund donaton A Other than corpus fund donaton (a) (b) (c) (d) Grants Receved from Government Grants Receved from Companes under Corporate Socal Responsblty Other specfc grants Other Donatons (e) Total Ae Voluntary contrbuton local (A + Ae) A Foregn contrbuton Corpus fund donaton B Other than corpus fund donaton B Foregn contrbuton (B + B) B C Total Contrbutons (A + B) C D Anonymous donatons, ncluded n C, chargeable u/s 115BBC Aggregate of such anonymous donatons receved 5% of total donatons receved at C or 1,00,000 whchever s hgher Anonymous donatons chargeable u/s 30% ( ) Schedule AI Aggregate of ncome derved durng the prevous year excludng Voluntary contrbutons [to be flled by assesses clamng exempton u/s 11 and 12 or u/s 10(23C)(v)/(v)/(v)/(va)] 1 Recepts from man objects 1 2 Recepts from ncdental objects 2 3 Rent 3 4 Commsson 4 5 Dvdend ncome 5 6 Interest ncome 6 7 Agrculture ncome 7 8 Net consderaton on transfer of captal asset 8 AGGREGATE OF INCOME 9 Any other ncome (specfy nature and amount) 10 a b c d Nature a b c d Amount e Total (9a+ 9b+ 9c +9d) e 9e Total 10 Revenue expendture ncurred durng the year and amount appled to stated objects of the trust/nsttuton Schedule ER durng the prevous year - Revenue Account [to be flled by assessee clamng exempton u/s 11 and 12 or u/s 10(23C)(v),(v),(v),(va)] Amount A Establshment and Admnstratve expenses 1 Rents 1 2 Repars and mantenance 2 3 Compensaton to employees 3

188 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 437 B 4 Insurance 4 5 Workmen and staff welfare expenses 5 6 Entertanment and Hosptalty 6 7 Advertsement 7 8 Professonal / Consultancy fees / Fee for techncal servces 8 9 Conveyance and Travelng expenses other than on foregn travel 9 10 Remuneraton to Trustee Rates and taxes, pad or payable to Government or any local body 11 (excludng taxes on ncome) 12 Interest Audt fee Deprecaton and amortzaton cost of whch s not already clamed as applcaton n same or any other prevous year Other expenses (Specfy nature and amount) a b c d Nature a b c d Amount e Total (15a+ 15b+ 15c+ 15d) e Total (A1 to A15) A16 Expendture on objects of the trust/nsttuton Donaton 1 Corpus Other than Corpus Relgous Relef of poor Educatonal Yoga Medcal relef 7 Preservaton of envronment 7 8 Preservaton of monuments etc. 8 9 General publc utlty 9 10 Total (B 1 to B9) B10 C Dsallowable expendture (C1 + C2 + C3) C 1 Bad debts 1 2 Provsons 2 3 Any other dsallowable expendture 3 D Total Revenue expendture ncurred durng the year (A16 + B10 + C) D E Source of fund to meet revenue expendture E 1 Income derved from the property/ncome earned durng prevous year 1 2 Income deemed as applcaton n any precedng year under clause 2 of explanaton 1 of secton 11(1) (applcable only when exempton s clamed u/s 11 and 12) 2 3 Income of earler years upto 15% accumulated or set apart 3 4 Borrowed Fund 4 5 Any other (Please specfy)

189 438 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule EC Amount appled to chartable or relgous purposes n Inda or for the stated objects of the trust/nsttuton durng the prevous year Captal Account [excludng amount exempt u/s 11(1A)] [to be flled by assesses clamng exempton u/s 11 and 12 or u/s 10(23C)(v)/(v)/(v)/(va)] 1 Addton to Captal work n progress (for whch exempton u/s 11(1A) has not been clamed) 1 2 Acquston of captal asset (not clamed earler as applcaton of ncome and for whch exempton u/s 11(1A) has not been clamed) 2 3 Cost of new asset for clam of Exempton u/s 11(1A) (restrcted to the net consderaton (row 8 of schedule AI, f new asset s not applcaton towards object) 3 4 Other captal expenses v Total expenses ( ) 4 Amount 5 Total captal expenses ( ) 5 A Source of fund to meet captal expendture 1 Income derved from the property durng prevous year 1 2 Income deemed as applcaton n any precedng year under clause 2 of explanaton 1 of secton 11(1) 2 3 Income of earler years upto 15% accumulated or set apart 3 4 Borrowed Fund 4 5 Any other (Please specfy) 5 Schedule IE Income & Expendture statement (Applcable for assessees clamng exempton under sectons 10(21), 10(22B), 10(23AAA), 10(23B), 10(23D), 10(23DA), 10(23EC), 10(23ED), 10(23EE), 10(29A), 10(46), 10(47) and other clauses of secton 10 where ncome s uncondtonally exempt) Total recepts ncludng any voluntary contrbuton 1 Applcaton of ncome towards object of the nsttuton 2 Accumulaton of ncome 3 Schedule IE- 2 Income & Expendture statement (Applcable for assessees clamng exempton under sectons 10(23A), 10(24) A B Total recepts ncludng any voluntary contrbuton 1 Applcaton of ncome towards object of the nsttuton 2 Accumulaton of ncome 3 Do you have any ncome whch s taxable? If Yes Please provde detals of taxable ncome (Tck ) Yes No a Income from House Property (Please fll Schedule HP) 1a b Income from Busness or Professon (Please fll Schedule BP) 1b c Income from Captal gans (Please fll Schedule CG) 1c d Income from other Sources (Please fll Schedule OS) 1d Schedule IE- 3 Income & Expendture statement (applcable for assessees clamng exempton under sectons 10(23C)(ab) or 10(23C)(ac) (please fll up separate schedule for each nsttuton): 1 Objectve of the nsttuton (drop down to be provded - Educatonal / Medcal) 2 Addresses where actvty s carryng out 3 Total recepts ncludng any voluntary contrbuton 4 Government Grants out of Sl. No. 3 above 5 Amount appled for objectve 6 Balance accumulated Schedule IE- 4 Income & Expendture statement (applcable for assessees clamng exempton under sectons 10(23C)(ad) or 10(23C)(ae)( (please fll up separate schedule for each nsttuton): 1 Objectve of the nsttuton (drop down to be provded - Educatonal / Medcal) 2 Addresses where actvty s carryng out 3 Gross Annual recepts 4 Amount appled for objectve 5 Balance accumulated

