Part A-GEN GENERAL First name Middle name Last name PAN. Flat/Door/Block No Name of Premises/Building/Village Status (Tick)

Transcription

1 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) PERSONAL INFORMATION Indvdual HUF Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Do you have Aadhaar Number? (For Indvdual) Yes No. If Yes, please provde 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) Moble No. 2 Employer Category (f n employment) (Tck) Govt. PSU Others Income Tax Ward/Crcle Emal Address-2 Passport No. (Indvdual)(If avalable) FILING STATUS Return fled (Tck)[Please see nstructon number-7] On or before due date-139(1), After due date-139(4), Revsed Return-139(5), under secton 119(2)(b), or n response to notce 139(9)-Defectve, 142(1), 148, 153A/153C If revsed/defectve, 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 enter date of such notce / / Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes No (If YES please fll Schedule 5A) Whether 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 - TI TOTAL INCOME Computaton of total ncome PART-B 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 (7 of tem E of Sch CG) Short term (7 of tem E of Sch CG) Short term chargeable at applcable rate (7v of tem E of Sch CG) a v Total Short term (a + a + a) b Long-term Long term (7v of tem E of Sch CG) Long term (7v of tem E of Sch CG) Total Long-term (b + b) (enter nl f loss) c Total captal gans (3av + 3b) (enter nl f loss) Do not wrte or stamp n ths area (Space for bar code) a a 3av b b 3b 3c For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal Page S0

2 4 Income from other sources from sources other than from ownng race horses and ncome chargeable to tax at specal a rate (1 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate (1fv of Schedule OS) c from the actvty of ownng and mantanng race horses (3c of Schedule OS)(enter nl f loss) d Total (4a + 4b + 4c) (enter nl f loss) 4a 4b 4c 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 col. 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 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 Rebate under secton 87A (applcable for resdent and f 12 of Part B-TI does not exceed 5 lakh) 2 1a 1b 1c 1d COMPUTATION OF TAX LIABILITY 3 Tax payable (1d - 2) 3 4 Surcharge on 3 (applcable f 12 of Part B-TI exceeds 1 crore) 4 5 Educaton cess, ncludng secondary and hgher educaton cess, on (3 + 4) 5 6 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 Interest payable a For default n furnshng the return (secton 234A) 9a b For default n payment of advance tax (secton 234B) c For deferment of advance tax (secton 234C) 9b 9c d Total Interest Payable (9a+9b+9c) 9d 10 Aggregate lablty (8 + 9d) Taxes Pad a Advance Tax (from column 5 of 18A) 11a TAXES PAID b TDS (total of column 5 of 18B and column 8 of 18C) 11b c TCS (total of column 5 of 18D) 11c d Self-Assessment Tax (from column 5 of 18A) 11d e Total Taxes Pad (11a + 11b + 11c+11d) 11e 12 Amount payable (Enter f 10 s greater than 11e, else enter 0) Refund (If 11e s greater than 10) (Refund, f any, wll be drectly credted nto the bank account) 13 BANK ACCO UNT14 Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) Total number of savngs and current bank accounts held by you at any tme durng the prevous year (excludng dormant accounts). Provde the detals below. Page S1

3 Sl. IFS Code of the Bank Name of the Bank Account Number (the number should be 9 dgts or more as per CBS system of the bank ) Savngs/ Current Indcate the account n whch you prefer to get your refund credted, f 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 Inda; or () have sgnng authorty n any account located outsde Inda; or Yes () 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 ] 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 Date Sgn here 16 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 C D TDS ON OTHER INCOME TCS If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY Sl No 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. 11a & 11c 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) NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 11b of Part B-TTI Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued by Deductor(s) or Form 26QB] Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) Fn. Year n whch deducted Amount b/f TDS of the current fn. year Amount out of (6) or (7) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) n the hands of n own hands spouse, f secton 5A s applcable Amount out of (6) or (7) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 11b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax 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) NOTE Please enter total of column (5) of Schedule-TCS n 11c NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1-S11) AS APPLICABLE Page S2

4 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) 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 separately below) 2 Allowances exempt under secton 10 (Not to be ncluded n 7 below) 1 SALARIES Travel concesson/assstance receved [(sec. 10(5)] 2 Tax pad by employer on non-monetary perquste [(sec. 10(10CC)] 2 Allowance to meet expendture ncurred on house rent [(sec. 10(13A)] 2 v Other allowances 2v 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) Percentage Share n Property HOUSE PROPERTY 2 I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II 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 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 Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty State PIN Code Is the property co-owned? Yes Your percentage of share n the property No (f YES please enter followng detals) Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN(s) of Tenant (optonal) I II Page S3

