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1 TOTAL INCOME FILING STATUS PERSONAL INFORMATION FORM ITR-2 INDIAN INCOME TAX RETURN [For Indvduals and HUFs not havng Income from Busness or Professon] (Please see Rule 12 of the Income-tax Rules,1962) (Also see attached nstructons) Assessment Year Part A-GEN GENERAL Frst name Mddle name Last name PAN Flat/Door/Block No Name Of Premses/Buldng/Vllage Status (Tck) Indvdual Road/Street/Post Offce Area/localty Date of Brth (DD/MM/YYYY) ( n case of ndvdual) / / HUF Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) Country Male Female Resdental/Offce Phone Number wth STD code/ Moble No. 1 Emal Address-1 (self) Emal Address-2 Moble No. 2 Employer Category(f n employment) (Tck) Govt. Income Tax Ward/Crcle PSU Others Return fled (Tck)[Please see nstructon number-7] On or before due date -139(1), After due date -139(4), Revsed Return-139(5) or In response to notce 139(9)-Defectve 142( A/153C If revsed/defectve, then enter Recept No and Date of flng orgnal return (DD/MM/YYYY) / / Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent Are you governed by Portuguese Cvl Code? Tck) Yes No (If YES please fll Schedule 5A) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (a) (b) Name of the representatve Address of the representatve ( c) Permanent Account Number (PAN) of the representatve PART-B Part B - TI Computaton of total ncome 1 Salares (7 of Schedule S) 1 2 Income from house property (3c of Schedule HP) (enter nl f loss) 2 3 Captal gans a Short term Short-term (u/s 111A) (enter nl, f loss) (A1a+A 2e of Schedule CG) 3a Short-term (others) (enter nl f loss) ((A5 A1a-A 2e) of Schedule 3a CG) Total short-term (3a + 3a) (A5 of Schedule CG) 3a b Long-term (B6 - B3e B4 of Schedule CG) (enter nl f loss) 3b Long-term wthout ndexaton (B3e + B4 of Schedule CG) (enter 3b nl f loss) Total Long-Term (3b +3b) 3b c Total captal gans (3a + 3b) (enter nl f 3c s a loss) Do not wrte or stamp n ths area (Space for bar code) 3c For Offce Use Only Recept No Date Seal and Sgnature of recevng offcal Page 1 of 10

2 REFUND TAXES PAID COMPUTATION OF TAX LIABILITY 4 Income from other sources a from sources other than from ownng race horses and wnnngs from Lottery etc. (1g of 4a Schedule OS) b wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. (2 of 4b Schedule OS) c from ownng and mantanng race horses (4c of Schedule OS) (enter nl f loss) 4c d Total (4a + 4b + 4c) (enter nl f 4d s a loss) 4d 5 Total (1+2+3c +4d) 5 6 Losses of current year set off aganst 5 (total of 2v and 3v of Schedule CYLA) 6 7 Balance after set off current year losses (5-6) (also total of column 4 of Schedule CYLA +4b) 7 8 Brought forward losses set off aganst 7 (2v of Schedule BFLA) 8 9 Gross Total ncome (7-8)(also 3v of Schedule BFLA +4b ) 9 10 Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deductons under Chapter VI-A [q 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 () of schedule SI) Net agrcultural ncome/ any other ncome for rate purpose (4 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) 16 Part B - TTI Computaton of tax lablty on total ncome 1 Tax payable on total ncome a Tax at normal rates on 15 of Part B-TI b Tax at specal rates (total of () of Schedule SI) 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 (1a + 1b 1c) 2 Educaton cess, ncludng secondary and hgher educaton cess, on 1d 2 3 Gross tax lablty (1d+ 2) 3 4 Tax relef a Secton 89 b Secton 90/90A ( 3 of Schedule TR) c Secton 91( 4 of Schedule TR) d Total (4a + 4b + 4c) 5 Net tax lablty (3 4d) 5 6 Interest payable a For default n furnshng the return (secton 234A) b For default n payment of advance tax (secton 234B) c For deferment of advance tax (secton 234C) d Total Interest Payable (6a+6b+6c) 7 Aggregate lablty (5 + 6d) 7 8 Taxes Pad a Advance Tax (from Schedule-IT) b TDS (total of column 5 of Schedule-TDS1 and column 7 of Schedule-TDS2) c Self-Assessment Tax(from Schedule-IT) d Total Taxes Pad (8a+8b+8c) 9 Amount payable (Enter f 7 s greater than 8d, else enter 0) 9 10 Refund (If 8d s greater than 7) Enter your bank account number (mandatory and for drect depost of refund nto bank, the number should be 11 dgts or more ) 12 Do you want your refund by cheque, or deposted drectly nto your bank account? (tck as applcable ) 13 Gve addtonal detals of your bank account IFSC Code 4a 4b 4c 6a 6b 6c 8a 8b 8c 1a 1b 1c 1d 4d 6d 8d Type of Account (tck as applcable ) Savngs Current Page 2 of 10