190 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 439 Detals of Income from House Property (Please refer to nstructons) (Drop down to be provded ndcatng Schedule HP ownershp of property) Address of property 1 Town/ Cty State PIN Code/ Zp Code 1 Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner(s) (optonal) Percentage Share n Property I II HOUSE PROPERTY 2 [Tck the applcable opton] Let out Deemed let out Name(s) of Tenant (f let out) I II PAN of Tenant(s) (f avalable) PAN/TAN of Tenant(s) (f TDS credt s clamed) a Gross rent receved or recevable or letable value 1a b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2)of the Act) 1e f 30% of 1e 1f g Interest payable on borrowed captal 1g h Total (1f + 1g) 1h Arrears/Unrealsed rent receved durng the year less 30% 1 j Income from house property 1 (1f 1 + 1j) 1j Address of property 2 Town/ Cty State PIN Code/ Zp Code Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner(s) (optonal) Percentage Share n Property I II [Tck the applcable opton] Let out Deemed let out Name(s) of Tenant (f let out) I II PAN of Tenant(s) (Please see note) Gross rent receved/ recevable/ letable value (hgher of the two, f let out for whole of a 2a the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) 2e f 30% of 2f 2f g Interest payable on borrowed captal 2g h Total (2f + 2g) 2h Arrears/Unrealsed rent receved durng the year less 30% 2 j Income from house property 2 (2e 2h + 2j) 2j 3 Pass through ncome f any * 3 Income under the head Income from house property (1j + 2j + 3) 4 (f negatve take the fgure to 2 of schedule CYLA) 4 NOTE Furnshng of PAN of tenant s mandatory, f tax s deducted under secton 194-IB. Furnshng of TAN of tenant s mandatory, f tax s deducted under secton 194-I. PAN/TAN of Tenant(s) (Please see note)

191 440 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule CG Captal Gans A Short-term captal gan 1 From assets (shares/unts) where secton 111A s applcable (STT pad) a Full value of consderaton 1a b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (1a bv) 1c d Loss, f any, to be gnored under secton 94(7) or 1d 94(8) (Enter postve value only) CAPITAL GAINS e Short-term captal gan (1c +1d) 2 From assets where secton 111A s not applcable a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (2a bv) 2c d Loss, f any, to be gnored under secton 94(7) or 94(8) (Enter 2d postve value only) e Short-term captal gan (2c + 2d) 2e 3 Deemed short term captal gan on deprecable assets A3 4 Exempton other than u/s 11(1A), f any (pls. specfy secton) A4 5 Pass Through Income n the nature of Short Term Captal Gan, (Fll up schedule PTI) (A5a + A5b + A5c) Pass Through Income n the nature of Short Term Captal Gan, a A5a 15% Pass Through Income n the nature of Short Term Captal Gan, A5b b chargeable at applcable rates 6 Total short term captal gan (A1e + 2e + A3 - A4 + A5) A6 B Long term captal gan 1 From asset where provso under secton 112(1) s not applcable a In case assets sold nclude shares of a company other than quoted shares, enter the followng detals a Full value of consderaton receved/recevable n respect of unquoted shares b Far market value of unquoted shares determned n the prescrbed manner c Full value of consderaton n respect of unquoted shares adopted as per secton 50CA for the purpose of Captal Gans (hgher of a or b) Full value of consderaton n respect of assets other than unquoted shares Total (c + ) b Deductons under secton 48 Cost of acquston after ndexaton b a b c a a 1b a b c a a A1e A5

