(A) after the word, brackets, figure and letter sub-section (4E), the words, brackets, figure and letter or sub-section (4F) shall be inserted;

Transcription

1 INCOME TAX -COPY OF- NOTIFICATION NO.24/2016 Dated 30 th March, 2016 In exercse of the powers conferred by secton 295 of the Income-tax Act, 1961 (43 of 1961), the Central Board of Drect Taxes hereby makes the followng rules further to amend the Income-tax Rules, 1962, namely:- 1. (1) These rules may be called the Income-tax (9 th Amendment) Rules, (2) They shall come nto force wth effect from the 1 st day of Aprl, In the Income-tax rules, 1962,- (1) n rule 12,- (A) after the word, brackets, fgure and letter sub-secton (4E), the words, brackets, fgure and letter or sub-secton (4F) shall be nserted; (B) for the fgures 2015, the fgures 2016 shall be substtuted; (C) n clause ( ca), after the words Hndu undvded famly, the words or a frm, other than a lmted lablty partnershp frm, shall be nserted; (D) n clause (g), after the word, brackets, fgure and letter sub-secton (4E), the words, brackets, fgure and letter or sub-secton (4F) shall be nserted; (b) n sub-rule (5), for the fgures 2014, the fgures 2015 shall be substtuted. (2) n Appendx-II, for Forms Sahaj (ITR-1), ITR-2, ITR-2A, ITR-3, Sugam (ITR-4S), ITR-4, ITR-5, ITR-6, ITR-7 and ITR-V, the followng forms shall respectvely be substtuted, (a) n sub-rule (1),- namely:- Informaton on ths page s provded by Shakun & Company (Servces) Prvate Lmted, New Delh, Inda to ts subscrbers aganst the annual subscrpton. Non-subscrbers may vst for more detals.

2 ) ITR-1 SAHAJ INDIVIDUAL INCOME TAX RETURN (For Indvduals havng Income from Salares, One house property, Other sources (Interest etc.) Refer to Instructons for elgblty.) Assessment Year (A1) Frst name (A2) Mddle name (A3) Last name (A4) Permanent Account Number (A5) Sex (Tck) (A6) Date of Brth (DD/MM/YYYY) (A7) Income Tax Ward/Crcle (A8) Flat/Door/Buldng (A9) Name of Premses/ Buldng/ Vllage (A10) Road/Street (A11) Area/localty (A12) Town/Cty/Dstrct (A13) State (A15) Pn code (A17) Moble No./Resdental/Offce Phone Number wth STD code (A14) Country (A18) Moble No. 2 (A16) Emal Address (A19) Fll only one f you belong to- (A20) Fll only one- (A21) Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent (A22) Fll only one: Fled- On or before due date -139(1), After due date -139(4), Revsed Return-139(5) or In response to notce under secton 139(9)-Defectve 142(1) A/153C or Under Sec. 119(2)(b) (A23) Whether Person governed by Portuguese Cvl Code under Secton 5A (A24) If A23 s applcable, PAN of the Spouse (A25) If revsed/defectve, then enter Recept No and Date of flng orgnal return (DD/MM/YYYY) (A26) If fled n response to notce u/s 139(9) /142(1)/148/153A/153C, enter the date of such notce (A27)Whether you have Aadhar Number Yes No / / (A28) If A27 s yes, please provde Tck) Yes No / / PART B GROSS TOTAL INCOME Whole- Rupee( ) only B1 B2 B3 B4 Income From Salary /Penson NOTE- Ensure to Fll Sch TDS1 gven n Page 2 Income from One house property (If loss, put the fgure n negatve) Self Occuped Let Out Income from Other Sources(In case of loss use ITR 2) NOTE- Ensure to Fll Sch TDS2 gven n Page 2 Gross Total Income (B1+B2+B3) (If loss, put the fgure n negatve) B1 B2 ( ) B3 B4( ) PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer to nstructons for lmts on Amount of Deductons as per Income Tax Act ) C1 80C C2 80CCC C3 80CCD (1) C4 80CCD (1B) C5 80CCD(2) C6 80CCG C7 80D C8 80DD C9 80DDB C10 80E C11 80G C12 80GG C13 80GGA C14 80GGC C15 80RRB C16 80QQB C17 80TTA C18 80U C19 Total deductons (Total of C1 to C18) C19 C20 Taxable Total Income (B4-C19) C20 FOR OFFICE USE ONLY STAMP RECEIPT NO. HERE SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL Page 1 of 7

3 BANK ACCOUNT PAN-- PART D TAX COMPUTATIONS AND TAX STATUS D1 Tax payable on total ncome(c20) D1 D2 Rebate on 87A D2 D3 Tax payable after Rebate (D1-D2) D3 D4 Surcharge f C20 exceeds 1 Crore D4 D5 Cess, on (D3+D4) D5 D6 Total Tax Surcharge and Cess ( D3+D4+D5) D6 D7 Relef u/s 89 D7 D8 Balance Tax after Relef (D6-D7) D8 D9 Total Interest u/s 234A D9 D10 Total Interest u/s 234B D10 D11 Total Interest u/s 234C D11 D12 Total Tax and Interest(D8+D9+D10+D11) D12 D13 Total Advance Tax Pad D13 D14 Total Self-Assessment Tax Pad D14 D15 Total TDS Clamed D15 D16 Total TCS Clamed D16 D17 Total Taxes Pad ( D13+D14+D15+D16) D17 D18 Amount payable (D12 D17)(f D12 > D17) D18 D19 Refund (D17 D12)(f D17 > D12) D19 D20 Exempt Income only for Reportng Purpose (If agrcultural ncome s more than Rs 5000/- use ITR 2 or 2A) D21 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. Sl. IFS Code of Name of the Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) VERIFICATION I, son/ daughter of solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return s correct and complete and 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 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: Sgn here TRP PIN (10 Dgt) Name of TRP TRP Sgnature Amount to be pad to TRP Page 2 of 7

4 PAN-- Schedule IT Detals of Advance Tax and Self-Assessment Tax payments BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Tax pad R1 R2 R3 R4 R5 Col (1) Col (2) Col (3) Col (4) NOTE Enter the totals of totals of Advance tax and Self-Assessment tax n D13 & D14 S1 S2 S3 Schedule TDS1 Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Tax Deducton Account Number (TAN) of the Employer Name of the Employer Income chargeable under Salares Tax deducted Col (1) Col (2) Col (3) Col (4) NOTE Please enter total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2 n D15 Schedule TDS2 Detals of Tax Deducted at Source on Income Other than Salary[As per Form 16 A ssued by Deductor(s)] Tax Deducton Account Number (TAN) of the Deductor T1 T2 Name of the Deductor Unque TDS Certfcate Number Deducted year Tax Deducted Amount out of (5) clamed ths Year If A23 s applcable, amount clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) Col (7) T3 T4 NOTE Please enter total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2 n D15 Schedule TCS Detals of Tax Collected at Source [As per Form 27D ssued by the Collector(s)] Sl No Tax Collecton Account Number of the Collector Name of the Collector 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 D16 Page 3 of 7

5 DETAILS OF ASSET AND LIABILITY PAN-- 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.) 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 Supplementary Schedule TDS 1(to be used only after exhaustng tem S1-S3 of Schedule TDS1 n man form etc. Tax Deducton Account Number (TAN) of the Employer Name of the Employer Income chargeable under Salares Tax deducted Col (1) Col (2) Col (3) Col (4) S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19 Page 4 of 7

6 PAN-- S20 S21 S22 S23 S24 S25 S26 S27 S28 S29 S30 Supplementary Schedule TDS 2(to be used only after exhaustng tem T1-T4 of Schedule TDS2 n man form etc. Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Fnancal Year n whch TDS s Deducted Total Tax Deducted Amount out of (5) clamed ths Year If A23 s applcable, amount clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) Col (7) T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16 T17 T18 T19 T20 T21 Page 5 of 7

7 PAN-- T22 T23 T24 T25 T26 T27 T28 T29 T30 T31 Supplementary Schedule IT (to be used only after exhaustng tem R1-R5 of Schedule IT n man form etc. BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Tax pad Col (1) Col (2) Col (3) Col (4) R6 R7 R8 R9 R10 R11 R12 R13 R14 R15 R16 R17 R18 R19 R20 R21 R22 R23 R24 Page 6 of 7

8 PAN-- R25 R26 R27 R28 R29 R30 R31 R32 Page 7 of 7

9 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 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) Emal Address-2 Moble No. 2 Employer Category (f n employment) (Tck) Govt. PSU Others Income Tax Ward/Crcle Passport No. (Indvdual)(If avalable) 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 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 (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