3 HOUSE PROPERTY SALARIES 14 Do you have,- () any asset (ncludng fnancal nterest n any entty) located outsde Inda or () sgnng authorty n any account located outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] Yes No VERIFICATION I, son/ daughter of holdng permanent account number 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 that the amount of total ncome and other partculars shown theren are truly stated and are n accordance wth the provsons of the Income-tax Act, 1961, n respect of ncome chargeable to Income-tax for the prevous year relevant to the Assessment Year Place Sgn here Date 15 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof 16 Schedule S Detals of Income from Salary Name of Employer PAN of Employer (optonal) 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 1 separately below) 2 Allowances exempt under secton 10 (Not to be ncluded n 7 below) 2 3 Allowances not exempt (refer Form 16 from employer) 3 4 Value of perqustes (refer Form 16 from employer) 4 5 Profts n leu of salary (refer Form 16 from employer) 5 6 Deducton u/s 16 (Entertanment allowance by Government and tax on employment) 6 7 Income chargeable under the Head Salares ( ) 7 Schedule HP Detals of Income from House Property (Please refer to nstructons) Address of property 1 Town/ Cty State PIN 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 (Tck) f let out Name of Tenant PAN of Tenant (optonal) 2 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) 1e f 30% of 1e 1f g Interest payable on borrowed captal 1g h Total (1f + 1g) 1h Income from house property 1 (1e 1h) 1 Address of property 2 Town/ Cty State PIN Code Is the property co-owned? Yes No (f YES please enter followng detals) Page 3 of 10

4 CAPITAL GAINS Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) (optonal ) Percentage Share n Property (optonal) I II (Tck) f let out Name of Tenant PAN of Tenant (optonal) NOTE 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) 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 30% of 2e 2f g Interest payable on borrowed captal 2g h Total (2f + 2g) 2h Income from house property 2 (2e 2h) 2 3 Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA 3a b Arrears of rent receved durng the year under secton 25B after deductng 30% 3b c Total (3a + 3b ) 3c Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head Schedule CG Captal Gans A Short-term captal gan 1 In case of NON-RESIDENT to whch frst provso to secton 48 s applcable From assets (shares/unts) where secton 111A s applcable (STT pad) From assets where secton 111A s not applcable 2 From assets (shares/ unts) n the case of others where secton 111A s applcable (STT pad) a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (2a 2bv) 2c d Loss, f any, to be gnored under secton 94(7) or 2d 94(8) (Enter postve value only) e Short-term captal gan (2c +2d) 3 From assets n case of others where secton 111A s not applcable a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (2a bv) 3c d Loss, f any, to be gnored under secton 94(7) or 3d 94(8) (Enter postve value only) e Deducton under secton 54B/ 54D 3e f Short-term captal gan (2c + 2d 2e) 3f 4 Amount deemed to be short term captal gans under sectons 54B/54D/54G/ 54GA A4 5 Total short term captal gan (1a+1b+2e + 3f + A4) A5 B Long term captal gan 1 From asset n case of non-resdent to whch frst provso to secton 48 s applcable 1 2 From asset n the case of others where provso under secton 112(1) s not applcable a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston after ndexaton b Cost of mprovement after ndexaton b Expendture on transfer b 1a 1b 2e Page 4 of 10