192 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 441 Cost of mprovement after ndexaton b Expendture on transfer b v Total (b + b +b) bv c Balance (1a bv) 1c d Long-term captal gans where provso under secton 112(1) s not applcable 2 From asset where provso under secton 112(1)/112A s applcable (wthout ndexaton) a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture on transfer b v Total (b + b +b) bv c Balance (2a bv) 2c d Exempton other than u/s 11(1A), f any (pls. specfy secton) e Exempton u/s 112A f Balance after exempton (2c-2d-2e) g Long-term captal gans where provso under secton 112(1)/112A s applcable 2e 2f) 3 Pass Through Income n the nature of Long Term Captal Gan, (Fll up schedule PTI) (B3a + B3b) a Pass Through Income n the nature of Long Term Captal Gan, 10% Pass Through Income n the nature of Long Term Captal Gan, b 20% B3b 4 Total long term captal gan (B1e + B2g + B3) B4 C Income chargeable under the head CAPITAL GAINS (A6 + B4) (enter B4 as nl, f C loss) Schedule OS OTHER SOURCES Income from other sources 1 Gross ncome chargeable to tax at normal applcable rates (1a+ 1b+ 1c+ 1d + 1e) 1 a Dvdends, Gross b Interest, Gross From Savngs Bank From Deposts (Bank/ Post Offce/ Cooperatve) Socety) From Income-tax Refund v In the nature of Pass through ncome v Others bv c Rental ncome from machnery, plants, buldngs, etc., Gross Income of the nature referred to n secton 56(2)(x) whch s d chargeable to tax (d + d + d + dv + dv) Aggregate value of sum of money receved wthout consderaton v v In case mmovable property s receved wthout consderaton, stamp duty value of property In case mmovable property s receved for nadequate consderaton, stamp duty value of property n excess of such consderaton b b b In case any other property s receved wthout consderaton, far market value of property In case any other property s receved for nadequate consderaton, far market value of property n excess of such consderaton bv e Income chargeable at specal rates (2a+ 2b+ 2c+ 2d + 2e) 2 a Income from wnnngs from lotteres, crossword puzzles etc. b Income chargeable u/s 115BBE (b + b + b + bv+ bv + bv) Cash credts u/s 68 Unexplaned nvestments u/s 69 Unexplaned money etc. u/s 69A v Undsclosed nvestments etc. u/s 69B B3a 1a 1b 1c 1d d d d dv dv 2a 2b b b b bv B1d 2d 2e 2f 2g B3

193 442 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] v Unexplaned expendture etc. u/s 69C v Amount borrowed or repad on hund u/s 69D c Accumulated balance of recognsed provdent fund taxable u/s 111 S.No. Assessment Year Income beneft Tax beneft () () () (v) bv bv 2c d Any other ncome chargeable at specal rate (total of d to dxx) Dvdends receved by non-resdent (not beng d company) or foregn company chargeable u/s 115A(1)(a)() Interest receved from Government or Indan d concern on foregn currency debts chargeable u/s 115A(1)(a)() v v v v v x Interest receved from Infrastructure Debt Fund chargeable u/s 115A(1)(a)(a) Interest referred to n secton 194LC - chargeable u/s 115A(1)(a)(aa) Interest referred to n secton 194LD - chargeable u/s 115A(1)(a)(ab) Dstrbuted ncome beng nterest referred to n secton 194LBA - chargeable u/s 115A(1)(a)(ac) Income from unts of UTI or other Mutual Funds specfed n secton 10(23D), purchased n Foregn Currency - chargeable u/s 115A(1)(a)() Income from royalty or fees for techncal servces receved from Government or Indan concern - chargeable u/s 115A(1)(b) Income by way of nterest or dvdends from bonds or GDRs purchased n foregn currency by non-resdents - chargeable u/s 115AC d dv dv dv dv dv dx 2d x x x Income by way of dvdends from GDRs purchased n foregn currency by resdents - chargeable u/s 115ACA Income (other than dvdend) receved by an FII n respect of securtes (other than unts referred to n secton 115AB) - chargeable u/s 115AD(1)() Income by way of nterest receved by an FII on bonds or Government securtes referred to n secton 194LD chargeable as per provso to secton 115AD(1)() dx dx dx e f x xv xv xv xv xv Tax on non-resdents sportsmen or sports assocatons chargeable u/s 115BBA Anonymous Donatons n certan cases chargeable u/s 115BBC Income by way of dvdend receved by specfed assessee, beng resdent, from domestc company exceedng rupees ten lakh chargeable u/s 115BBDA Income by way of royalty from patent developed and regstered n Inda - chargeable u/s 115BBF Income by way of transfer of carbon credts - chargeable u/s 115BBG Investment Income of a Non-Resdent Indan - chargeable u/s 115E dx dxv dxv dxv dxv dv xx Any other ncome (Please specfy) dxx Pass through ncome n the nature of ncome from other sources chargeable at specal rates (drop down to be provded) Amount ncluded n 1 and 2 above, whch s chargeable at specal rates n Inda as per DTAA (total of column (2) of table below) 2e 2f

