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1 FORM TR-2 NDAN NCOME TAX RETURN [For ndvduals and HUFs not havng ncome from profts and gans of busness or professon] (Please see Rule 12 of the ncome-tax Rules, 1962) (Also see attached nstructons) Assessment Year Part A-GEN GENERAL Frst name Mddle name Last name PAN Flat/Door/Block. Name of Premses/Buldng/Vllage Status (Tck) PERSONAL NFORMATON Road/Street/Post Offce Area/localty Date of Brth/ Formaton (DD/MM/YYYY) ndvdual HUF Aadhaar Number (12 dgt)/ Aadhaar Enrolment d (28 dgt) (f elgble for Aadhaar) Town/Cty/Dstrct State Pn code/zp code Employer Category(f n employment) (Tck) Govt. PSU Others Country Resdental/Offce Phone Number wth STD code/ Moble. 1 Moble. 2 Emal Address-1 (self) Emal Address-2 ncome Tax Ward/Crcle FLNG STATUS (a) (b) (c) Return fled (Tck)[Please see nstructon number-7] On or before due date-139(1), After due date-139(4), Revsed Return- 139(5), Modfed return- 92CD, under secton 119(2)(b), or n response to notce 139(9)-Defectve, 142(1), 148, 153A/153C f revsed/defectve/modfed, then enter Recept. and Date of flng orgnal return (DD/MM/YYYY) / / f fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of / / advance prcng agreement (d) Resdental Status Tck applcable opton Resdent n-resdent Resdent but t Ordnarly Resdent Do you want to clam the beneft under secton 115H? (applcable n case of resdent) Yes (e) Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes (f YES please fll Schedule 5A) (g) Part B - T Whether ths return s beng fled by a representatve assessee? (Tck) Yes f yes, please furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) Permanent Account Number (PAN) of the representatve Computaton of total ncome PART-B 1 Salares (6 of Schedule S) 1 2 ncome from house property (3b of Schedule HP) (enter nl f loss) 2 TOTAL NCOME 3 Captal gans a Short term Short-term 15% (7 of tem E of schedule CG) a Short-term 30% (7 of tem E of schedule CG) a Short-term chargeable at applcable rate (7v of tem E of schedule CG) a v Total Short-term (a + a + a) 3av Do not wrte or stamp n ths area (Space for bar code) For Offce Use Only Recept. Date Seal and Sgnature of recevng offcal Page 1

2 b Long-term Long-term 10% (7v of tem E of schedule CG) b Long-term 20% (7v of tem E of schedule CG) b Total Long-term (b + b) (enter nl f loss) 3b c Total captal gans (3av + 3b) (enter nl f loss) 3c 4 ncome from other sources a from sources other than from ownng race horses and ncome chargeable to tax at specal rate (1k of Schedule OS) (enter nl f loss) 4a b ncome chargeable to tax at specal rate (1fv of Schedule OS) 4b c from the actvty of ownng and mantanng race horses ( 3e of Schedule OS) (enter nl f loss) 4c d Total (4a + 4b + 4c) (enter nl f loss) 4d 5 Total (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+4b) 7 8 Brought forward losses set off aganst 7 (2x of Schedule BFLA) 8 9 Gross Total ncome ( 7-8) (3x of Schedule BFLA +4b) 9 10 ncome chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deductons under Chapter V-A [ t of Schedule VA and lmted to ( 9-10)] Total ncome ( 9-11) ncome whch s ncluded n 12 and chargeable to tax at specal rates (total of () of schedule S) Net agrcultural ncome/ any other ncome for rate purpose (4 of Schedule E) 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) 16 Part B -TT Computaton of tax lablty on total ncome 1 Tax payable on total ncome a Tax at normal rates on 15 of Part B-T b Tax at specal rates (total of col. () of Schedule S) c Rebate on agrcultural ncome [applcable f (12-13) of Part B-T exceeds maxmum amount not chargeable to tax] d Tax Payable on Total ncome (1a + 1b 1c) 1a 1b 1c 1d COMPUTATON OF TAX LABLTY TAXE S PAD 2 Rebate under secton 87A 2 3 Tax payable after rebate (1d - 2) 3 4 Surcharge 25% of 12() of Schedule S 4 On [(3) (12() of Schedule S)] 4 Total Educaton cess, ncludng secondary and hgher educaton cess on (3 + 4) Gross tax lablty ( ) 6 7 Tax relef a Secton 89 7a b Secton 90/ 90A (2 of Schedule TR) 7b c Secton 91 (3 of Schedule TR) 7c d Total (7a + 7b+ 7c) 7d 8 Net tax lablty (6 7d) (enter zero f negatve) 8 9 nterest and fee payable a nterest for default n furnshng the return (secton 234A) 9a b nterest for default n payment of advance tax (secton 234B) 9b c nterest for deferment of advance tax (secton 234C) 9c d Fee for default n furnshng return of ncome (secton 234F) 9d e Total nterest and Fee Payable (9a+9b+9c+9d) 9e 10 Aggregate lablty (8 + 9e) Taxes Pad a Advance Tax (from column 5 of 19A) 11a Page 2