5 OTHER SOURCES v Total (b + b +b) bv c Balance (2a bv) 2c d Deducton under sectons 54/54B/54D/54EC/54F 2d 54G/54GA/54GB e Net balance (2c 2d) 3 From asset where provso under secton 112(1) s applcable (wthout ndexaton) 2e a Full value of consderaton 3a 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 (3a bv) 3c d Deducton under sectons 3d 54/54B/54D/54EC/54F/54GB e Net balance (3c-3d) B3e 4 From unlsted securtes n case of non-resdent as per secton 112(1)(c)() B4 5 Amount deemed to be long term captal gans under sectons 54/54B/54D/54EC/54F/54GB B5 6 Total long term captal gan [1 +2e +B3e + B4 + B5] B6 7 In case of deducton u/s 54GB, furnsh PAN of the company C Income chargeable under the head CAPITAL GAINS (A5 + B6) (enter B6 as nl, f loss) D Informaton about accrual/recept of captal gan Date Upto 15/9 () 1 Long- term [where provso under secton 112(1) s applcable (Wthout Indexaton) + non-resdents as per secton 112(1)(c)()]- Tax Rate s 10% ; Enter only postve value from Item B3e + B4 of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 2 Long- term where provso under secton 112(1) s not applcable (Wth Indexaton)- Tax Rate s 20%; Enter only postve value from Item (B6 -B3e- B4) of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 3 Short-term under 111A- Tax Rate s 15% ; Enter only postve value from Item A1a+A 2e of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 4 Short-term OTHERS- Taxed at normal rates; Enter only postve value from Item (A5 A 2e-A1a) of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. NOTE Schedule OS 16/9 to 15/12 () C 16/12 to 15/3 () Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head Income from other sources 1 Income a Dvdends, Gross b Interest, Gross c Rental ncome from machnery, plants, buldngs, etc., Others, Gross Gross (excludng ncome from ownng race d horses)menton the source Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1d) f Deductons under secton 57:- Expenses / Deductons Deprecaton f Total f g Balance (1e f) 1g 2 Wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. (Gross) 2 1a 1b 1c 1d 1d 1d 1d f 1e 16/3 to 31/3 (v) Page 5 of 10

6 CARRY FORWARD OF LOSS BROUGHT FORWARD LOSS ADJUSTMENT CURRENT YEAR LOSS ADJUSTMENT NOTE 3 Income from other sources (other than from ownng race horses) (1g + 2) (enter1g as nl, f loss) 3 4 Income from ownng and mantanng race horses a Recepts 4a b Deductons under secton 57 n relaton to (4) 4b c Balance (4a 4b) Income chargeable under the head Income from other sources (3 + 4c) (enter 4c as nl f loss 5 and take 4c loss fgure to Schedule CFL) Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head. 4c 5 Schedule CYLA Detals of Income after Set off of current year losses Sl.No Head/ Source of Income of current House property loss of the current Income year year set off (Fll ths column only f ncome s zero or Total loss (3c of Schedule HP) postve) Loss to be adjusted Salares House property Short-term captal gan v 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 v Total loss set off v Loss remanng after set-off out of 2 & 3 Other sources loss (other than loss from race horses) of the current year set off Total loss (3 of Schedule-OS) Current year s Income remanng after set off =1-2-3 Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years Sl. Head/ Source of Income Income after set off, f any, of Brought forward loss set off Current year s ncome No. current year s losses as per 4 of remanng after set off Schedule CYLA Salares House property Short-term captal gan v 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 v Total of brought forward loss set off v Current year s ncome remanng after set off Total ( v3 + v3+v3) Schedule CFL Detals of Losses to be carred forward to future years Assessment Year Date of Flng House property (DD/MM/YYYY) loss Short-term captal loss Long-term Captal loss Other sources loss (from ownng race horses) v v v v v Page 6 of 10

7 DETAILS OF DONATIONS TOTAL DEDUCTIONS x Total of earler year losses x Adjustment of above losses n Schedule BFLA x (Current year losses) x Total loss Carred Forward to future years Schedule VIA Deductons under Chapter VI-A (Secton) a 80C g 80DDB n 80RRB b 80CCC h 80E o 80TTA c() 80CCD(1) (assessees contrbuton) c() 80CCD(2) (employers j 80GG contrbuton) d 80CCG k 80GGA e 80D l 80GGC f 80DD m 80QQB 80G p 80U q Total deductons (total of a to p) q Schedule 80G Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout A qualfyng lmt PAN of Donee Amount of donaton Elgble Amount of Name and address of donee donaton B v v Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee v v Total Donatons enttled for 100% deducton subject to C qualfyng lmt Name and address of donee v v Total Donatons enttled for 50% deducton subject to D qualfyng lmt Name and address of donee v v Total E Total donatons (Av + Bv + Cv + Dv) PAN of Donee Amount of donaton Elgble Amount of donaton PAN of Donee Amount of donaton Elgble Amount of donaton PAN of Donee Amount of donaton Elgble Amount of donaton Page 7 of 10