10 BANK ACCO UNT TAXES PAID COMPUTATION OF TAX LIABILITY 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) 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 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 b Secton 90/90A (2 of Schedule TR) c Secton 91(3 of Schedule TR) d Total (7a + 7b + 7c) 8 Net tax lablty (6 7d) (enter zero f negatve) 8 9 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 (9a+9b+9c) 10 Aggregate lablty (8 + 9d) Taxes Pad a Advance Tax (from column 5 of 18A) b TDS (total of column 5 of 18B and column 8 of 18C) c TCS (total of column 5 of 18D) d Self-Assessment Tax (from column 5 of 18A) e Total Taxes Pad (11a + 11b + 11c+11d) 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) 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. 7a 7b 7c 9a 9b 9c 11a 11b 11c 11d 1a 1b 1c 1d 7d 9d 4a 4b 4c 4d 11e Page S1

11 TCS TDS ON OTHER INCOME TDS ON SALARY ADVANCE/ SELF ASSESSMENT TAX Sl. IFS Code of the Bank Name of the Bank Account Number (the number should be 9 Savngs/ dgts or more as per CBS system of the bank ) 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 If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A B 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 Tax Deducton Account Name of the Employer Income chargeable under Total tax deducted No Number (TAN) of the Salares Employer (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

12 HOUSE PROPERTY SALARIES 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 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 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 No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN(s) of Tenant (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) 2a Page S3

13 Short-term Captal Gans 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 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 a Full value of consderaton 5a b Deductons under secton 48 4d A3b A4e Page S4

14 Long-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 ( + + ) 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 n whch asset deducton clamed n transferred that year New asset acqured/constructed Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account 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) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 7 FOR NON-RESIDENTS- STCG ncluded n A1-A6 but not chargeable to tax n Inda as per DTAA Sl. Country name, code I II Artcle of DTAA Whether Tax Resdency Certfcate obtaned? III Total amount of STCG not chargeable to tax as per DTAA Item no. A1 to A6 above Amount of n whch ncluded STCG A1e/A2e/A3a/A3b/A4e/A5e/A6 A1e/A2e/A3a/A3b/A4e/A5e/A6 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 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 c Balance (3a bv) 3c 2c 2d A5e A6 A7 B1e B2e Page S5

15 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 a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. New asset acqured/constructed Prevous year n Secton under whch whch asset deducton clamed n Amount utlsed Year n whch asset transferred that year out of Captal acqured/constructed Gans account /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) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 9 FOR NON-RESIDENTS- LTCG ncluded n B1- B8 but not chargeable to tax n Inda as per DTAA Sl. I II Country name, Artcle of DTAA code 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 Date of ts acquston/constructon a dd/mm/yyyy B8 B9 B10 C Page S6

16 OTHER SOURCES Amount deposted n Captal Gans Accounts 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 a 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 Loss to be set off (Fll ths row f computed fgure s negatve) Gan of current year (Fll ths column only f computed fgure s postve) 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 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= ) (A2e+A3a) 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. A4e (A1e+A3b+ A5 +A6) (B3e+ B5e+B6c) Upto 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 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 b Interest, Gross c Rental ncome from machnery, plants, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng race horses)menton the source Wnnngs from lotteres, crossword puzzles etc. v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) 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 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 v Income ncluded n 1e chargeable to tax at specal rate (1f +1f + 1f) 1a 1b 1c 1d 1d 1d 1dv 1e 1f 1f 1fv Page S7

17 BROUGHT FORWARD LOSS ADJUSTMENT CURRENT YEAR LOSS ADJUSTMENT NOTE 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 for non-resdents) Expenses / Deductons h 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. 1g 1 3c Schedule CYLA Detals of Income after Set off of current year losses Sl.No Head/ Source of Income Income of current year (Fll ths column only f ncome s 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 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 Brought forward loss set off current year s losses as per col. 4 of Schedule CYLA Salares (4 of schedule CYLA) 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

18 DETAILS OF DONATIONS TOTAL DEDUCTIONS CARRY FORWARD OF LOSS Schedule CFL 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 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 Total B Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton C Total Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton D Total Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Page S9

19 PASS THROUGH INCOME EXEMPT INCOME SPECIAL RATE 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) 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 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any Page S10

20 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. b Assessment year n whch tax relef allowed n Inda Schedule 5A Name of the spouse PAN of the spouse Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code 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

21 DETAILS OF FOREIGN ASSETS 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) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Country Nature of Name and Nature of Interest- Date Total Income Nature of Name and entty Address of Drect/ Benefcal snce Investment accrued from Income Amount Schedule code the Entty owner/ Benefcary held (at cost) (n such Interest where offered Sl No Item number of schedule Income taxable and offered n ths return Item number of schedule rupees) (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 No Nature of Asset 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 asset 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 If (8) s yes, Income offered n ths No Name and address of address of address of address of return code the trust trustees Settlor Benefcares Amount Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon If (6) s yes, Income offered n ths return Country Name 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) () () 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. Page S12

22 DETAILS OF ASSET AND LIABILITY 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.) 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

23 TOTAL INCOME FILING STATUS PERSONAL INFORMATION FORM ITR-2A INDIAN INCOME TAX RETURN [For Indvduals and HUFs not havng Income from Busness or Professon and Captal Gans and who do not hold foregn assets] (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 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) Emal Address-2 Moble No. 2 Employer Category (f n employment) (Tck) Govt. PSU Others Income Tax Ward/Crcle Passport No. (Indvdual)(If avalable) 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 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 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 (3a + 3b + 3c) (enter nl f loss) 4 Total (1+2+3d) 4 5 Losses of current year set off aganst 4 (total of 2v and 3v of Schedule CYLA) 5 6 Balance after set off current year losses (4-5) (total of col. 4 of Schedule CYLA +3b) 6 7 Brought forward losses set off aganst 6 (2v of Schedule BFLA) 7 8 Gross Total ncome (6-7)(3v of Schedule BFLA +3b ) 8 Do not wrte or stamp n ths area (Space for bar code) 3a 3b 3c 3d For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal Page 1 of 3

24 BANK ACCOUNT TAXES PAID COMPUTATION OF TAX LIABILITY 9 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 (8-9)] Total ncome (8-10) Income whch s ncluded n 11 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 (11-12) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of row x of Schedule CFL) 15 Part B - TTI Computaton of tax lablty on total ncome 1 Tax payable on total ncome a Tax at normal rates on 14 of Part B-TI b Tax at specal rates (total of () of Schedule SI) c Rebate on agrcultural ncome [applcable f (11-12) 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 11 of Part B-TI does not exceed 5 lakh) 2 3 Tax payable (1d - 2) 3 4 Surcharge on 3 (applcable f 11 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 under secton Net tax lablty (6 7) (enter zero f negatve) 8 9 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 (9a+9b+9c) 10 Aggregate lablty (8 + 9d) Taxes Pad a Advance Tax (from column 5 of 17A) b TDS (total of column 5 of 17B and column 8 of 17C) c TCS (total of column 5 of 17D) d Self-Assessment Tax (from column 5 of 17A) e Total Taxes Pad (11a + 11b + 11c+11d) 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) Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) 9a 9b 9c 11a 11b 11c 11d 1a 1b 1c 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. Sl. IFS Code of Name of Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank the Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) 1 2 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 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 1d 9d 11e Page 2 of 3

25 TCS TDS ON OTHER INCOME TDS ON SALARY ADVANCE/ SELF ASSESSMENT TAX If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A B C 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. 11a & 11c of Part B-TTI Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Sl Tax Deducton Account Name of the Employer Income chargeable under Total tax deducted No Number (TAN) of the Salares Employer (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)] Sl No 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) D 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 SCHEDULE TO THE RETURN FORM (PAGES S1-S5) AS APPLICABLE Page 3 of 3

26 HOUSE PROPERTY SALARIES 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 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 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 No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant PAN of Tenant (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b 2a Page S1

27 CURRENT YEAR OTHER SOURCES 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 OS NOTE Income from other sources 1 Income a Dvdends, Gross b Interest, Gross c Rental ncome from machnery, plants, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng race horses)menton the source Wnnngs from lotteres, crossword puzzles etc. v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) 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 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 v Income ncluded n 1e chargeable to tax at specal rate (1f +1f + 1f) 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 for non-resdents) Expenses / Deductons h 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 4x 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. 1a 1b 1c 1d 1d 1d 1dv 1e 1f 1f 1fv 1g 1 3c Schedule CYLA Detals of Income after Set off of current year losses year (Fll ths column only f ncome s postve) LOSS ADJUSTMENT Sl.No Head/ Source of Income Income of current 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) Page S2

28 DETAILS OF DONATIONS TOTAL DEDUCTIONS CARRY FORWARD OF LOSS BROUGHT FORWARD LOSS ADJUSTMENT v v Other sources (excludng proft from ownng race horses and amount chargeable to specal rate of tax) Proft from ownng and mantanng race horses v Total loss set off ( + + v + v) v Loss remanng after set-off ( - v) (1 of schedule OS) (3c of schedule OS) Schedule BFLA Sl. No. Detals of Income after Set off of Brought Forward Losses of earler years Head/ Source of Income Income after set off, f any, of Brought forward loss set off current year s losses as per col. 4 of Schedule CYLA Salares (4 of schedule CYLA) Current year s ncome remanng after set off House property (4 of schedule CYLA) (B/f house property loss) Other sources (excludng proft from ownng race horses and wnnngs from lottery, game etc.) (4v of Schedule CYLA) v Proft from ownng and mantanng race horses (4v of Schedule CYLA) (B/f loss from horse races) v Total of brought forward loss set off ( v2) v Current year s ncome remanng after set off Total ( v3) Schedule CFL v v v v v x Total of earler year losses x Assessment Year Date of Flng House property loss Loss from ownng and mantanng race (DD/MM/YYYY) horses Adjustment of above losses n Schedule BFLA x (Current year losses) x Total loss carred forward to future years (2 of schedule BFLA) (2v of schedule CYLA) (2v of schedule BFLA) Schedule VIA 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 A Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total Page S3