194 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Sl. No. Amount of ncome Item No.2a to 2e n whch ncluded Country Artcle of name & DTAA Code Rate as per Treaty (enter NIL, f not chargeable) Whether TRC obtaned (Y/N) Secton of I.T. Act Rate as per I.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) I II Deductons under secton 57(other than those relatng to ncome chargeable at specal rates under 2a, 2b & 2d) a Expenses / Deductons b Deprecaton c Total 4 Amounts not deductble u/s Profts chargeable to tax u/s NOTE Net ncome from other sources chargeable at normal applcable rates ( ) (If negatve take the fgure to 4 of schedule CYLA) 7 Income from other sources (other than from ownng race horses) (2 +6) (enter 6 as nl, f negatve) 7 8 Income from the actvty of ownng and mantanng race horses a Recepts 8a Deductons under secton 57 n relaton to (3) b recepts at 8a only 8b c Amounts not deductble u/s 58 8c d Profts chargeable to tax u/s 59 8d e Balance (8a - 8b + 8c + 8d) 9 Income under the head Income from other sources (7 + 8e) (take 8e as nl f negatve) 9 10 Informaton about accrual/recept of ncome from Other Sources S. No. Other Source Income Upto 15/6 From 16/6 to 15/9 3a 3b 3c From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3 () () () (v) (v) 1 Dvdend Income u/s 115BBDA Income by way of wnnngs from lotteres, crossword 2 puzzles, races, games, gamblng, bettng etc. referred to n secton 2(24)(x) Please nclude the ncome of the specfed persons (spouse, mnor chld etc.) referred to n Schedule SPI whle computng the ncome under ths head. 6 8e Schedule OA General Do you have any ncome under the head busness and professon? Yes No (f yes please enter followng 1 Nature of Busness or professon (refer to the nstructons) 1 2 Number of branches 2 3 Method of accountng employed n the prevous year (Tck) mercantle 3 4 Is there any change n method of accountng (Tck) Yes 4 5 Effect on the proft because of devaton, f any, n the method of accountng employed n the prevous year from accountng standards prescrbed under secton 145A 6 Method of valuaton of closng stock employed n the prevous year 6 Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte a 2, f at market rate wrte 3) Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost b wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 6d

195 444 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness [ncludng busness ncome as referred to n secton 11(4A)] INCOME FROM BUSINESS OR PROFESSION 1 Proft before tax as per proft and loss account Net proft or loss from speculatve busness ncluded n 1 (enter ve sgn n case of loss) Net proft or loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) Proft or loss ncluded n 1, whch s referred to n 4 4 secton 44AD/44AE 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome 5c d Total exempt ncome 6 Balance ( d) 6 Expenses debted to proft and loss account 7 7 consdered under other heads of ncome 8 Expenses debted to proft and loss account whch relate to exempt ncome 9 Total (7 + 8) 9 10 Adjusted proft or loss (6+9) 10 Deemed ncome under secton AB/33ABA/35ABB Any other tem or tems of addton under secton to 44DA 13 Any other ncome not ncluded n proft and loss 13 account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch company s a partner) 14 Total ( ) Deducton allowable under secton 32(1)() Any other amount allowable as deducton Total ( ) Income (14 17) Profts and gans of busness or professon deemed to be under - Secton 44AD Secton 44ADA Secton 44AE v Total (19 to 19) 20 Net proft or loss from busness or professon other than speculatve and specfed 20 busness ( v) 21 Net Proft or loss from busness or professon other than speculatve busness and A21 specfed busness after applyng rule 7A, 7B or 7C, f applcable (If rule 7A, 7B or 7C s not applcable, enter same fgure as n 20) B Computaton of ncome from speculatve busness 24 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Proft or loss from speculatve busness ( ) (enter nl f loss) B27 C Computaton of ncome from specfed busness under secton 35AD C 28 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA 29 Deductons n accordance wth secton 28 to 44DA (other than deducton under secton, () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 2 3 5d v