5 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 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 Income from house property 2 (2f 2) 2j 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 (1j + 2j +3a + 3b ) (f negatve take the fgure to 2 of schedule CYLA) 3c NOTE 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 Gans (STCG) (Items 3, 4 and 7 are not applcable for resdents) 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 a Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans (a or a) a b Deductons under secton 48 Short-term Captal Gans 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 (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e 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 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 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) 2d e Short-term captal gan on equty share or equty orented MF (STT pad) (2c +2d) A2e For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to 3 be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A3a 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 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 ( + + ) bv c Balance (4a bv) 4c 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 4d A3b A4e Page S4

6 a Full value of consderaton 5a 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) 5c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- 5d 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 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 Secton under whch New asset acqured/constructed Amount not used for new asset or remaned n whch asset deducton clamed n Year n whch asset Amount utlsed out of unutlzed n Captal transferred that year acqured/constructed Captal Gans account gans account (X) D/54G/54GA B b Amount deemed to be short term captal gans, other than at a Total amount deemed to be short term captal gans (X + X + b) 7 FOR NON-RESIDENTS- STCG ncluded n A1-A6 but not chargeable to tax n Inda as per DTAA Sl. Country Whether Tax Resdency Item no. A1 to A6 above Amount of Artcle of DTAA name, code Certfcate obtaned? n whch ncluded STCG I A1e/A2e/A3a/A3b/A4e/A5e/A6 II A1e/A2e/A3a/A3b/A4e/A5e/A6 III Total amount of STCG not chargeable to tax as per DTAA A7 8 Total Short-term Captal Gan chargeable under I.T. Act (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6-A7) A8 B Long-term captal gan (LTCG) (Items 4, 5, 6 & 9 are not applcable for resdents) 1 From sale of land or buldng or both Long-term Captal Gans 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 wth ndexaton Cost of Improvement 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/54F/54GB (Specfy detals n tem D d 1d below) e Long-term Captal Gans on Immovable property (1c - 1d) 2 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 2a 3 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/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 to secton 112(1) s applcable () GDR of an Indan company referred n sec. 115ACA a a b b b bv 1c b b b bv 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 2c 2d A5e A6 B1e B2e Page S5

7 c Balance (3a bv) 3c 4 d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 3d e Long-term Captal Gans on assets at B3 above (3c 3d) B3e 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 4a b Deducton under sectons 54EC/54F (Specfy detals n tem D below) 4b c LTCG on share or debenture (4a 4b) B4c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as 5 referred n sec. 115AC, () securtes by FII as referred to n sec. 115AD a Full value of consderaton 5a 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 (5a bv) 5c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 5d e Long-term Captal Gans on assets at 5 above n case of NON-REESIDENT (5c 5d) B5e 6 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) 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 a Full value of consderaton 7a 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 (7a bv) 7c d Deducton under sectons 54EC/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 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. New asset acqured/constructed Amount not used for Prevous year n Secton under whch whch asset deducton clamed n Amount utlsed new asset or remaned Year n whch asset unutlzed n Captal transferred that year out of Captal acqured/constructed Gans account gans account (X) /54D/54F/54G/54GA B 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) 9 FOR NON-RESIDENTS- LTCG ncluded n B1- B8 but not chargeable to tax n Inda as per DTAA Country name, Sl. Artcle of DTAA code I II Whether Tax Resdency Certfcate obtaned? Item B1 to B8 above n whch ncluded B1e/B2e/B3e/ B4c/ B5e/B6c/B6f/B7e/B8 B1e/B2e/B3e/ B4c/ B5e/B6c/B6f/B7e/B8 Amount of LTCG III Total amount of LTCG not chargeable to tax as per DTAA Total long term captal gan chargeable under I.T. Act [B1e +B2e +B3e + B4c + B5e +B6c+ B6f+ 10 B7e+ B8 - B9] (In case of loss take the fgure to 5x of schedule CFL) Income chargeable under the head CAPITAL GAINS (A8 + B10) (take B10 as nl, f loss) (If C s negatve, C 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 1 In case of deducton u/s 54/54B/54EC/54F/54GB/115F gve followng detals a Secton under whch deducton clamed 1a amount of deducton Cost of new asset a B8 B9 B10 C Page S6