29 PASS THROUGH INCOME EXEMPT INCOME SPECIAL RATE B Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total C Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total D Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total E Total donatons (A + B + C + D) 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 115BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) 2 115AC (Income of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) 3 Chargeable under DTAA rate (part of 1f of schedule OS) 4 Total 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 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 TDS on such amount, f any Page S4

30 DETAILS OF ASSET AND LIABILITY NOTE v Please refer to the nstructons for fllng out ths schedule. Captal Gans a Short term b Long term Other Sources Income clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s Schedule 5A Name of the spouse PAN of the spouse Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code 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 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.) 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 S5

31 TOTAL INCOME FILING STATUS PERSONAL INFORMATION FORM ITR-3 INDIAN INCOME TAX RETURN [For Indvduals/HUFs beng partners n frms and not carryng out busness or professon under any propretorshp] (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 HUF Road/Street/Post Offce Area/localty Date of Brth/ Formaton(DD/MM/YYYY) Do you have Aadhaar Number? (n case of ndvdual) 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 Moble No. 2 Employer Category(f n employment) (Tck) Govt. PSU Others Emal Address-1 (self) Emal Address-2 Income Tax Ward/Crcle Passport No. (Indvdual)(If avalable) (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 In response to notce 139(9)-Defectve, 142(1), 148, 153A/153C If revsed/defectve/modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) / / If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of advance prcng agreement (d) Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent (e) / / Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) 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 Profts and gans from busness or professon (6 of Schedule BP) (enter nl f loss) 3 Do not wrte or stamp n ths area (Space for bar code) For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal Page 1

32 COMPUTATION OF TAX LIABILITY 4 Captal gans a Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chargeable at applcable rate (7v of tem E of schedule CG) a v Total Short-term (a + a + a) b Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) Total Long-term (b + b) (enter nl f loss) c Total captal gans (4av + 4b) (enter nl f loss) 5 Income from other sources a from sources other than from ownng race horses and ncome 5a chargeable to tax at specal rate (1 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate (1fv of Schedule OS) 5b c from the actvty of ownng and mantanng race horses (3c of Schedule 5c OS) (enter nl f loss) d Total (5a + 5b + 5c) (enter nl f loss) 5d 6 Total ( c+5d) 6 7 Losses of current year set off aganst 6 (total of 2x,3x and 4x of Schedule CYLA) 7 8 Balance after set off current year losses (6-7) (total of column 5 of Schedule CYLA+5b) 8 9 Brought forward losses set off aganst 8 (2x of Schedule BFLA) 9 10 Gross Total ncome (8-9) (3x of Schedule BFLA +5b) Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deductons under Chapter VI-A [s of Schedule VIA and lmted to (10-11)] Total ncome (10 12) Income whch s ncluded n 13 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 (13-14) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of row x of Schedule CFL) 17 a a 4av b b 4b 4c Part B - TTI Computaton of tax lablty on total ncome 1 Tax payable on total ncome a Tax at normal rates on 16 of Part B-TI b Tax at specal rates (total of () of Schedule SI) c Rebate on agrcultural ncome [applcable f (13-14) of Part 1c B-TI exceeds 10 maxmum Deductons amount not under chargeable Chapter to tax] VI-A (o of Schedule VIA) 10 d Tax Payable 11 on Total ncome Income (1a + 1b 1c) 1d 11 2 Rebate under secton 12 Net 87A agrcultural (applcable ncome/ f 13 of Part any other B-TI does ncome not for exceed rate 5 purpose lakh) (4 of Schedule EI) Tax payable after 13 rebate Aggregate (1d - 2) ncome (8+ 9) Surcharge on 314 (applcable Losses of f 13 current of Part year B-TI to exceeds be carred 1 crore) forward (total of 2v and 3v of Schedule CYLA) Educaton cess, ncludng secondary and hgher educaton cess on (3 + 4) 5 6 Gross tax lablty ( ) 6 7 Tax relef a Secton 89 b Secton 90/ 90A (2 of Schedule TR) c Secton 91 (3 of Schedule TR) d Total (7a + 7b+ 7c) 8 Net tax lablty (6 7d) (enter zero f negatve) 8 9 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) 7a 7b 7c 9a 9b 1a 1b 9c 7d Page 2

33 TDS ON SALARY ADVANCE/ SELF ASSESSMENT TAX BANK ACCOUNT TAXES PAID d Total Interest Payable (9a+9b+9c) 10 Aggregate lablty (8 + 9d) Taxes Pad a Advance Tax (from column 5 of 19A) b TDS (total of column 5 of 19B and column 8 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 (If 11e s greater than 10) (Refund, f any, wll be drectly credted nto the bank account) Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) 11a 11b 11c 11d 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. Sl. IFS Code of Name of the Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) 9d 11e 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 Yes () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] 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 I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Sgn here Date 17 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A B 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 & 11d 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 Name of the Employer Number (TAN) 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 Page 3

34 TCS TDS ON OTHER INCOME C D Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued by Deductor(s) or Form 26QB ssued by Deductor(s)] Sl No 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 own hands n the hands of 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 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) NOTE Please enter total of column (5) of Schedule-TCS n 11c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1 S12) AS APPLICABLE Page 4

35 HOUSE PROPERTY SALARIES 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 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) Travel concesson/assstance receved (sec. 10(5) Tax pad by employer on non-monetary perquste (sec. 10(10CC) Allowance to meet expendture ncurred on house rent (sec. 10(13A) v Other allowances 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 ( ) v 1 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)e Percentage Share n Property I II 2 (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 No (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner(s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I Page S1

36 CAPITAL GAINS Short-term Captal Gans INCOME FROM FIRMS FIRMS IN WHICH PARTNER II a Annual letable value or rent receved/ 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 IF Informaton regardng partnershp frms n whch you are partner Number of frms n whch you are partner Whether Sl. No. Name of the Frm PAN of the frm Whether the secton 92E s frm s lable for applcable to audt? (Yes/No) frm? (Yes/ No) Percentage Share n the proft of the frm Amount of share n the proft Captal balance on 31 st March n the frm 4 Total Schedule BP Sl. No NOTE Frm PAN (From Schedule-IF) 4 Total Detals of Income from Frms of whch partner Salary, bonus, commsson or remuneraton receved from the frm Interest receved from the frm on the captal () () () v Total + Expenses n relaton to v Net Income v - v (v) (v) (v) 5 Deducton, f any, for payment of any sum for carryng out an elgble project or scheme as per secton 35AC 6 Net Income from Busness [4(v) 5] 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 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 Page S2

37 Longterm 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 ( + + ) bv c Balance (2a bv) 2c Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and d dvdend/ncome/bonus unts are receved, then loss arsng out of sale 2d of such asset to be gnored (Enter postve value only) e Short-term captal gan on equty share or equty orented MF (STT pad) (2c +2d) For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to 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 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 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 d dvdend/ncome/bonus unts are receved, then loss arsng out of sale 4d 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) A4e 5 From sale of assets other than at A1 or A2 or A3 or A4 above 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 (5a 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) A5e 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 n whch asset deducton clamed n transferred that year New asset acqured/constructed Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account 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) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 7 FOR NON-RESIDENTS- STCG ncluded n A1-A6 but not chargeable to tax n Inda as per DTAA Sl. Country name, code I II Artcle of DTAA Whether Tax Resdency Certfcate obtaned? III Total amount of STCG not chargeable to tax n Inda as per DTAA Item no. A1 to A6 above Amount of n whch ncluded STCG A1e/A2e/A3a/A3b/A4e/A5e/A6 A1e/A2e/A3a/A3b/A4e/A5e/A6 8 Total Short-term Captal Gan (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 a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty a A2e A3a A3b A6 A7 Page S3

38 Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans (a or a) a b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of Improvement wth ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b + b) bv c Balance (a bv) 1c 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 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 (2a bv) 2c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 2d e LTCG on bonds or debenture (2c 2d) B1e B2e 3 4 From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable () GDR of an Indan company referred n sec. 115ACA a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b 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/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 5 For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as 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 Page S4