3 BANK ACCOUNT b TDS (total of column 5 of 19B and column 9 of 19C) c TCS (total of column 5 of 19D) d Self-Assessment Tax (from column 5 of 19A) e Total Taxes Pad (11a+11b+11c+11d) 12 Amount payable (Enter f 10 s greater than 11e, else enter 0) Refund (f 11e s greater than 10) (Refund, f any, wll be drectly credted nto the bank account) b 11c 11d Detals of all Bank Accounts held n nda at any tme durng the prevous year (excludng dormant accounts) (n case of non-resdents, detals of any one foregn Bank Account may be furnshed for the purpose of credt of refund) Sl. FS Code of the Bank n case of Bank Name of the Bank Account Number ndcate the account n whch you Accounts held n nda (SWFT Code n (BAN n case of foregn Bank prefer to get your refund credted, f case of foregn Bank Account) Accounts) any (tck one account ) 15 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 nda; or () have sgnng authorty n any account located outsde nda; or () have ncome from any source outsde nda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] 11e Yes VERFCATON, 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 ncome-tax Act, further declare that am makng return n my capacty as and am also competent to make ths return and verfy t. am holdng permanent account number (f allotted) (Please see nstructon) 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 16 f the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Sgn here dentfcaton. of TRP Name of TRP Counter Sgnature of TRP f TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY C TDS ON OTHER NCOME 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) (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl. 11a & 11d of Part B-TT Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Sl Tax Deducton Account Number (TAN) of the Employer Name of the Employer ncome chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) NOTE Please enter total of column 5 n 11b of Part B-TT Detals of Tax Deducted at Source (TDS) on ncome [As per Form 16 A ssued or Form 26QB/26QC furnshed by Deductor(s)] Sl TAN of the Deductor/ PAN of the Buyer/ Tenant Name of the Deductor/ Buyer/Tenant Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) TDS of the current fn. Year TDS credt out of (7) or (8) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) TDS credt out of (7) or (8) beng carred forward Fn. Year Amount Deducted Deducted n the hands of spouse Clamed Clamed n the hands of n whch deducted b/f n own hands as per secton 5A or any other person as per rule 37BA(2) (f applcable) n own hands spouse as per secton 5A or any other person as per rule 37BA(2) (f applcable) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) ncome TDS PAN of spouse/ other person ncome TDS PAN of spouse/ other person Page 3

4 D NOTE Please enter total of column 9 n 11b of Part B-TT Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl 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) TCS NOTE Please enter total of column (5) n 11c of Part B-TT NOTE: PLEASE FLL SCHEDULES TO THE RETURN FORM (PAGES S1 S13) AS APPLCABLE Page 4

