(A1) First Name (A2) Middle Name (A3) Last Name (A4) Permanent Account Number

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1 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 (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 1 (A17) Moble 2 (A15) Status Indvdual HUF Frm (other than LLP) (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 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 Income (B1+B2+B3+B4) B5( ) FOR OFFICE USE ONLY STAMP RECEIPT NO. HERE Whole- Rupee( ) only SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL Page 1 of 5

2 BANK ACCOUNT 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 C7 80D Drop down to be provded n e-flng utlty 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 Tax, and Cess ( D3+D4) D5 D6 Relef u/s 89 D6 D7 Balance Tax after Relef (D5 D6) D7 D8 Interest u/s 234A D8 D9 Interest u/s 234B D9 D10 Interest u/s 234C D10 D11 Fee u/s 234F D12 Tax, Fee and Interest (D7 + D8 + D9 + D10 + D11) D12 D13 Advance Tax Pad D14 Self-Assessment Tax Pad D15 TDS Clamed (total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2) D15 D16 TCS Collected (total of column (5) of Schedule-TCS) D17 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) D20 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 ) 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 deductons (Add tems C1 to C17) C18 C19 Taxable Income (B5 - C18 ) C19 D11 D13 D14 D16 D17 Page 2 of 5

3 SCHEDULE BP DETAILS OF INCOME FROM BUSINESS OR PROFESSION COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD Name of Busness Busness code Descrpton () E1 Gross Turnover or Gross Recepts a Through a/c payee cheque or a/c payee bank draft or bank electronc clearng system receved E1a before specfed date b Any E1b E2 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 (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 Name of Busness Busness code Descrpton () 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 Name of Busness Busness code Descrpton () Regstraton 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 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 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 captal and labltes (E11+E12+E13+E14+E15+E16) E17 E18 Fxed assets E18 E19 Inventores E19 Page 3 of 5

4 E20 Sundry debtors E20 E21 Balance wth banks E21 E22 Cash-n-hand E22 E23 Loans and advances E23 E24 Other assets E24 E25 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 Donaton n donaton Elgble Amount of donaton B Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Donaton n Donaton n donaton Elgble Amount of donaton DETAILS OF DONATIONS C Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Donaton n Donaton n donaton Elgble Amount of donaton D Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Donaton n Donaton n donaton Elgble Amount of donaton E 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 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 Page 4 of 5

5 SCHEDULE TDS1 DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 ssued by Employer(s)] TAN Name of the Employer Income under Salary Tax deducted S1 S2 S3 NOTE Col (1) Col (2) Col (3) Col (4) 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. 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) 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) 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 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 Page 5 of 5

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