196 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) Proft or loss from specfed busness (31-32) (enter nl f loss) 33 Relevant clause of sub-secton (5) of secton 35AD whch covers the specfed busness (to be selected from drop down menu) D Income chargeable under the head Profts and gans (A21+B27+C33) D34 E Computaton of ncome chargeable to tax under secton 11(4) 35 Income as shown n the accounts of busness under takng [refer secton 11(4)] E35 36 Income chargeable to tax under secton 11(4) [D34-E35] E36 Schedule CYLA Detals of Income after set-off of current years losses CURRENT YEAR LOSS ADJUSTMENT Sl. No. v v v Head/ Source of Income Loss to be adjusted -> House property Busness (excludng speculaton ncome and ncome from specfed busness) Speculaton ncome Specfed busness ncome Short-term captal gan Long term captal gan v Other sources (excludng proft from ownng race horses and wnnngs from lottery) v Proft from ownng and mantanng race horses x Total loss set-off x Loss remanng after set-off Schedule PTI Sl. PASS THROUGH INCOME Income of current year (Fll ths column only f ncome s zero or postve) House property loss of the current year set off Total loss (4 of Schedule HP) Busness Loss (other than speculaton or specfed busness loss) of the current year set off Total loss (A21 of Schedule-BP) Other sources loss (other than loss from race horses) of the current year set off Total loss (6+2 of Schedule-OS) Current year s Income remanng after set off = Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Name of busness trust/ PAN of the busness Sl. Head of ncome Amount of nvestment fund trust/ nvestment ncome fund 1. House property Captal Gans a Short term b Long term Other Sources v Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s 2. House property Captal Gans a Short term b Long term Other Sources TDS on such amount, f any

197 446 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] NOTE v Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s Please refer to the nstructons for fllng out ths schedule. Schedule SI Income chargeable to tax at specal rates [Please see nstructon] Sl Secton Specal No rate (%) 1 111A (STCG on shares where STT pad) provso (LTCG on lsted securtes/ unts wthout (LTCG on others) A(LTCG on equty shares/unts of equty orented 10 fund/unts of busness trust on whch STT s pad) SPECIAL RATE 5 115B (Profts and gans of lfe nsurance busness) BB (Wnnngs from lotteres, puzzles, races, games BBDA (Dvdend Income from domestc company that 10 exceeds Rs.10 Lakh) 8 115BBE (Income under secton 68, 69, 69A, 69B, 69C or BBF (Tax on ncome from patent) BBG (Tax on ncome from transfer of carbon credts) Any other ncome chargeable at specal rate (Drop down to be provded) 12 Income from other sources chargeable at specal rates n Inda as per DTAA 13 Pass Through Income n the nature of Short Term Captal Gan 15 15% 14 Pass Through Income n the nature of Long Term Captal Gan 10% 15 Pass Through Income n the nature of Long Term Captal Gan 20% 16 Pass through ncome n the nature of ncome from other source chargeable at specal rates Total Income () (part of 2d of schedule OS) (part of 2f of schedule OS) (2e of schedule OS) Tax thereon () Schedule 115TD Accreted ncome under secton 115TD 1 Aggregate Far Market Value (FMV) of total assets of trust/nsttuton 1 2 Less: Total lablty of trust/nsttuton 2 3 Net value of assets (1 2) 3 4 () FMV of assets drectly acqured out of ncome referred to 4 n secton 10(1) () FMV of assets acqured durng the perod from the date 4 of creaton or establshment to the effectve date of regstraton u/s 12AA, f beneft u/s 11 and 12 not clamed durng the sad perod () FMV of assets transferred n accordance wth thrd 4 provso to secton 115TD(2) (v) Total ( ) 4v 5 Lablty n respect of assets at 4 above 5 6 Accreted ncome as per secton 115TD [3 (4 5)] 6 7 Addtonal ncome-tax payable u/s 115TD at maxmum margnal rate 7 8 Interest payable u/s 115TE 8 9 Specfed date u/s 115TD 9 10 Addtonal ncome-tax and nterest payable Tax and nterest pad Net payable/refundable (10-11) 12

198 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k Date(s) of depost of tax on accreted ncome Date 1 DD/MM/YYYY 14 Name of Bank and Branch 15 BSR Code 16 Seral number of challan 17 Amount deposted Date 2 DD/MM/YYYY Date 3 DD/MM/YYYY Schedule FSI INCOME FROM OUTSIDE INDIA AND TAX RELIEF Detals of Income from outsde Inda and tax relef Sl. Country Taxpayer Code Identfcaton Number Sl. Head of ncome Income from outsde Inda (ncluded n PART B-TI) 1 House Property Busness or Professon Captal Gans v Other sources Tax pad outsde Inda Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Total 2 House Property Busness or Professon Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Identfcaton (total of (c) of Schedule FSI n Number respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) TAX RELIEF FOR TAX PAID OUTSIDE INDIA (a) (b) (c) (d) (e) Total Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of total of 1(d)) Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total of 1(d)) Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below a NOTE Amount of tax refunded Please refer to the nstructons for fllng out ths schedule. b Assessment year n whch tax relef allowed n Inda Yes/No