5 SCHEDULES TO THE RETURN FORM (FLL AS APPLCABLE) Schedule S Name of Employer Detals of ncome from Salary PAN of Employer (f avalable) Address of employer Town/Cty State Pn code 1 Salary (Excludng all exempt/ non-exempt allowances, perqustes & proft n leu of salary as they are shown separately below) 1 SALARES 2 Allowances not exempt (refer Form 16 from employer) 2 3 Value of perqustes (refer Form 16 from employer) 3 4 Profts n leu of salary (refer Form 16 from employer) 4 5 Deducton u/s 16 (Entertanment allowance by Government and tax on employment) 5 6 ncome chargeable under the Head Salares ( ) 6 7 Allowances exempt under secton 10 (t to be ncluded n 6 above) 7 Travel concesson/assstance receved [(sec. 10(5)] 7 Tax pad by employer on non-monetary perquste [(sec. 10(10CC)] 7 Allowance to meet expendture ncurred on house rent [(sec. 10(13A)] 7 v Other allowances 7v Schedule HP Detals of ncome from House Property (Please refer to nstructons) Address of property 1 Town/ Cty State PN Code 1 s the property co-owned? Yes (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner(s)e Percentage Share n Property HOUSE PROPERTY 2 [Tck the applcable opton] Name(s) of Tenant (f let out) PAN of Tenant(s) (f avalable) Let out Self-occuped Deemed let out a Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of the year, lower of the two f let out for part of the year) 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 nterest payable on borrowed captal Total (1g + 1h) j ncome from house property 1 (1f 1) 1j Address of property 2 Town/ Cty State PN Code 1g 1h 1e 1f 1 s the property co-owned? Yes (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 Page S1

6 NOTE [Tck the applcable opton] Let out Self-occuped Deemed let out Name(s) of Tenant (f let out) Annual letable value or rent receved/ recevable (hgher of the two, f let out for whole of the year, lower a 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 nterest payable on borrowed captal Total (2g + 2h) j ncome from house property 2 (2f 2) 3 ncome under the head ncome from house property a Unrealzed rent and Arrears of rent receved durng the year under secton 25A after deductng 30% b Total (1j + 2j + 3a) (f negatve take the fgure to 2 of schedule CYLA) 2c 2d 2g 2h PAN of Tenant(s) (f avalable) Please nclude the ncome of the specfed persons referred to n Schedule SP whle computng the ncome under ths head 2a 2e 2f 2 2j 3a 3b 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 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 (a or 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 (b + b + b) c Balance (a bv) d Deducton under secton 54B (Specfy detals n tem D below) e Short-term Captal Gans on mmovable property (1c - 1d) 2 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 F) 3 a Full value of consderaton 2a 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 (2a 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 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) (2c +2d) For NON-RESDENT, not beng an F- from sale of shares or debentures of an ndan 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 b STCG on transactons on whch securtes transacton tax (STT) s not pad 4 For NON-RESDENT- from sale of securtes (other than those at A2) by an F as per secton 115AD a n 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 a a b b bv 1c 1d b b bv 2c 2d A1e A2e A3a A3b Page S2

7 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 + ) 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 F (other than those at A2) (4c +4d) 5 From sale of assets other than at A1 or A2 or A3 or A4 above a n 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 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 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 (5a bv) d n 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 t applcable. f yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year B b Amount deemed to be short term captal gans, other than at a 7 Total amount deemed to be short term captal gans (ax + b) New asset acqured/constructed Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account c b b bv 4c 4d b b bv 5c Amount not used for new asset or remaned unutlzed n Captal gans account (X) Amount of STCG ncluded n A1-A6 but not chargeable to tax or chargeable at specal rates n nda as per DTAA Sl.. tem. A1 Amount of to A6 above ncome n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NL, f not chargeable) Whether TRC obtaned (Y/N) Secton of.t. Act Rate as per.t. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A4e A5e A6 a Total amount of STCG not chargeable to tax n nda as per DTAA b Total amount of STCG chargeable at specal rates n nda as per DTAA 8 Total Short-term Captal Gan (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6-A7a) A8 B Long-term captal gan (LTCG) (Sub-tems 4, 5 & 6 are not applcable for resdents) Long-term Captal Gans 1 From sale of land or buldng or both 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 (a or a) b Deductons under secton 48 a a A7a A7b Page S3