39 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 a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA B New asset acqured/constructed Year n whch asset Amount utlsed out acqured/constructed of Captal Gans account b Amount deemed to be long-term captal gans, other than at a Total amount deemed to be long-term captal gans (X + X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 9 FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 but not chargeable to tax n Inda as per DTAA Sl. Country name, code Artcle of DTAA Whether Tax Resdency Certfcate obtaned? Item B1 to B8 above n whch ncluded Amount of LTCG I B1e/B2e/B3e/ B4c/ B5e/B6c/B6f/B7e/B8 10 II III Total amount of LTCG not chargeable to tax n Inda as per DTAA B1e/B2e/B3e/ B4c/ B5e/B6c/B6f/B7e/B8 Total long term captal gan chargeable under I.T. Act [B1e +B2e +B3e + B4c + B5e +B6c+ B6f+ B7e+ B8-B9] (In case of loss take the fgure to 6x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A8 + B10) (take B10 as nl, f loss) 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 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) 1c 2 In case of deducton u/s 54GB, furnsh PAN of the company 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) Loss to be set off (Fll ths row f computed fgure s negatve) 15% (A2e+A3a) Short term 30% A4e captal gan v applcable rate (A1e+A3b+A5e+ Short term captal loss set off Long term captal loss set off 15% 30% applcable rate 10% 20% B8 B9 B10 C Current year s captal gans remanng after set off (7= ) (A2e+A3a) A4e (A1e+A3b+ A5 +A6) (B3e+ B5e+B6c) (B1e+B2e+ B4c+ B6f+ B7e+B8) v Long term 10% (B3e+ A6) B5e+B6c) v captal gan 20% (B1e+B2e+B4c+ 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 Page S5

40 CURRENT YEAR LOSS ADJUSTMENT OTHER SOURCES NOTE Type of Captal gan / Date Short-term captal gans taxable at the rate of 15% Enter value from tem 3v 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 () 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 16/3 to 31/3 (v) Schedule OS NOTE 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 Income by way of wnnngs from lotteres, crossword puzzles etc. 1d 1d 1d v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) 1e f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng 1f etc (u/s 115BB) Any other ncome chargeable to tax at the rate specfed under chapter XII/XII-A 1f FOR NON-RESIDENTS- Income chargeable to be tax under DTAA Country Artcle Rate of tax Whether TRC Correspondng secton of the Amount of Sl. 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 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 4 of schedule CYLA) 2 Income from other sources (other than from ownng race horses) (1fv + 1) (enter 1 as nl, f negatve) 2 1dv 3 Income from the actvty of ownng and mantanng race horses a Recepts 3a b Deductons under secton 57 n relaton to (3) 3b c Balance (3a 3b) (f negatve take the fgure to 7x 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. Schedule CYLA Detals of Income after Set off of current year losses Sl.No Head/ Source of Income Income of current House property loss year (Fll ths column of the current year only f ncome s zero set off or postve) h Busness Loss 1 3c Other sources loss (other than loss from race horses) of the current year set off Current year s Income remanng after set off = Loss to be set off (3c of Schedule HP) (4v of Schedule BP) (1 of Schedule-OS) Salares (7 of Schedule S) Page S6

41 CARRY FORWARD OF LOSS BROUGHT FORWARD LOSS ADJUSTMENT House property (3c of Schedule HP) v Busness or professon (4v of Schedule BP) Short-term captal gan v 15% Short-term captal gan v 30% Short-term captal gan taxable at v applcable rates Long term captal gan v 10% Long term captal gan x 20% Other sources (excludng proft from x ownng race horses and amount chargeable to specal rate of tax) Proft from ownng and mantanng x race horses 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) (1 of schedule OS) (3c of schedule OS) Total loss set off ( + + v + v + v + v + v + x + x + x) x Loss remanng after set-off ( - x) Schedule BFLA Sl. No. Detals of Income after Set off of Brought Forward Losses of earler years Head/ Source of Income Income after set off, f any, of Brought forward loss set off current year s losses as per 4 of Schedule CYLA) Salares (5 of schedule CYLA) Current year s ncome remanng after set off House property (5 of schedule CYLA) (B/f house property loss) Busness or professon (5v of schedule CYLA) (B/f busness loss) v Short-term captal gan 15% (5v of schedule CYLA) (B/f short-term captal loss) v Short-term captal gan 30% (5v of schedule CYLA) (B/f short-term captal loss) v Short-term captal gan taxable at applcable rates (5v of schedule CYLA) (B/f short-term captal loss) v Long-term captal gan 10% (5v of schedule CYLA) (B/f short-term or long-term captal loss) v Long term captal gan 20% (5x of schedule CYLA) (B/f short-term or long-term captal loss) Other sources (excludng proft from x ownng race horses and wnnngs from (5x of schedule CYLA) lottery, game etc.) x Proft from ownng and mantanng race horses (5x of schedule CYLA) (B/f loss from horse races) x Total of brought forward loss set off ( v2 + v2+v2+v2+x2+x2) x Current year s ncome remanng after set off Total ( v3 + v3+ v3+ v3 + v3+ x3+ x3 + x3) Schedule CFL Detals of Losses to be carred forward to future years Assessment Year Date of Flng House property Busness or (DD/MM/YYYY) loss professon loss v v v v v 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 Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses (2 of schedule BFLA) (2x of schedule CYLA) (2 of schedule BFLA) (3x of schedule CYLA) ((2v+3v+4v) of tem E of schedule CG) ((5v+6v)of tem E of schedule CG) (2x of schedule BFLA) (3c of schedule OS, f ve) Page S7

42 DETAILS OF DONATIONS TOTAL DEDUCTIONS Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80C c 80CCD(1) e 80CCD(2) g 80D 80DDB k 80G m 80GGA b 80CCC d 80CCD(1B) f 80CCG h 80DD j 80E l 80GG n 80GGC 2 Part C, CA and D- Deducton n respect of certan ncomes/other deducton o 80QQB q 80TTA p 80RRB r 80U s Total deductons under Chapter VI-A (Total of a to r) s Schedule 80G Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout A qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton B C Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Elgble Amount of donaton Total Donatons enttled for 50% deducton subject to D qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Total E Total donatons (A + B + C + D) Elgble Amount of donaton 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) Page S8

43 PASS THROUGH INCOME EXEMPT INCOME SPECIAL RATE Schedule SI Income chargeable to tax at specal rates (please see nstructons No. 9 for rate of tax) Sl Secton Specal rate Income No (%) 1 111A (STCG on shares unts on whch STT pad) 15 (3v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (3v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 3v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 3v of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 3v of schedule BFLA) 6 115ACA (LTCG for an employee of specfed 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 (part of 1f of schedule OS) n foregn currency) 12 Chargeable under DTAA rate (part of 1f of schedule OS) 13 Total 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 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any 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 outsde Inda (ncluded n PART B-TI) Tax pad outsde Inda Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Page S9

44 DETAILS OF FOREIGN ASSETS House Property Busness or Professon v Captal Gans v Other sources 2 Salary House Property Busness or Professon v Captal Gans v Other sources Total 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 Summary 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) Tax Relef Clamed under secton (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total 2 Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of total of 1(d)) 2 3 Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total of 1(d)) 3 4 Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below 4 Yes/No a Amount of tax refunded b Assessment year n whch tax relef allowed n Inda NOTE Please refer to the nstructons for fllng out ths schedule. 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- Owner/ Benefcal owner/ Benefcary Account Number 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 Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Country Nature of Name and Nature of Date snce Total Income Nature of Name and entty Address of Interest- held Investment accrued from Income Amount Schedule code the Entty Drect/ (at cost) (n such Interest where offered Benefcal rupees) owner/ Sl No Income taxable and offered n ths return Item number of schedule Benefcary (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 Page S10

45 Sl No Country Name and code Address of the Property Ownershp- Drect/ Benefcal owner/ Benefcary Date of acquston Total Investment (at cost) (n rupees) Income derved from the property Nature of Income Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the prevous year Sl Country Nature of Ownershp- Date of Total Income Nature of Income taxable and offered n ths return No Name and Asset Drect/ Benefcal acquston Investment (at derved from Income Amount Schedule Item number of code owner/ Benefcary cost) (n rupees) the asset where offered 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 Account Number If (7) s yes, Income offered n ths return Amount Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account 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 If (8) s yes, Income offered n ths return No Amount Country Name and code Name and address of the trust Name and address of trustees Name and address of Settlor Name and address of Benefcares Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust 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) () () NOTE Please refer to nstructons for fllng out ths schedule. In case of an ndvdual, not beng an Indan ctzen, who s n Inda on a busness, employment or student vsa, an asset acqured durng any prevous year n whch he was non-resdent s not mandatory to be reported n ths schedule f no ncome s derved from that asset durng the current prevous year. Schedule 5A Name of the spouse PAN of the spouse Heads of Income Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the head Amount apportoned n the hands of the spouse Amount of TDS deducted on ncome at () TDS apportoned n the hands of spouse () () () (v) (v) 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Page S11

46 DETAILS OF ASSET AND LIABILITY Asset and Lablty at the end of the year (other than those ncluded n Part A BS of the return of the Frm n Schedule AL whch partner) (Applcable n a case where total ncome exceeds Rs. 50 lakh) A Partculars of Asset Amount (Cost) (Rs.) B 1 Immovable Asset a Land b Buldng 2 Movable Asset a Fnancal Asset Deposts n Bank (ncludng balance n any account) Shares and securtes Insurance polces v Loans and Advances gven v Cash n hand b Jewellery, bullon etc. c Archaeologcal collectons, drawngs, pantng, sculpture or any work of art d Vehcles, yachts, boats and arcraft 3 Total Lablty n relaton to Assets at A Page S12