199 448 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] Schedule FA DETAILS OF FOREIGN ASSETS Detals of Foregn Assets and Income from any source outsde Inda A1 Detals of Foregn Depostory Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod) Sl. Country Country ZIP Account Status Account Closng No. name code code number openng date balance Name of fnancal nsttuton Address of fnancal nsttuton Peak balance durng the perod Gross nterest pad/credted to the account durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A2 Detals of Foregn Custodal Accounts held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl. Country Country ZIP Account Status Closng No. name code code number balance Name of fnancal nsttuton Address of fnancal nsttuton Account openng date Peak balance durng the perod Gross amount pad/credted to the account durng the perod (drop down to be provded specfyng nature of amount vz. nterest/dvdend/proceeds from sale or redempton of fnancal assets/ other ncome) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () A3 Sl No Detals of Foregn Equty and Debt Interest held (ncludng any benefcal nterest) n any entty at any tme durng the relevant accountng perod Country Country Name of Address of ZIP Nature name code entty entty code of entty Date of acqurng the nterest Intal value of the nvestment Peak value Closng of value nvestment durng the perod Total gross amount pad/credted wth respect to the holdng durng the perod Total gross proceeds from sale or redempton of nvestment durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) () () A4 Sl. No. Detals of Foregn Cash Value Insurance Contract or Annuty Contract held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Country Country name code Name of fnancal nsttuton n whch nsurance contract held Address of fnancal nsttuton ZIP code Date of contract The cash value or surrender value of the contract Total gross amount pad/credted wth respect to the contract durng the perod (1) (2) (3) (4) (5) (6) (7) (8) (9) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl. No. Country Name and code Nature of entty Name and Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Investment (at cost) (n rupees) Income Nature of accrued from Income such Interest Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod

200 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 449 Sl No Country Name and code Address of the Property Ownershp- Drect/ Benefcal owner/ Benefcary Date of acquston Total Investment (at cost) (n rupees) Income derved from the property Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod Sl Country Nature of Date of Total Income Nature of Income taxable and offered n ths return No Name and code Asset acquston Investment (at cost) (n rupees) derved from the asset Income Item number of schedule Ownershp- Drect/ Benefcal owner/ Benefcary Amount Schedule where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () E Detals of account(s) n whch you have sgnng authorty held (ncludng any benefcal nterest) at any tme durng the relevant accountng perod and whch has not been ncluded n A to D above. Sl No Account Number If (7) s yes, Income offered n ths return Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl No Country Name and code Name and address of the trust Name and address of trustees Name and address of Settlor Name and address of Benefcares Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust If (8) 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) (12) () () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon Country Name and code Name and address of the person from whom derved Income derved Nature of ncome Whether taxable n your hands? If (6) s yes, Income offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule.

201 450 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] SCHEDULE SH SHAREHOLDING OF UNLISTED COMPANY If you are an unlsted company, please furnsh the followng detals;- Detals of shareholdng at the end of the prevous year Name of the shareholder Resdental status n Inda Type of share PAN Date of acquston Number of shares held Face value per share Issue Prce per share Amount receved Detals of equty share applcaton money pendng allotment at the end of the prevous year Name of the applcant Resdental status n Inda Type of share PAN Date of applcaton Number of shares appled for Applcaton money receved Face value per share Proposed ssue prce Detals of shareholders who s not a shareholder at the end of the prevous year but was a shareholder at any tme durng the prevous year Name of the shareholder Resdental status n Inda Type of share PAN Number of shares held Face value per share Issue Prce per share Amount receved Date of acquston Date on whch cease to be shareholder Mode of cessaton In case of transfer, PAN of the shareholder Part-B Part B STATEMENT OF INCOME FOR THE PERIOD ENDED ON 31 ST MARCH, 2019 TI If regstered under secton 12A/12AA or approved under secton 10(23C)(v)/10(23C)(v)/ 10(23C)(v)/10(23C)(va), fll out tems 1 to 7 (as applcable) 1 Voluntary Contrbutons other than Corpus fund [(Ae + B) of Schedule VC] 1 2 Voluntary contrbuton formng part of corpus [(A + B) of schedule VC] 2 3 Aggregate of ncome referred to n sectons 11, 12 and sectons 10(23C)(v), 10(23C)(v), 10(23C)(v) and 10(23C)(va) derved durng the prevous year excludng Voluntary contrbuton ncluded n 1 and 2 above (10 of Schedule AI) 3 4 Applcaton of ncome for chartable or relgous purposes or for the stated objects of the trust/nsttuton:- Amount appled durng the prevous year- Revenue Account [Excludng applcaton from 4 borrowed fund, deemed applcaton, prevous year accumulaton upto 15% etc,.e. not from the ncome of prev. year] [(A16 + B10- E2-E3-E4-E5) from Schedule ER] Amount appled durng the prevous year- Captal Account [Excludng applcaton from 4 Borrowed Funds, deemed applcaton, prevous year accumulaton upto 15% etc.,.e. not from ncome of the prev. year] [(5 A2-A3-A4-A5) of Schedule EC] Amount appled durng the prevous year- Revenue/ Captal Account (Repayment of Loan) 4 v v Amount deemed to have been appled durng the prevous year as per clause (2) of Explanaton to secton 11(1) a If (v) above applcable, whether opton n Form No. 9A 4va has been furnshed to the Assessng Offcer b If yes, date of furnshng Form No. 9A (DD/MM/YYYY) 4vb Amount accumulated or set apart for applcaton to chartable or relgous purposes or for the stated 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)(a)/11(1)(b) or n terms of thrd provso to secton 10(23C) [restrcted to the maxmum of 15% of (2 + 3) above] v Amount n addton to amount referred to n (v) above, accumulated or set apart for 4v specfed purposes f all the condtons n secton 11(2) and 11(5) or thrd provso to secton 10(23C) are fulflled (fll out schedule I) v Amount elgble for exempton under secton 11(1)(c) 4v a Approval number gven by the Board 4va b Date of approval by board 4vb v Total [ v+4v+4v] (excludng the tem 4v - Utlsaton of deemed ncome of an earler year) 4v 5 Addtons Corpus donaton to other trust or nsttuton chargeable as per Explanaton 2 to secton 11(1) 5 [tem No. B1() of Schedule ER] Income chargeable under secton 11(1B) 5 4v 4v