8 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 (a bv) Deducton under secton 54/54B/54EC/54EE/54F/54GB (Specfy detals n tem D d below) e Long-term Captal Gans on mmovable property (1c - 1d) 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 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 54EC/54EE/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 ndan 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 1c 1d 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 54EC/54EE/54F (Specfy detals n tem D below) 3d e Long-term Captal Gans on assets at B3 above (3c 3d) B3e For NON-RESDENTS- from sale of shares or debenture of ndan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 4a b Deducton under sectons 54EC/54EE/54F (Specfy detals n tem D below) 4b c LTCG on share or debenture (4a-4b) B4c For NON-RESDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as referred n sec. 115AC, () securtes by F as referred to n sec. 115AD n case securtes sold nclude shares of a company other than quoted shares, a 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 c 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 + ) 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 (5a bv) 5c d Deducton under sectons 54EC/54EE/54F (Specfy detals n tem D below) 5d e Long-term Captal Gans on assets at 5 above n case of NON-REESDENT (5c 5d) B5e 6 From sale of foregn exchange asset by NON-RESDENT NDAN (f opted under chapter X-A) a LTCG on sale of specfed asset (computed wthout ndexaton) 6a b Less deducton under secton 115F (Specfy detals n tem D below) 6b c Balance LTCG on sale of specfed asset (6a 6b) B6c d LTCG on sale of asset, other than specfed asset (computed wthout ndexaton) 6d e Less deducton under secton 115F (Specfy detals n tem D below) 6e f Balance LTCG on sale of asset, other than specfed asset (6d 6e) B6f 7 From sale of assets where B1 to B6 above are not applcable 2c 2d b b b bv B1e B2e Page S4

9 a n 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 wth ndexaton Cost of mprovement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (7a bv) 7c d Deducton under sectons 54EC/54EE/54F (Specfy detals n tem D below) 7d e Long-term Captal Gans on assets at B7 above (7c-7d) B7e 8 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? Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54F/ 54GB B New asset acqured/constructed Year n whch asset acqured/constructed b Amount deemed to be long-term captal gans, other than at a Total amount deemed to be long-term captal gans (ax + ax + b) Amount utlsed out of Captal Gans account c a b b b bv Amount not used for new asset or remaned unutlzed n Captal gans account (X) 9 Amount of LTCG ncluded n B1- B8 but not chargeable to tax or chargeable at specal rates n nda as per DTAA Sl.. Amount of ncome tem. B1 to B8 above n whch ncluded Country name & Code Artcle of DTAA Rate as per Treaty (enter NL, f not chargeable) Whether TRC obtaned (Y/N) Secton of.t. Act Rate as per.t. Act B8 Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) a Total amount of LTCG not chargeable to tax as per DTAA B9a b Total amount of LTCG chargeable at specal rates as per DTAA B9b 10 Total long term captal gan chargeable under.t. Act [B1e +B2e +B3e + B4c + B5e +B6c+ B6f+ B7e+ B8 - B9a] (n case of B10 loss take the fgure to 5x of schedule CFL) C ncome chargeable under the head CAPTAL GANS (A8 + B10) (take B10 as nl, f loss) (f C s negatve, take the fgure to 4x C of schedule CFL and f t s postve, take the fgure to respectve row n tem E) D nformaton about deducton clamed aganst Captal Gans 1 n case of deducton u/s 54/54B/54EC/54EE/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 a Date of purchase/constructon of new resdental house a dd/mm/yyyy b c 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 b Date of purchase of new agrcultural land b dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due bv 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 ( c Page S5