47 ITR-4S SUGAM PRESUMPTIVE BUSINESS INCOME TAX RETURN Assessment Year (A1) Frst Name (A2) Mddle Name (A3) Last Name (A4) Permanent Account Number (A5) Sex (for Indvduals) (A6) Date of Brth/Formaton (DD/MM/YYYY) (A7) Income Tax Ward/Crcle (A8) Flat/Door/Buldng (A9) Name of Premses/ Buldng/ Vllage (A10) Road/Street (A11) Area/localty (A12) Town/Cty/Dstrct (A13) State & Country (A14) Pn code (A15) Status Indvdual HUF Frm (other than LLP) (A16) Emal Address (A17) Moble No.1 /Resdental/Offce Phone Number wth STD code (A18) Moble No. 2 (A19) Fll only one- (A20) Fll only one-- Resdent Non-Resdent Resdent but Not Ordnarly Resdent (A21) Fll only one: Fled- On or before due date -139(1), After due date -139(4), Revsed Return-139(5) or In response to notce 139(9)-Defectve 142(1) A/153C or u/s 119(2)(b) (A22) Whether Person governed by Portuguese Cvl Code under Secton 5A (A23) If A22 s applcable, PAN of the Spouse (A24) If revsed/defectve, then enter Recept No and Date of flng of orgnal return (DD/MM/YYYY) (A25) If fled n response to notce notce u/s 139(9) /142(1)/148/153A/153C, enter the date of such notce DD / MM / YYYY (A26) Whether you have Aadhaar Number Yes No Not applcable (for HUF) (A27) If A26 s yes, please provde PART B GROSS TOTAL INCOME B1 Income from Busness NOTE-Enter value from E6 of Schedule BP B1 B2 Income From Salary /Penson NOTE- Ensure to Fll Sch TDS1 gven n Page 3 B2 B3 Income from One house property Self Occuped Let Out (If loss, put the fgure n negatve) B3( ) B4 Income from Other Sources NOTE- Ensure to Fll Sch TDS2 gven n Page 3 B4( ) B5 Gross Total Income (B1+B2+B3+B4) B5( ) DD/MM/YYYY Whole- Rupee( ) only PART C DEDUCTIONS AND TAXABLE TOTAL INCOME (Refer to nstructons for lmts on Amount of Deductons as per Income Tax Act ) C1 80C C2 80CCC C3 80CCD (1) C4 80CCD(1B) C5 80CCD(2) C6 80CCG C7 80D C8 80DD C9 80DDB C10 80E C11 80G C12 80GG C13 80GGC C14 80RRB C15 80QQB C16 80TTA C17 80U C18 Total deductons (Add tems C1 to C17) C18 C19 Taxable Total Income (B5 - C18) C19 FOR OFFICE USE ONLY STAMP RECEIPT NO. HERE SEAL, DATE AND SIGNATURE OF RECEIVING OFFICIAL Page 1 of 8

48 BANK ACCOUNT PAN-- PART D TAX COMPUTATIONS AND TAX STATUS D1 Tax payable on total ncome(c19) D2 Rebate on 87A D3 Tax payable after Rebate (D1-D2) D4 Surcharge f C19 exceeds Rs. 1 Crore D5 Cess on (D3+D4) D6 Total Tax, Surcharge and Cess ( D3+D4+D5) D7 Relef u/s 89 D8 Balance Tax after Relef (D6-D7) D9 Total Interest u/s 234A D10 Total Interest u/s 234B D11 Total Interest u/s 234C D12 Total Tax and Interest(D8+D9+D10+D11) D13 Total Advance Tax Pad D14 Total Self-Assessment Tax Pad D15 Total TDS Clamed D16 Total TCS Collected D17 Total Taxes Pad (D13+D14+D15+D16) D18 Total payable (D12 - D17, If D12 > D17) D19 Refund (D17 D12, If D17 > D12) D20 Exempt ncome only for reportng purposes (If agrcultural ncome s more than Rs.5,000/-, use ITR 4) D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13 D14 D15 D16 D17 D18 D19 D20 D21 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. Sl. IFS Code of Name of the Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) VERIFICATION I, son/ daughter of solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return s correct and complete and 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 : If the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: Sgn here TRP PIN (10 Dgt) Name of TRP Counter Sgnature of TRP Amount to be pad to TRP Page 2 of 8

49 DETAILS OF ASSET AND LIABILITY PAN-- S.No. NATURE OF BUSINESS, IF MORE THAN ONE BUSINESS INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS Code Name of the Busness Descrpton () () () SCHEDULE BP DETAILS OF INCOME FROM BUSINESS COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AD E1 Gross Turnover or Gross Recepts E1 E2 Presumptve Income under secton 44AD (8% of E1) NOTE If Income s less than 8% of Gross Recepts, t s mandatory to have a tax audt under 44AB & regular ITR 4 has to be flled not ths form COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AE E3 Presumptve Income from Goods Carrage under secton 44AE E3 NOTE If the profts are lower than prescrbed under S.44AE or the number of Vehcles owned at any tme exceed 10 then the regular ITR 4 form has to be flled and not ths form E4 Presumptve Income under secton 44AD and 44AE (E2 + E3) E4 E5 Salary and nterest pad to the partners E5 NOTE Ths s to be flled up only by frms E6 Income chargeable under Busness (E4 - E5) E6 E2 FINANCIAL PARTICULARS OF THE BUSINESS NOTE For E5 to E8 furnsh the nformaton as on 31 st day of March,2016 E7 Amount of Total Sundry Debtors E7 E8 Amount of Total Sundry Credtors E8 E9 Amount of Total Stock-n-trade E9 E10 Amount of the Cash Balance E10 Schedule AL Asset and Lablty at the end of the year (Applcable n the case of Indvdual or HUF where total ncome exceeds Rs. 50 lakh) A Partculars of Asset Amount (Cost) (Rs.) 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 3 of 8

50 PAN-- SCHEDULE IT DETAILS OF ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS BSR Code Date of Depost (DD/MM/YYYY) Challan No. Tax pad R1 R2 R3 R4 R5 NOTE Col (1) Col (2) Col (3) Col (4) Enter the totals of Advance tax and Self-Assessment tax n D13 & D14 SCHEDULE TCS DETAILS OF TAX COLLECTED AT SOURCE U1 Tax Collecton Account Number Name of the Collector Total Collected Amount n (3) clamed ths Year If A22 s applcable amount clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) U2 U3 NOTE Enter the totals of (col. 4) of Schedule-TCS n D16 SCHEDULE TDS1 DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY [As per Form 16 ssued by Employer(s)] TAN Name of the Employer Income under Salary Tax deducted S1 Col (1) Col (2) Col (3) Col (4) S2 S3 NOTE Enter the total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2 n D15 SCHEDULE TDS2 DETAILS OF TAX DEDUCTED AT SOURCE FROM INCOME OTHER THAN SALARY [As per Form 16 A ssued by Deductor(s)] T1 TAN Name of the Deductor Unque TDS Certfcate Number Deducted Year Tax Deducted Amount out of (5) clamed ths Year If A22 s applcable, amount clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) Col (7) T2 T3 T4 NOTE Enter the total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2 n D15 Page 4 of 8

51 PAN-- Supplementary Schedule TDS 1(to be used only after exhaustng tem S1-S3 of Schedule TDS1 n man form etc.) TAN Name of the Employer Income under Salary Tax deducted Col (1) Col (2) Col (3) Col (4) S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 S25 S26 S27 S28 S29 S30 Page 5 of 8

52 PAN-- T5 Supplementary Schedule TDS 2(to be used only after exhaustng tem T1-T4 of Schedule TDS2 n man form etc) TAN Name of the Deductor Unque TDS Certfcate Number Deducted Year Tax Deducted Amount out of (5) clamed ths Year If A22 s applcable, amount clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) Col (6) Col (7) T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16 T17 T18 T19 T20 T21 T22 T23 T24 T25 T26 T27 T28 T29 T30 T31 Page 6 of 8

53 PAN-- Supplementary Schedule IT (to be used only after exhaustng tem R1-R5 of Schedule IT n man form etc) BSR Code Date of Depost (DD/MM/YYYY) Challan No. Tax pad Col (1) Col (2) Col (3) Col (4) R6 R7 R8 R9 R10 R11 R12 R13 R14 R15 R16 R17 R18 R19 R20 R21 R22 R23 R24 R25 R26 R27 R28 R29 R30 R31 R32 Page 7 of 8

54 PAN- Supplementary Schedule TCS (to be used only after exhaustng tem U1-U5 of Schedule TCS n man form etc) U4 Tax Collecton Name of the Collector Total Collected Amount out of (3) clamed ths If A22 s applcable amount Account Number Year clamed n the hands of spouse Col (1) Col (2) Col (3) Col (4) Col (5) U5 U6 U7 U8 U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 U20 U21 U22 U23 U24 U25 U26 U27 U28 U29 U30 Page 8 of 8