8 Date of ts acquston/constructon a dd/mm/yyyy Amount deposted n Captal Gans Accounts a Scheme before due date b Secton under whch deducton clamed 1b amount of deducton Cost of new asset b Date of ts acquston/constructon b dd/mm/yyyy Amount deposted n Captal Gans Accounts b Scheme before due date c Total deducton clamed (1a + 1b) 2 In case of deducton u/s 54GB, furnsh PAN of the company 1c 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 15% 30% applcable rate 10% 20% Current year s captal gans remanng after set off (7= ) Loss to be set off (Fll ths (B1e+B2e+ (A1e+A3b+ A5 (B3e+ row f computed fgure s (A2e+A3a) A4e B4c+ B6f+ +A6) B5e+B6c) negatve) B7e+B8) 15% (A2e+A3a) Short term 30% A4e captal gan v applcable rate (A1e+A3b+A5e+ A6) v 10% (B3e+ B5e+B6c) Long term captal gan (B1e+B2e+B4c+ v 20% B6f+ B7e+B8) v Total loss set off ( + + v + v + v) v Loss remanng after set off ( v) F Informaton about accrual/recept of captal gan Type of Captal gan / Date Short-term captal gans taxable at the rate of 15% Enter value from tem 3 of schedule BFLA, f any. Short-term captal gans taxable at the rate of 30% Enter value from tem 3v of schedule BFLA, f any. Short-term captal gans taxable at applcable rates Enter value from tem 3v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% Enter value from tem 3v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% Enter value from tem 3v of schedule BFLA, f any. Upto 15/9 () 16/9 to 15/12 () NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head 16/12 to 15/3 () 16/3 to 31/3 (v) Schedule OS Income from other sources 1 Income a Dvdends, Gross 1a b Interest, Gross 1b c Rental ncome from machnery, plants, buldngs, etc., Gross 1c d Others, Gross (excludng ncome from ownng race horses)menton the source Wnnngs from lotteres, crossword puzzles etc. 1d 1d 1d v Total (1d + 1d+ 1d) 1dv e Total (1a + 1b + 1c + 1dv) 1e f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc (u/s 115BB) 1f Any other ncome chargeable to tax at the rate specfed under Chapter XII/XII-A 1f FOR NON-RESIDENTS- Income chargeable to be taxed under DTAA Sl. Country Artcle Rate of tax Whether TRC Correspondng secton of the Amount of name, code of DTAA under DTAA obtaned? Act whch prescrbes rate ncome I II III Total amount of ncome chargeable to tax under DTAA 1f OTHER SOURCES Page S7

9 NOTE v Income ncluded n 1e chargeable to tax at specal rate (1f +1f + 1f) 1fv g Gross amount chargeable to tax at normal applcable rates (1e-1fv) 1g h Deductons under secton 57 (other than those relatng to ncome under 1f, 1f & 1f for non-resdents) Expenses / Deductons Deprecaton h Total h Income from other sources (other than from ownng race horses and amount chargeable to tax at specal rate) (1g h) (If negatve take the fgure to 3 of schedule CYLA) 2 Income from other sources (other than from ownng race horses) (1fv + 1) (enter 1 as nl, f negatve) 2 3 Income from the actvty of ownng and mantanng race horses a Recepts 3a b Deductons under secton 57 n relaton to (4) 3b c Balance (3a 3b) (f negatve take the fgure to 6x of Schedule CFL) 4 Income under the head Income from other sources (2 + 3c) (take 3c as nl f negatve) 4 Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head. h 1 3c Schedule CYLA CURRENT YEAR LOSS ADJUSTMENT Sl.No Head/ Source of Income Detals of Income after Set off of current year losses Income of current year (Fll ths column only f ncome s 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 Income remanng after set off =1-2-3 Loss to be set off (3c of Schedule HP) (1 of Schedule-OS) Salares (7 of Schedule S) House property (3c 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 (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) (1 of schedule OS) (3c of schedule OS) x Total loss set off ( + + v + v + v + v + v + x + x) x 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 col. 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 Long-term captal gan 10% (4v of 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 ownng race v horses and wnnngs from lottery, game etc.) (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 ( v2 + v2+v2+v2+x2) x Current year s ncome remanng after set off Total ( v3 + v3+v3+v3+v3+x3) Page S8