10 d e f g v Amount of deducton clamed cv Deducton clamed u/s 54EE Date of transfer of orgnal asset d dd/mm/yyyy Amount nvested n specfed asset d Date of nvestment d dd/mm/yyyy v Amount of deducton clamed dv Deducton clamed u/s 54F Date of transfer of orgnal asset e dd/mm/yyyy Cost of new resdental house e 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 ev Deducton clamed u/s 54GB Date of transfer of orgnal resdental property f dd/mm/yyyy PAN of the elgble company f Amount utlsed for subscrpton of equty shares of elgble f company v Date of subscrpton of shares fv dd/mm/yyyy v Cost of new plant and machnery purchased by the elgble company fv v Date of purchase of plant and machnery fv dd/mm/yyyy v Amount deposted n Captal Gans Accounts Scheme before due fv date v Amount of deducton clamed fv Deducton clamed u/s 115F (for n-resdent ndans) Date of transfer of orgnal foregn exchange asset g dd/mm/yyyy ev Amount nvested n new specfed asset or savngs certfcate g Date of nvestment g dd/mm/yyyy v Amount of deducton clamed gv h Total deducton clamed (1a + 1b + 1c + 1d + 1e + 1f + 1g) 1h E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A7 & B9 whch s chargeable under DTAA) F Sl. Type of Captal Gan Gan of current year (Fll ths column only f computed fgure s postve) Loss to be set off (Fll ths row f computed fgure s (A2e+A3a) negatve) captal gan Short term 15% 30% (A2e+A3a) A4e v applcable rate (A1e+A3b+A5e+ A6) v Long term 10% (B3e+ B5e+B6c) captal gan v 20% (B1e+B2e+B4c+ B6f+ B7e+B8) v Total loss set off ( + + v + v + v) v Loss remanng after set off ( v) nformaton about accrual/recept of captal gan Type of Captal gan / Date 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 Long- term captal gans taxable at the rate of 10% Enter value from tem 3v of schedule BFLA, f any. 5 Long- term captal gans taxable at the rate of 20% Enter value from tem 3v of schedule BFLA, f any. Short term captal loss set off Long term captal loss set off 15% 30% applcable rate 10% 20% Current year s captal gans remanng after set off (7= ) A4e (A1e+A3b+A5e +A6) Upto 15/6 () (B3e+ B5e+B6c) 16/6 to 15/9 () (B1e+B2e+ B4c+ B6f+ B7e+B8) 16/9 to 15/12 () NOTE Please nclude the ncome of the specfed persons referred to n Schedule SP whle computng the ncome under ths head 16/12 to 15/3 (v) 16/3 to 31/3 (v) Page S6