55 AUDIT INFORMATION FILING STATUS PERSONAL INFORMATION FORM ITR-4 INDIAN INCOME TAX RETURN (For ndvduals and HUFs havng ncome from a propretary 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 HUF Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Do you have Aadhaar Number? (n case of ndvdual) 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) Emal Address-2 Moble No. 2 Employer Category (f n employment) (Tck) Govt. PSU Others Income Tax Ward/Crcle Passport No. (Indvdual) (If avalable) (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 In response to notce 139(9)-Defectve 142(1) A/153C If revsed/defectve/modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of advance prcng agreement / / / / (d) Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent (e) Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) Permanent Account Number (PAN) of the representatve (h) In case of non-resdent, s there a permanent establshment (PE) n Inda? (Tck) Yes No (a) Are you lable to mantan accounts as per secton 44AA? (Tck) Yes No (b) Are you lable for audt under secton 44AB? (Tck) Yes No (c) If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton below (1) Date of furnshng of the audt report (DD/MM/YYYY) / / (2) Name of the audtor sgnng the tax audt report (3) Membershp no. of the audtor (4) Name of the audtor (propretorshp/ frm) (5) Permanent Account Number (PAN) of the propretorshp/ frm (6) Date of report of the audt For Offce Use Only For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal Page 1

56 APPLICATION OF FUNDS SOURCES OF FUNDS (d) If lable to furnsh other audt report, menton the date of furnshng the audt report? (DD/MM/YY) (Please see Instructon 6)) 92E 115JC NATURE OF BUSINESS S.No. NATURE OF BUSINESS OR PROFESSION, IF MORE THAN ONE BUSINESS OR PROFESSION INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS Code Trade name of the Descrpton [Please see nstructon No.7()] propretorshp, f any () () () Part A-BS 1 Propretor s fund BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2016 OF THE PROPRIETORY BUSINESS OR PROFESSION (fll tems below n a case where regular books of accounts are mantaned, otherwse fll tem 6) a Propretor s captal b Reserves and Surplus Revaluaton Reserve b Captal Reserve b Statutory Reserve b v Any other Reserve bv v Total (b + b + b + bv) bv c Total propretor s fund (a + bv) 2 Loan funds a Secured loans Foregn Currency Loans a Rupee Loans A From Banks B From others C Total ( A + B) Total (a + C) a b Unsecured loans (ncludng deposts) From Banks b From others b Total (b + b) b c Total Loan Funds (a + b) 3 Deferred tax lablty 3 4 Sources of funds (1c + 2c +3) 4 1 Fxed assets a Gross: Block b Deprecaton c Net Block (a b) d Captal work-n-progress e Total (1c + 1d) 2 Investments a Long-term nvestments Government and other Securtes - Quoted a Government and other Securtes Unquoted a Total (a + a) a b Short-term nvestments A B C 1a 1b 1c 1d a 1c 2c 1e Page 2

57 NO ACCOUNT CASE Equty Shares, ncludng share applcaton money b Preference Shares b Debentures b v Total (b + b + b) bv c Total nvestments (a + bv) 3 Current assets, loans and advances a Current assets Inventores Stores/consumables ncludng packng A materal B Raw materals C Stock-n-process D Fnshed Goods/Traded Goods E Total (A + B + C + D) Sundry Debtors a Cash and Bank Balances A Cash-n-hand B Balance wth banks C Total (A + B) v Other Current Assets av v Total current assets (E + a + C + av) av b Loans and advances Advances recoverable n cash or n knd or for value to be receved b Deposts, loans and advances to corporates and others b Balance wth Revenue Authortes b v Total (b + b + b ) bv c Total of current assets, loans and advances (av + bv) d Current labltes and provsons Current labltes A Sundry Credtors B Lablty for Leased Assets C Interest Accrued on above D Interest accrued but not due on loans E Total (A + B + C + D) Provsons A Provson for Income Tax B Provson for Wealth Tax Provson for Leave C encashment/superannuaton/gratuty D Other Provsons E Total (A + B + C + D ) Total (E + E) d e Net current assets (3c d) 4 a Mscellaneous expendture not wrtten off or adjusted 4a b Deferred tax asset c Proft and loss account/ Accumulated balance d Total (4a + 4b + 4c) 5 Total, applcaton of funds (1e + 2c + 3e +4d) 5 6 In a case where regular books of account of busness or professon are not mantaned - (furnsh the followng nformaton as on 31 st day of March, 2016, n respect of busness or professon) a Amount of total sundry debtors b Amount of total sundry credtors c Amount of total stock-n-trade A B C D A B C D A B C D 4b 4c A B 2c E C 3c E E 3e 4d 6a 6b 6c Page 3

58 DEBITS TO PROFIT AND LOSS ACCOUNT CREDITS TO PROFIT AND LOSS ACCOUNT d Amount of the cash balance 6d Proft and Loss Account for the fnancal year (fll tems 1 to 52 n a case where regular books of accounts are Part A-P& L mantaned, otherwse fll tem 53) 1 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a a b c Total (a + b) c v Total ( + + c) Av Dutes, taxes and cess receved or recevable n respect of goods and servces sold or B suppled Unon Excse dutes Servce tax VAT/ Sales tax v Any other duty, tax and cess v Total ( v) C Total Revenue from operatons (Av + Bv) 2 Other ncome Rent Commsson Dvdend ncome v Interest ncome b v Proft on sale of fxed assets v Proft on sale of nvestment beng securtes chargeable v v to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Proft on account of currency fluctuaton x Agrcultural ncome x Any other ncome (specfy nature and amount) a b c Total (xa + xb) x Total of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Raw materal Work-n-progress Fnshed goods Total ( ) 4 Total of credts to proft and loss account (1C + 2x + 3v) 4 5 Openng Stock Raw materal Work-n-progress Fnshed goods v Total ( ) 6 Purchases (net of refunds and duty or tax, f any) 6 7 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty v v v x xa xb xc Bv 1C 2x 3v 5v Page 4

59 v Unon excse duty v Servce tax v VAT/ Sales tax v Any other tax, pad or payable v Total ( v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores and spare parts 9 10 Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages Bonus Rembursement of medcal expenses v Leave encashment v Leave travel benefts v Contrbuton to approved superannuaton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed gratuty fund 7v 7v 7v 7v v 14v 14v 14v 14v x Contrbuton to any other fund 14x x Any other beneft to employees n respect of whch an 14x expendture has been ncurred Total compensaton to employees ( v + 14v + 14v + 14v + 14v + x 14x + 14x) Whether any compensaton, ncluded n 14x, pad to x non-resdents xa Yes / No If Yes, amount pad to non-resdents xb 15 Insurance Medcal Insurance 15 Lfe Insurance 15 Keyman s Insurance 15 Other Insurance ncludng factory, offce, car, goods, v etc. 15v v Total expendture on nsurance ( v) 16 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 23 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 24 Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 7v 14x 15v Page 5

60 NO ACCOUNT CASE PROVISIONS FOR TAX AND APPROPRIATIONS 25 Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty Servce tax VAT/ Sales tax v Cess v Any other rate, tax, duty or cess ncl STT and CTT v v Total rates and taxes pad or payable ( v + 36v) 37 Audt fee Other expenses (specfy nature and amount) Total ( + ) Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s 39 clamed and amount) 39 Others (more than Rs. 1 lakh) where v PAN s not avalable v Others (amounts less than Rs. 1 lakh) v 39v v Total Bad Debt ( v + 39v) 40 Provson for bad and doubtful debts Other provsons 41 Proft before nterest, deprecaton and taxes [4 (5v v + 8 to x + 15v + 16 to to v v )] 43 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 44 Deprecaton and amortsaton Proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Transferred to reserves and surplus Balance carred to balance sheet n propretor s account (50 51) In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton for prevous year n respect of busness or professon a Gross recepts 53a b Gross proft 53b c Expenses 53c 36v 36v 38 39v 43 Page 6

61 OTHER INFORMATION d Net proft 53d Part A- OI Other Informaton (optonal n a case not lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No Effect on the proft because of devaton, f any, as per Income Computaton Dsclosure 3 3 Standards notfed under secton 145(2) [column 11() of Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 5a b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value 5b added tax, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year 5c d any other tem of ncome 5d e captal recept, f any 5e f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to non-fulflment of condtons specfed n relevant clauses Premum pad for nsurance aganst rsk of damage or a destructon of stocks or store [36(1)()] 6a Premum pad for nsurance on the health of employees b [36(1)(b)] 6b Any sum pad to an employee as bonus or commsson for c servces rendered, where such sum was otherwse payable 6c to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed d captal [36(1)()] 6d e Amount of dscount on a zero-coupon bond [36(1)(a)] 6e f Amount of contrbutons to a recognsed provdent fund [36(1)(v)] 6f Amount of contrbutons to an approved superannuaton g fund [36(1)(v)] 6g Amount of contrbuton to a penson scheme referred to n h secton 80CCD [36(1)(va)] 6h Amount of contrbutons to an approved gratuty fund [36(1)(v)] 6 j Amount of contrbutons to any other fund 6j Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up k under ESI Act or any other fund for the welfare of 6k employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] 6l m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] Expendture for the purposes of promotng famly o plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of p transacton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] q Any other dsallowance r Total amount dsallowable under secton 36 (total of 6a to 6q) 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] 7a b Expendture of personal nature [37(1)] 7b 6m 6n 6o 6p 6q 4d 6r 5f Page 7