202 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 451 Income chargeable under secton 11(3) 5 v Income n respect of whch exempton under secton 11 s not avalable a Beng anonymous donaton (D of schedule VC) 5va b Dsallowable u/s 13(1)(c) or 13(1)(d) (ncludng Part E of Schedule J) 5vb v Income chargeable under secton 12(2) 5v v Amount dsallowable under secton 11(1) r.w.s 40(a)(a) or 10(23C) r.w.s 40(a)(a) 5v v Amount dsallowable under secton 11(1) r.w.s 40A(3)/(3A) or 10(23C) r.w.s 40A(3)/(3A) 5v v Total [ va+5vb+5v + 5v + 5v] 5v 6 Income chargeable u/s 11(4) [as per tem No. E36 of Schedule BP] 6 7 Total (2+3-4v+5v+6) 7 8 Amount elgble for exempton under sectons 10(21), 10(22B), 10(23A), 10(23AAA), 10(23B), 8 10(23EC), 10(23ED), 10(23EE), 10(29A) 9 Amount elgble for exempton under secton 10(23C)(ab), 10(23C)(ac), 10(23C)(ad), 9 10(23C)(ae), 10(23D), 10(23DA), 10(23FB), 10(24), 10(46), 10(47) 10 Amount elgble for exempton under any other clause of secton 10 (other than those at 8 and 9) Income chargeable under secton 11(3) read wth secton 10(21) 11 12a Income clamed/ exempt under secton 13A n case of a Poltcal Party 12a 12b Income clamed/ exempt under secton 13B n case of an Electoral Trust (tem No. 6v of Schedule ET) 12b 13 Income not formng part of tem No. 7 to 12 above Income from house property [ 4 of Schedule HP] (enter nl f loss) 13 Profts and gans of busness or professon [as per tem No. D 34 of schedule BP] 13 Income under the head Captal Gans a Short term (A6 of schedule CG) 13a b Long term (B4 of schedule CG) (enter nl f loss ) 13b c Total captal gans (13a +13b) (enter nl f loss ) 13c v Income from other sources [as per tem No. 9 of Schedule OS] 13v v Total ( c + 13v) 13v 14 Gross ncome [ v a-12b] Losses of current year to be set off aganst 13v (total of 2x, 3x and 4x of Schedule CYLA) Gross Total Income (14-15) Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10AA Total Income [16-18] Income whch s ncluded n 19 and chargeable to tax at specal rates (total of col. () of schedule SI) Net Agrcultural ncome for rate purpose Aggregate Income ( ) [applcable f (19-20) exceeds maxmum amount not chargeable to tax] Anonymous donatons, ncluded n 22, to be taxed under secton 30% (D of Schedule VC) Income chargeable at maxmum margnal rates (22-23) 24 Part B - TTI 1 Tax payable on total ncome Computaton of tax lablty on total ncome a Tax at normal rates on [ ) of Part B-TI] b Tax at specal rates (total of col. () of Schedule-SI) Tax on anonymous donaton u/s on 23 of c Part B-TI d Tax at maxmum margnal rate on 24 of Part B-TI e Rebate on agrcultural ncome [applcable f (19-20) of Part B-TI exceeds maxmum amount not chargeable to tax] f Tax Payable on Total Income (1a+ 1b+1c+ 1d+ 1e) 2 Surcharge 25% of 8() of Schedule SI On [1f (8() of Schedule SI)] Total ( + ) 3 Health and Educaton 4% on (1f+ 2) 3 1a 1b 1c 1d 1e 2 2 1f 2