8 TDS ON SALARY TAX PAYMENTS EXEMPT INCOME SPECIAL RATE Income of specfed persons (spouse, mnor chld etc) ncludable n ncome of the assessee (ncome of the mnor Schedule SPI chld, n excess of Rs. 1,500 per chld, to be ncluded) Sl No Name of person PAN of person (optonal) Relatonshp Nature of Income Amount (Rs) Schedule SI Sl No Income chargeable to tax at specal rates (please see nstructons No. 9 for rate of tax) Secton Specal rate (%) 1 111A (STCG on shares where STT pad) provso (LTCG on lsted securtes/ unts wthout ndexaton) (LTCG on others) (1)(c)() (LTCG on unlsted securtes n case of non-resdents) BB (Wnnngs from lotteres, puzzles, races, games etc.) Total Income () Tax thereon () Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income) 1 Interest ncome 1 2 Dvdend ncome 2 3 Long-term captal gans from transactons on whch Securtes Transacton Tax s pad 3 4 Gross Agrcultural ncome (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expenses relatng to above Agrcultural ncome Brought forward loss as per part IV of Schedule I of the Fnance Act Net Agrcultural ncome (--) 4 5 Others, ncludng exempt ncome of mnor chld 5 6 Total ( ) 6 Schedule IT 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 v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 8a & 8c of Part B-TTI Schedule TDS1 Sl No Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Name of the Employer Income chargeable under Salares Tax Deducton Account Number (TAN) of the Employer Total tax deducted (1) (2) (3) (4) (5) NOTE Please enter total of column 5 of Schedule-TDS1 and column 7 of Schedule-TDS2 n 8(b) of Part B-TTI Page 8 of 10

9 DETAILS OF FOREIGN ASSETS TAXES PAID OUTSIDE INDIA INCOME ACCRUING OR ARISING OUTSIDE INDIA TDS ON OTHER INCOME Schedule TDS2 Sl No Tax Deducton Account Number (TAN) of the Deductor Detals of Tax Deducted at Source on Income [As per Form 16 A ssued by Deductor(s)] Name of the Deductor Unque TDS Certfcate Number Fnancal Year n whch TDS s Deducted Total Tax Deducted Amount out of (6) clamed ths Year (1) (2) (3) (4) (5) (6) (7) NOTE Please enter total of column 5 of Schedule-TDS1 and column 7 of Schedule-TDS2 n 8(b) of Part B-TTI Schedule FSI Detals of Income accrung or arsng outsde Inda 1 Detals of Income ncluded n Total Income n Part-B-TI above Country Code Taxpayer Identfcaton Number Income from Salary (ncluded n PART B-TI) (A) Income from House Property (ncluded n PART B-TI) (B) Busness Income (ncluded n PART B- TI) (C) Captal Gan Income (ncluded n PART B-TI) (D) Other source Income (ncluded n PART B-TI) (E) Total Income from Outsde Inda (F)=A+B+C+D +E Total 2 Total Income from outsde Inda (Total of F as per tem no.1 above) 2 3 Total Income from outsde Inda where DTAA s applcable 3 4 Total Income from outsde Inda where DTAA s not applcable (2-3) 4 NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Detals of Taxes Pad outsde Inda 1 Detals of Taxes Pad outsde Inda Country Code Taxpayer Identfcaton Number Relevant artcle of DTAA Total taxes pad on ncome declared n Schedule FSI (A) Relef clamed u/s 90/90A (B1) Tax Relef Clamed (B) Relef clamed u/s 91 (B2) Total 2 Total Taxes pad outsde Inda (Total of 1A) 2 3 Total Taxes Pad outsde Inda where DTAA s applcable 3 4 Total Taxes Pad outsde Inda where DTAA s not applcable (2-3) 4 NOTE Please refer to the nstructons for fllng out ths schedule. Schedule FA Detals of Foregn Assets A Detals of Foregn Bank Accounts Sl No Country Name Country Code Name and Address of the Name mentoned Account Number Peak Balance Durng the Year Bank n the account (n rupees) (1) (2) (3) (4) (5) (6) (7) () () Page 9 of 10

10 B Detals of Fnancal Interest n any Entty Sl No Country Name Country Code (1) (2) () Nature of entty (3) Name and Address of the Entty (4) Total Investment (at cost) (n rupees) (5) () C Detals of Immovable Property Sl No Country Name Country Code (1) (2) (3) () Address of the Property (4) Total Investment (at cost) (n rupees) (5) () D Detals of any other Asset n the nature of Investment Country Name Country Code (2) (3) Sl No (1) Nature of Asset (4) Total Investment (at cost) (n rupees) (5) () () E Sl No (1) () Detals of account(s) n whch you have sgnng authorty and whch has not been ncluded n A to D above. Name of the Insttuton n whch Address of the Name of the account Account Number Peak Balance/Investment durng the account s held Insttuton holder (5) the year (n rupees) (2) (3) (4) (6) () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee Country Name Country Code (2) (3) Sl No (1) () Name and address of the trust (4) Name and address of other trustees (5) Name and address of Settlor (6) Name and address of Benefcares (7) () Schedule 5A Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code Name of the spouse PAN of the spouse 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Heads of Income Amount apportoned n the hands of the spouse Page 10 of 10

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