62 c Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] 7c Expendture on advertsement n any souvenr, brochure, d tract, pamphlet or the lke, publshed by a poltcal party 7d [37(2B)] e Expendture by way of penalty or fne for volaton of any law 7e for the tme beng n force f Any other penalty or fne 7f Expendture ncurred for any purpose whch s an offence or g whch s prohbted by law 7g h Amount of any lablty of a contngent nature 7h Any other amount not allowable under secton 37 7 j Total amount dsallowable under secton 37 (total of 7a to 7) 8 A Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 a Amount dsallowable under secton 40 (a)(), on account of Aa non-complance wth the provsons of Chapter XVII-B b Amount dsallowable under secton 40(a)(a) on account of Ab non-complance wth the provsons of Chapter XVII-B c Amount dsallowable under secton 40(a)() on account of Ac non-complance wth the provsons of Chapter XVII-B d Amount of tax or rate leved or assessed on the bass of profts [40(a)()] Ad e Amount pad as wealth tax [40(a)(a)] Ae f Amount pad by way of royalty, lcense fee, servce fee etc. as per secton 40(a)(b) Af g Amount of nterest, salary, bonus, commsson or remuneraton pad to any partner or member [40(b)] Ag h Any other dsallowance Total amount dsallowable under secton 40(total of Aa to Ah) Any amount dsallowed under secton 40 n any precedng prevous year but allowable B durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A a Amounts pad to persons specfed n secton 40A(2)(b) Amount pad n excess of twenty thousand rupees otherwse b than by account payee cheque or account payee bank draft under secton 40A(3) 100% dsallowable c Provson for payment of gratuty [40A(7)] any sum pad by the assessee as an employer for settng up or d as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance f Total amount dsallowable under secton 40A Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng 10 the prevous year a Any sum n the nature of tax, duty, cess or fee under any law 10a Any sum payable by way of contrbuton to any provdent fund b or superannuaton fund or gratuty fund or any other fund for 10b the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered 10c Any sum payable as nterest on any loan or borrowng from d any publc fnancal nsttuton or a State fnancal corporaton 10d or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank 10e f Any sum payable towards leave encashment 10f g Total amount allowable under secton 43B (total of 10a to 10f) Any amount debted to proft and loss account of the prevous year but dsallowable under 11 secton 43B a Any sum n the nature of tax, duty, cess or fee under any law 11a Any sum payable by way of contrbuton to any provdent fund b or superannuaton fund or gratuty fund or any other fund for 11b the welfare of employees Any sum payable to an employee as bonus or commsson for c 11c servces rendered Ah 9a 9b 9c 9d 9e 7j 8A 8B 9f 10g Page 8

63 TOTAL INCOME QUANTITATIVE DETAILS Any sum payable as nterest on any loan or borrowng from d any publc fnancal nsttuton or a State fnancal corporaton or a State Industral nvestment corporaton Any sum payable as nterest on any loan or borrowng from e any scheduled bank f Any sum payable towards leave encashment g Total amount dsallowable under Secton 43B (total of 11a to 11f) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Any other tax e Total amount outstandng (total of 12a to 12d) 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss 15 account (net) 15 11d 11e 11f 12a 12b 12c 12d 11g 12e Part A QD Quanttatve detals (optonal n a case not lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern Part B - TI 6 Raw materals a Openng stock b Purchases durng the prevous year c Consumpton durng the prevous year d Sales durng the prevous year e Closng stock f Yeld fnshed products g Percentage of yeld h Shortage/ excess, f any 7 Fnshed products/ By-products a openng stock b purchase durng the prevous year c quantty manufactured durng the prevous year d sales durng the prevous year e closng stock f shortage/ excess, f any 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 Profts and gans from busness or professon Proft and gans from busness other than speculatve busness and specfed busness (A37 of Schedule-BP) (enter nl f loss) Proft and gans from speculatve busness (B41 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) Proft and gans from specfed busness (C47 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) v Total ( ) (enter nl f 3v s a loss) 4 Captal gans a Short term a 6b 6c 6d 6e 6f 6g 6h 7a 7b 7c 7d 7e 7f 3v Page 9

64 COMPUTATION OF TAX LIABILITY Short-term 15% (7 of tem E of schedule CG) 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) 4av b Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) b Total Long-term (b + b + b) (enter nl f loss) c Total captal gans (4av + 4b) (enter nl f loss) 5 Income from other sources a from sources other than from ownng race horses and ncome chargeable to tax at specal 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 (5a + 5b + 5c) (enter nl f loss) 6 Total ( v +4c +5d) 6 7 Losses of current year to be set off aganst 6 (total of 2x,3x and 4x of Schedule CYLA) 7 8 Balance after set off current year losses (6 7) (total of column 5 of Schedule CYLA+5b) 8 9 Brought forward losses to be set off aganst 8 (total of 2x, 3x and 4x of Schedule BFLA) 9 10 Gross Total ncome (8-9) (5xv of Schedule BFLA+ 5b) Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA (c of Sch. 10A + c of Sch. 10AA) Deductons under Chapter VI-A a Part-B, CA and D of Chapter VI-A [(1 + 3) of Schedule VI-A and lmted upto (10-11)] a b 4b b Part-C of Chapter VI-A [(2 of Schedule VI-A and lmted upto ( )] c Total (13a + 13b) [lmted upto (10-11)] 14 Total ncome ( c) Income whch s ncluded n 14 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 (14-15) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of row x of Schedule CFL) 18 Part B - TTI Computaton of tax lablty on total ncome 1 a Tax payable on deemed total ncome under secton 115JC (4 of Schedule AMT) 1a b Surcharge on (a) (applcable f 3 of schedule AMT exceeds 1 crore) c Educaton Cess, ncludng secondary and hgher educaton cess on (1a+1b) above d Total Tax Payable on deemed total ncome (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on 17 of Part B-TI b Tax at specal rates (total of () of Schedule-SI) c Rebate on agrcultural ncome [applcable f (14-15) of Part B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on Total Income (2a + 2b 2c) e Rebate under secton 87A (applcable f 14 of Part B-TI does not exceed 5 lakh) f Tax payable after rebate (2d 2e) g Surcharge on 2f (applcable f 14 of Part B-TI exceeds 1 crore) h Educaton cess, ncludng secondary and hgher educaton cess on (2f + 2g) Gross tax lablty (2f + 2g + 2h) 3 Gross tax payable (hgher of 1d and 2) 3 Credt under secton 115JD of tax pad n earler years (applcable f 2 s more than 1d) (5 of 4 4 Schedule AMTC) 5 Tax payable after credt under secton 115JD (3-4) 5 6 Tax relef a Secton 89 6a 2a 2b 2c 5a 5b 5c 4c 5d 13a 13b 13c 1b 1c 1d 2d 2e 2f 2g 2h 2 Page 10

65 ADVANCE/ SELF ASSESSMENT TAX BANK ACCOUNT TAXES PAID b Secton 90/ 90A ( 2 of Schedule TR) c Secton 91 ( 3 of Schedule TR) d Total (6a + 6b+ 6c) 7 Net tax lablty (5-6d) (enter zero f negatve) 7 8 Interest payable a For default n furnshng the return (secton 234A) 8a b For default n payment of advance tax (secton 234B) c For deferment of advance tax (secton 234C) d Total Interest Payable (8a+8b+8c) 9 Aggregate lablty (7 + 8d) 9 10 Taxes Pad a Advance Tax (from column 5 of 18A) b TDS (total of column 5 of 18B and column 8 of 18C) c TCS (column 7 of 18D) d Self-Assessment Tax (from column 5 of 18A) e Total Taxes Pad (10a+10b+10c+10d) 11 Amount payable (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (Refund, f any, wll be drectly credted nto the bank account) Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) 6b 6c 8b 8c 10a 10b 10c 10d 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. Sl. IFS Code of Name of the Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) 6d 8d 10e 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or Yes () 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 I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here 16 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A Detals of payments of Advance Tax and Self-Assessment Tax 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. 10a & 10d of Part B-TTI Page 11

66 TCS ON INCOME TDS ON OTHER INCOME TDS ON SALARY B Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Sl No Tax Deducton Account Name of the Employer Number (TAN) of the Employer Income chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) D C NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 10b 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] Sl No 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 own hands n the hands of 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 10b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Tax Collecton Account Number of the Collector Name of the Collector Unclamed TCS brought forward (b/f) Fn. Year n whch collected Amount b/f TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (5) or (6) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) of Schedule-TCS n 10c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1-S20) AS APPLICABLE Page 12