11 Schedule OS ncome from other sources 1 ncome a Dvdends, Gross b nterest, Gross c Rental ncome from machnery, plants, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng race horses) Menton the nature OTHER SOURCES Wnnngs from lotteres, crossword puzzles etc. a Cash credts u/s 68 b Unexplaned nvestments u/s 69 c Unexplaned money etc. u/s 69A d Undsclosed nvestments etc. u/s 69B e Unexplaned expendture etc. u/s 69C f Amount borrowed or repad on hund u/s 69D Total (a + b + c + d + e + f) 1d ncome of the nature referred to n secton 56(2)(x) whch s chargeable to tax a Aggregate value of sum of money receved wthout consderaton b n case mmovable property s receved wthout consderaton, stamp duty value of property n case mmovable property s receved for c nadequate consderaton, stamp duty value of property n excess of such consderaton d n case any other property s receved wthout consderaton, far market value of property n case any other property s receved for e nadequate consderaton, far market value of property n excess of such consderaton Total (a+ b + c +d + e) 1d v v Total (1d + 1d+ 1d + 1dv) e Total (1a + 1b + 1c + 1dv) f ncome ncluded n 1e chargeable to tax at specal rate (to be taken to schedule S) ncome by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. (u/s 115BB) Dvdend ncome from domestc company that exceeds Rs.10 Lakh (u/s 115BBDA) Deemed ncome chargeable to tax u/s 115BBE v ncome from patent chargeable u/s 115BBF v ncome from transfer of carbon credts u/s 115BBG v Any other ncome chargeable to tax at the rate specfed under Chapter X/X-A v ncome chargeable at specal rates under DTAA Sl.. Amount of ncome Nature of ncome Country name & Code Artcle of DTAA Rate as per Treaty (enter NL, f not chargeable) Whether TRC obtaned (Y/N) 1a 1b 1c 1d 1dv 1dv Secton of Rate as per.t. Act.T. Act Applcable rate [lower of (6) or (9)] (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Total amount of ncome chargeable at specal rates under DTAA v ncome ncluded n 1e chargeable to tax at specal rate (1f +1f + 1f+1fv+1fv+1fv +1fv ) g Gross amount chargeable to tax at normal applcable rates (1e-1fv) h Deductons under secton 57 (other than those relatng to ncome under 1f, 1f, 1f, 1fv, 1fv, 1fv & 1fv for non-resdents) Expenses / Deductons h Deprecaton h Total h Amounts not deductble u/s 58 1 j Profts chargeable to tax u/s 59 1j k ncome from other sources (other than from ownng race horses and amount chargeable to tax at 1k specal rate) (1g h j) (f negatve take the fgure to 3x of schedule CYLA) 2 ncome from other sources (other than from ownng race horses) (1fv + 1k) (enter 1k as nl, f negatve) 2 3 ncome from the actvty of ownng and mantanng race horses a Recepts 3a b Deductons under secton 57 n relaton to (4) 3b c Amounts not deductble u/s 58 3c 1e 1f 1f 1f 1fv 1fv 1fv 1fv 1fv 1g Page S7

12 d Profts chargeable to tax u/s 59 3d e Balance (3a 3b + 3c + 3d) (f negatve take the fgure to 6x of Schedule CFL) 3e 4 ncome under the head ncome from other sources (2 + 3e) (take 3e as nl f negatve) 4 NOTE Please nclude the ncome of the specfed persons referred to n Schedule SP whle computng the ncome under ths head. Schedule CYLA Sl. Head/ Source of ncome Detals of ncome after Set off of current year losses ncome of current year (Fll ths column only f ncome s zero or postve) House property loss of the current year set off Other sources loss (other than loss from race horses) of the current year set off Current year s ncome remanng after set off =1-2-3 CURRENT YEAR LOSS ADJUSTMENT Loss to be set off (3b of Schedule HP) (1k of Schedule-OS) Salares (6 of Schedule S) House property (3b of Schedule HP) v Short-term captal gan 15% v Short-term captal gan 30% v Short-term captal gan taxable at applcable rates v Long term captal gan 10% v Long term captal gan 20% x x Other sources (excludng proft from ownng race horses and amount chargeable to specal rate of tax) Proft from ownng and mantanng race horses x Total loss set off ( + + v + v + v + v + v + x + x) x Loss remanng after set-off ( - x) (7 of tem E of schedule CG) (7 of tem E of schedule CG) (7v of tem E of schedule CG) (7v of tem E of schedule CG) (7v of tem E of schedule CG) (1k of schedule OS) (3e of schedule OS) Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT Sl.. Detals of ncome after Set off of Brought Forward Losses of earler years Head/ Source of ncome ncome 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% (4vof schedule CYLA) (B/f short-term captal loss) v Short-term captal gan 30% (4vof schedule CYLA) (B/f short-term captal loss) Short-term captal gan taxable at v (4vof schedule CYLA) (B/f short-term captal loss) applcable rates v Long-term captal gan 10% (4vof schedule CYLA) (B/f short-term or long-term captal loss) v Long term captal gan 20% (4v of schedule CYLA) (B/f short-term or long-term captal loss) Other sources (excludng proft from v ownng race horses and wnnngs from lottery, game etc.) (4xof schedule CYLA) x Proft from ownng and mantanng race horses (4xof schedule CYLA) (B/f loss from horse races) x Total of brought forward loss set off ( v2 + v2+v2+v2+x2) x Current year s ncome remanng after set off Total ( v3 + v3+ v3+ v3 + v3+ x3) Schedule CFL CARRY FORWARD OF LOSS v Detals of Losses to be carred forward to future years Assessment Year Date of Flng (DD/MM/YYYY) House property loss Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses Page S8