10 Schedule CFL CARRY FORWARD OF LOSS v v v v v x Total of earler year losses 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 Adjustment of above losses n Schedule BFLA x (Current year losses) x 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) Schedule VIA TOTAL DEDUCTIONS Deductons under Chapter VI-A (Secton) a 80C f 80DD m 80QQB b 80CCC g 80DDB n 80RRB c() 80CCD(1) h 80E o 80TTA c() 80CCD(1B) 80G p 80U c() 80CCD(2) j 80GG d 80CCG k 80GGA e 80D l 80GGC 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 DETAILS OF DONATIONS B Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee Total Donatons enttled for 100% deducton subject to C qualfyng lmt Name and address of donee Total Donatons enttled for 50% deducton subject to D qualfyng lmt Name and address of donee 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 S9

11 Total E Total donatons (A + B + C + D) 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 Income chargeable to tax at specal rates (please see nstructons No. 9 for rate of tax) Sl. Secton/ Descrpton Specal rate Income No. (%) () 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) SPECIAL RATE 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 company 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) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) 115AC (Income of a non-resdent from bonds or GDR purchased n 11 foregn currency) 10 (part of 1f of schedule OS) 12 Chargeable under DTAA rate (part of 1f of schedule OS) 13 Total Tax thereon () Schedule EI EXEMPT INCOME 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 Gross Agrcultural recepts (other than ncome to be excluded under 4 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) 4 5 Others, ncludng exempt ncome of mnor chld 5 6 Total ( ) 6 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 nvestment fund trust/ nvestment fund 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 a u/s 10(23FBB) b u/s.. c u/s PASS THROUGH INCOME TDS on such amount, f any Page S10

12 NOTE Please refer to the nstructons for fllng out ths schedule. Schedule FSI Sl. Country Code Taxpayer Identfcaton Number 1 Salary Detals of Income from outsde Inda and tax relef Sl. Head of ncome Income from Tax pad Tax payable on outsde Inda outsde Inda such ncome (ncluded n PART under normal B-TI) provsons n Inda House Property Busness or Professon v Captal Gans v Other sources 2 Salary 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 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 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 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 4 Yes/No a Amount of tax refunded NOTE Please refer to the nstructons for fllng out ths schedule. Schedule 5A Name of the spouse b Assessment year n whch tax relef allowed n Inda Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code PAN of the spouse Heads of Income Income receved Amount apportoned n the Amount of TDS deducted TDS apportoned n the under the head hands of the spouse on ncome at () hands of spouse () () () (v) (v) 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Page S11

13 Schedule FA Detals of Foregn Assets and Income from any source outsde Inda A Detals of Foregn Bank Accounts held (ncludng any benefcal nterest) at any tme durng the prevous year Sl No Country Name and Code Name and Address of the Bank Account holder name Status- Account Owner/ Benefcal Number owner/benefcary Account openng date Peak Balance Durng the Year (n rupees) Interest accrued n the account Interest taxable and offered n ths return Amount Schedule where offered (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () Item number of schedule DETAILS OF FOREIGN ASSETS () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Sl No Country Nature of Name and entty code Name and Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Income Nature of Investment accrued from Income (at cost) (n such Interest rupees) 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 prevous year Sl No Address of the Property Date of acquston Nature of Income Income taxable and offered n ths return Amount Country Name and code Ownershp- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Income derved from the property 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 prevous year Sl Country Nature of Ownershp- Date of Total Investment Income Nature of Income taxable and offered n ths return No Name and code Asset Drect/ Benefcal owner/ Benefcary acquston (at cost) (n rupees) derved from the asset Income 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 prevous year and whch has not been ncluded n A to D above. Sl No Address of the Name of the account Account Number If (7) s yes, Income offered n ths return Insttuton holder Amount Name of the Insttuton n whch the account s held 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 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 Country Name and Name and Name and Name and Date Whether If (8) s yes, If (8) s yes, Income offered n ths No Name and address of address of address of address of snce ncome derved Income return code the trust trustees Settlor Benefcares poston held s taxable n your hands? derved from the trust 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 If (6) s yes, Income offered n ths return Country Name Name and address of the Whether taxable Income derved Nature of ncome and code person from whom derved n your hands? Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () Page S12

14 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 AL Asset and Lablty at the end of the year (Applcable n a case where total ncome exceeds Rs. 50 lakh) A Partculars of Asset Amount (Cost) (Rs.) DETAILS OF ASSET AND LIABILITY B 1 Immovable Asset a Land b Buldng 2 Movable Asset a Cash n hand b Jewellery, bullon etc. c Vehcles, yachts, boats and arcraft 3 Total Lablty n relaton to Assets at A Page S13