203 452 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] 4 Gross tax lablty (1f ) 4 5 Tax relef a Secton 90/90A (2 of Schedule TR) b Secton 91 (3 of Schedule TR) c Total (5a + 5b) 6 Net tax lablty (4 5c) 6 7 Interest and fee payable Interest a for default n furnshng the return (secton 234A) Interest for default n payment of advance tax (secton b 234B) c Interest for deferment of advance tax (secton 234C) 5a 5b 7a 7b 7c 5c TAXES PAID d Fee for default n furnshng return of ncome (secton 234F) e Total Interest and Fee Payable (7a+ 7b+ 7c+ 7d) 8 Aggregate lablty) (6 + 7e) 8 9 Taxes Pad a Advance Tax (from column 5 of 14A) b TDS (total of column 9of 14B) c TCS (total of column 7 of 14C) d Self-Assessment Tax (from column 5 of14a) e Total Taxes Pad (9a+ 9b+ 9c+ 9d) 10 Amount payable (Enter f 8 s greater than 9e, else enter 0) Refund(If 9e s greater than 8) (refund, f any, wll be drectly credted nto the bank account) 11 9a 9b 9c 9d 7d 7e 9e BANK ACCOUNT 12 Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) (In case of non-resdents, detals of any one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. IFS Code of the Bank n case of Bank Accounts held n Inda (SWIFT Code n case of foregn Bank Account) Name of the Bank Account Number ( (IBAN n case of foregn Bank Accounts) Indcate the account n whch you prefer to get your refund credted, f any (tck one account ) 13 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] Yes No 14 TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX Detals of payments of Advance Tax and Self-Assessment Tax Sl BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) No (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 9a & 9d of Part B-TTI

204 ¹Hkkx IIµ[k.M 3()º Hkkjr dk jkt=k % vlk/kj.k 453 B Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued or Form 16B/16C furnshed by Deductor(s)] Sl. No. TDS credt relatng to self /other person [spouse as per secton 5A/other person as per rule 37BA(2)] PAN of Other Person (f TDS credt related to other person) TAN of the Deductor/ PAN of Tenant/ Buyer Unclamed TDS brought forward (b/f) Fn. TDS Year n b/f whch deducted TDS of the current Fn. Year Deducted n own hands Deducted n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) TDS credt beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Clamed n own hands Clamed n the hands of spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) Correspondng Income offered Gross Amount Head of Income TDS credt beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Income TDS Income TDS PAN NOTE Please enter total of column 9 n10b of Part B- TTI C TCS ON INCOME Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Tax Collecton Account Number of the Collector Name of the Collector Unclamed TCS brought forward (b/f) Fn. Year n whch TCS collected Amount b/f TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (5) or (6) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) n 9c of Part B-TTI VERIFICATION I, son/ daughter of, solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and the schedules, statements, etc. accompanyng t s correct and complete s n accordance wth the provsons of the Income-tax Act, I further declare that I am makng ths return n my capacty as and I am also competent to make ths return and verfy t. I am holdng permanent account number (f allotted) (Please see nstructon). I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here ITR- V ACKNOWLEDGEMENT AY (A1) Frst name (A2) Mddle name (A3) Last name (A4) Permanent Account Number (A5) Date of Brth(DD/MM/YYYY) (A6) Flat/Door/Buldng (A7) Name of Premses/ Buldng/ Vllage D D M M Y Y Y Y

205 454 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II SEC. 3()] (A8) Road/ Street (A9) Area/ localty (A10) Town/ Cty/ Dstrct (A11) State Country (A12) Pn code (A13) Fll only one: Fled- On or before due date -139(1), After due date -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) Receved wth thanks from a return of ncome n ITR No. 1(SAHAJ) O 2 O 3 O 4(SUGAM) O 5 O 7 O for assessment year , havng the followng partculars COMPUTATION OF INCOME AND TAX RETURN Whole Rupee (`) only. B1 Gross Total Income B1 ( ) B2 Deductons under Chapter-VI-A B3 Total Income B3 ( ) B4 Current loss, f any B4 ( ) B5 Net Tax Payable B6 Interest and fee Payable B7 Total Tax, Interest and fee Payable B8 Total Advance Tax Pad B9 Total Self-Assessment Tax Pad B10 Total TDS deducted B11 Total TCS collected B12 Total Prepad Taxes (B8 + B9 + B10+ B11) B13 Tax Payable (B7-B12, If B7>B12) B14 Refund (B12-B7, If B12>B7) Agrculture B2 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 B15 Exempt Income Others B15 STAMP RECEIPT NO. HERE SIGN HERE SEAL, DATE AND SIGNATRUE OF RECEIVING OFFICIAL. FOR OFFICIAL USE ONLY [Notfcaton No. 32/2019/ F.No /1/2019-TPL] SAURABH GUPTA, Under Secy. Note.- The prncpal rules were publshed n the Gazette of Inda, Extraordnary, Part-II, Secton 3, Sub-secton () vde notfcaton number S.O. 969(E), dated the 26 th March, 1962 and last amended by the Income-tax (Frst Amendment) Rules, 2019, vde notfcaton number G.S.R. No. 76(E), dated 30 th January, Uploaded by Dte. of Prntng at Government of Inda Press, Rng Road, Mayapur, New Delh and Publshed by the Controller of Publcatons, Delh