13 v v v v x x x x Total of earler year losses Adjustment of above losses n Schedule BFLA (Current year losses) Total loss carred forward to future years (2 of schedule BFLA) (2x of schedule CYLA) ((2v+3v+4v) of tem E of schedule CG) ((5v+6v)of tem E of schedule CG) (2x of schedule BFLA) (3e of schedule OS, f ve) Schedule V-A Deductons under Chapter V-A 1 Part B- Deducton n respect of certan payments a 80C b 80CCC c 80CCD(1) d 80CCD(1B) e 80CCD(2) f 80CCG TOTAL DEDUCTONS g 80D h 80DD 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 80U t Total deductons under Chapter V-A (Total of a to s) t Schedule 80G DETALS OF DONATONS A B C D Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout qualfyng lmt address of donee PAN of Donee Amount of donaton Total Donatons enttled for 50% deducton wthout qualfyng lmt address of donee PAN of Donee Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt address of donee PAN of Donee Amount of donaton Total Donatons enttled for 50% deducton subject to qualfyng lmt address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Page S9

14 Total E Total donatons (A + B + C + D) ncome of specfed persons (spouse, mnor chld etc.) ncludable n ncome of the assessee (ncome of the mnor chld, n excess Schedule SP of Rs. 1,500 per chld, to be ncluded) Sl Name of person PAN of person (optonal) Relatonshp Nature of ncome Amount (Rs) Schedule S SPECAL RATE ncome chargeable to tax at specal rates (please see nstructons. 9 for rate of tax) Sl Secton Specal rate (%) ncome 1 111A (STCG on shares unts on whch STT pad) 15 (3 of schedule BFLA) 2 115AD (STCG for Fs 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 Fs 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) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) BBDA (Dvdend ncome from domestc company exceedng Rs.10 lakh) 10 (1f of schedule OS) BBE (ncome under secton 68, 69, 69A, 69B, 69C or 69D) 60 (1f of schedule OS) BBF (Tax on ncome from patent) 10 (1fv of schedule OS) BBG (Tax on ncome from transfer of carbon credts) 10 (1fv of schedule OS) 115AC (ncome of a non-resdent from bonds or GDR purchased n foregn (part of 1fv of schedule OS) currency) Chargeable under DTAA rate (part of 1fv of schedule OS + A7b 16 and B9b of schedule CG) Total Tax thereon Schedule E EXEMPT NCOME Detals of Exempt ncome (ncome not to be ncluded n Total ncome) 1 nterest ncome 1 2 Dvdend ncome from domestc company (amount not exceedng Rs. 10 lakh) 2 3 Long-term captal gans from transactons on whch Securtes Transacton Tax s pad 3 4 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of.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) 4 5 Others, ncludng exempt ncome of mnor chld 5 6 Total ( ) 6 Schedule PT Pass Through ncome 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 ncome 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 Page S10 PASS THROUGH NCOME

15 NOTE Please refer to the nstructons for fllng out ths schedule. v ncome clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s Schedule FS Sl. Country Code 1 Taxpayer dentfcaton Number Detals of ncome from outsde nda and tax relef Sl. Head of ncome ncome from outsde nda (ncluded n PART B-T) Salary House Property Busness or Professon v Captal Gans v Other sources Tax pad outsde nda Tax payable on such ncome under normal provsons n nda Tax relef avalable n nda (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 Salary House Property Busness or Professon v Captal Gans v Other sources NOTE Total Please refer to the nstructons for fllng out ths schedule. Schedule TR 1 Summary of Tax relef clamed Country Code Summary of tax relef clamed for taxes pad outsde nda Taxpayer dentfcaton Number Total taxes pad outsde nda (total of (c) of Schedule FS n respect of each country) Total tax relef avalable (total of (e) of Schedule FS 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 nda, on whch tax relef was allowed n nda, has been refunded/credted by the foregn tax authorty durng the year? f 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 nda 4 Yes/ Schedule FA DETALS OF FOREGN ASSETS Detals of Foregn Assets and ncome from any source outsde nda A Detals of Foregn Bank Accounts held (ncludng any benefcal nterest) at any tme durng the prevous year Sl Country Code Address of the Bank Account holder name Status- Owner/ Benefcal owner/ Benefcary Account Number Account openng date Peak Balance Durng the Year (n rupees) nterest accrued n the account nterest taxable and offered n ths return Amount Schedule where offered tem number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detals of Fnancal nterest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Page S11

16 Sl Country Nature of code entty Address of the Entty Nature of nterest- Drect/ Benefcal owner/ Benefcary Date snce held Total nvestment (at cost) (n rupees) ncome Nature of accrued from ncome such nterest ncome taxable and offered n ths return Amount Schedule where offered tem number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of mmovable Property held (ncludng any benefcal nterest) at any tme durng the prevous year Sl Address of the Property Date of acquston Nature of ncome ncome taxable and offered n ths return Amount Country code Ownershp- Drect/ Benefcal owner/ Benefcary Total nvestment (at cost) (n rupees) ncome derved from the property Schedule where offered tem 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 prevous year Sl Nature of Asset Date of acquston Nature of ncome ncome taxable and offered n ths return Amount Country code Ownershp- Drect/ Benefcal owner/ Benefcary Total nvestment (at cost) (n rupees) ncome derved from the asset Schedule where offered tem 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 prevous year and whch has not been ncluded n A to D above. Sl Account Number f (7) s yes, ncome offered n ths return Amount Name of the nsttuton n whch the account s held Address of the nsttuton Name of the account holder Peak Balance/ nvestment durng the year (n rupees) Whether ncome accrued s taxable n your hands? f (7) s yes, ncome accrued n the account Schedule where offered tem 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 nda, n whch you are a trustee, benefcary or settlor Sl f (8) s yes, ncome offered n ths return Amount Country code address of the trust address of trustees address of Settlor address of Benefcares Date snce poston held Whether ncome derved s taxable n your hands? f (8) s yes, ncome derved from the trust Schedule where offered tem number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl Detals of any other ncome derved from any source outsde nda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon f (6) s yes, ncome offered n ths return Country Name address of the Whether taxable ncome derved Nature of ncome and code person from whom derved n your hands? Amount Schedule where offered tem number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule. n case of an ndvdual, not beng an ndan ctzen, who s n nda 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. Page S12

17 Schedule 5A Name of the spouse PAN of the spouse Heads of ncome 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total nformaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code ncome 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 Asset and Lablty at the end of the year (applcable n a case where total ncome exceeds Rs.50 lakh) A Detals of mmovable asset Sl. Descrpton Address Amount (cost) n Rs.. (1) (2) (3) (4) DETALS OF ASSETS AND LABLTES () () B Detals of movable asset Sl. 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 asset Amount (cost) n Rs. (a) Bank (ncludng all deposts) (b) Shares and securtes (c) nsurance polces (d) Loans and advances gven (e) Cash n hand C Lablty n relaton to Assets at (A + B) NOTE Please refer to nstructons for fllng out ths schedule. Page S13