67 HOUSE PROPERTY SALARIES 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 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) Travel concesson/assstance receved (sec. 10(5) Tax pad by employer on non-monetary perquste (sec. 10(10CC) Allowance to meet expendture ncurred on house rent (sec. 10(13A) v Other allowances 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 ( ) v 1 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 I II 2 (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a 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 No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property (optonal) I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN(s) of Tenant (optonal) I II Page S1

68 INCOME FROM BUSINESS OR PROFESSION Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a 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 BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 45 and 53d of Part A-P&L ) 1 Net proft or loss from speculatve busness ncluded n 1 (enter ve 2a sgn n case of loss) 2a Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 2b (enter ve sgn n case of loss) 2b a Salares 3a 3 Income/ recepts credted to proft and loss b House property 3b account consdered under other heads of ncome c Captal gans 3c d Other sources 3d 4 Proft or loss ncluded n 1, whch s referred to n secton 44AD/44AE/44B/44BB/44BBA/44BBB/44D/44DA/Chapter-XII-G/ Frst Schedule of Income-tax Act 4 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nature and amount) Total (c + c) 5c d Total exempt ncome (5a + 5b + 5c) 5d 6 Balance (1 2a 2b 3a - 3b 3c - 3d 4 5d) 6 7 Expenses debted to proft and loss account consdered under other heads of ncome c c a Salares 7a b House property 7b c Captal gans d Other sources 7d 8 Expenses debted to proft and loss account whch relate to exempt ncome 8 9 Total (7a + 7b + 7c + 7d + 8) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act Deprecaton allowable under secton 32(1)() and 32(1)(a) (tem 6 of Schedule-DEP) 12 Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) 12 Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) 13 Amounts debted to the proft and loss account, to the extent 14 dsallowable under secton 36 (6r of PartA-OI) 14 Amounts debted to the proft and loss account, to the extent 15 dsallowable under secton 37 (7j of PartA-OI) 15 Amounts debted to the proft and loss account, to the extent 16 dsallowable under secton 40 (8A of PartA-OI) 16 7c 12 Page S2

69 Amounts debted to the proft and loss account, to the extent 17 dsallowable under secton 40A (9f of PartA-OI) Any amount debted to proft and loss account of the prevous 18 year but dsallowable under secton 43B (11g of PartA-OI) Interest dsallowable under secton 23 of the Mcro, Small and 19 Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AD/ 33AB/ 33ABA/ 35ABB/ 21 40A(3A)/ 72A/80HHD/ 80-IA Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DA Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch ndvdual/huf/prop. concern s a partner) 25 Total ( ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD 27 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem x(4) 28 of Schedule ESR) (f amount deductble under secton 35 or 35CCC 28 or 35CCD s lower than amount debted to P&L account, t wll go to tem 24) Any amount dsallowed under secton 40 n any precedng 29 prevous year but allowable durng the prevous year(8b of 29 PartA-OI) Any amount dsallowed under secton 43B n any precedng 30 prevous year but allowable durng the prevous year(10g of 30 PartA-OI) 31 Deducton under secton 35AC a Amount, f any, debted to proft and loss account 31a b Amount allowable as deducton 31b c Excess amount allowable as deducton (31b 31a) 31c 32 Any other amount allowable as deducton Total ( c+32) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AD 35 Secton 44AE Secton 44B v Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v 35v 35v 35v v Secton 44DA 35v (tem 4 of Form 3CE) x Frst Schedule of Income-tax Act x Total (35 to 35x) 35x Net proft or loss from busness or professon other than speculatve and specfed busness ( x) Net Proft or loss from busness or professon other than speculatve busness and specfed 37 busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same A37 fgure as n 36) (If loss take the fgure to 2 of tem E) B Computaton of ncome from speculatve busness 38 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Income from speculatve busness ( ) (f loss, take the fgure to 6x of schedule CFL) B41 C Computaton of ncome from specfed busness under secton 35AD 42 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 35x Page S3

70 DEPRECIATION ON OTHER ASSETS DEPRECIATION ON PLANT AND MACHINERY 45 Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) or 35AD(1A) Income from Specfed Busness (45 46) (f loss, take the fgure to 7x of schedule CFL) C47 D Inco D Income chargeable under the head Profts and gans from busness or professon (A37+B41+C47) D E Intra head set off of busness loss of current year Sl. Type of Busness ncome Loss to be set off (Fll ths row only f fgure s negatve) Income from speculatve busness Income from specfed busness v Total loss set off ( + ) v Loss remanng after set off ( v) Income of current year (Fll ths column only f fgure s zero or postve) Busness loss set off Busness ncome remanng after set off (1) (2) (3) = (1) (2) NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head (B41) (C47) (A37) Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton Schedule DPM under any other secton) 1 Block of assets Plant and machnery 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) () () () (v) (v) (v) (v) Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Buldng Furnture and Intangble Shps fttngs assets 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year () () () (v) (v) (v) Page S4

71 DEEMED CAPITAL GAINS SUMMARY OF DEPRECIATION ON ASSETS 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) Summary of deprecaton on assets (Other than assets on whch full captal expendture s allowable as deducton under Schedule DEP any other secton) 1 Plant and machnery a Block enttled for 15 per cent 1a ( Schedule DPM - 14 ) b Block enttled for 30 per cent 1b ( Schedule DPM - 14 ) c Block enttled for 40 per cent 1c ( Schedule DPM - 14 ) d Block enttled for 50 per cent 1d ( Schedule DPM - 14 v) e Block enttled for 60 per cent 1e ( Schedule DPM - 14 v) f Block enttled for 80 per cent 1f ( Schedule DPM 14 v) g Block enttled for 100 per cent 1g ( Schedule DPM - 14 v) h Total deprecaton on plant and machnery ( 1a + 1b + 1c + 1d+ 1e + 1f + 1g ) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 14) b Block enttled for 10 per cent (Schedule 2b DOA- 14) c Block enttled for 100 per cent 2c (Schedule DOA- 14) d Total deprecaton on buldng (total of 2a + 2b + 2c) 3 Furnture and fttngs(schedule DOA- 14 v) 3 4 Intangble assets (Schedule DOA- 14 v) 4 5 Shps (Schedule DOA- 14 v) 5 6 Total deprecaton ( 1h+2d+3+4+5) 6 1h 2d Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery a Block enttled for 15 per cent 1a (Schedule DPM - 16) b Block enttled for 30 per cent (Schedule 1b DPM 16) c Block enttled for 40 per cent(schedule 1c DPM - 16) Page S5

72 Short-term Captal Gans d Block enttled for 50 per cent 1d (Schedule DPM - 16v) e Block enttled for 60 per cent 1e (Schedule DPM 16v) f Block enttled for 80 per cent (Schedule 1f DPM 16v) g Block enttled for 100 per cent 1g (Schedule DPM 16v) h Total ( 1a +1b + 1c + 1d + 1e + 1f + 1g) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 16) b Block enttled for 10 per cent (Schedule 2b DOA- 16) c Block enttled for 100 per cent 2c (Schedule DOA- 16) d Total ( 2a + 2b + 2c) 2d 3 Furnture and fttngs ( Schedule DOA- 16v) 3 4 Intangble assets (Schedule DOA- 16v) 4 5 Shps (Schedule DOA- 16v) 5 6 Total ( 1h+2d+3+4+5) 6 1h Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nature referred to n secton (1) Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) 35(1)() v v v v v x x 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Items 4, 5 and 8 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 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b + b) bv c Balance (a bv) 1c d Deducton under secton 54B/54D/ 54G/54GA (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) 3 b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) A2c From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b Page S6

73 v Total ( + + ) bv c Balance (3a bv) 3c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 3d e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e 4 For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a b STCG on transactons on whch securtes transacton tax (STT) s not pad A4b For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 5 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 ( + + ) bv c Balance (5a bv) 5c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) 5d e Short-term captal gan on sale of securtes (other than those at A3 above) by an FII (5c +5d) A5e 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a Full value of consderaton 6a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (6a bv) 6c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng 6d out of sale of such asset to be gnored (Enter postve value only) e Deemed short term captal gans on deprecable assets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e -6f) A6g 7 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year n whch asset transferred Secton under whch deducton clamed n that year New asset acqured/constructed Year n whch asset acqured/constructed Amount utlsed out of Captal Gans account D/54G/54GA B b Amount deemed to be short term captal gans u/s 54B/54D/54G/54GA, other than at a Total amount deemed to be short term captal gans (X + X + b) 8 FOR NON-RESIDENTS- STCG ncluded n A1-A7 but not chargeable to tax as per DTAA Sl. I II Country name, code Artcle of DTAA Whether Tax Resdency Certfcate obtaned? III Total amount of STCG not chargeable to tax as per DTAA Item No. A1 to A7 above n whch ncluded A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7/ A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7/ Amount not used for new asset or remaned unutlzed n Captal gans account (X) Amount of STCG 9 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7 -A8) A9 B Long-term captal gan (LTCG) (Items 5, 6, 7 & 10 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 A7 A8 Page S7

74 Long-term Captal Gans 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) d Deducton under secton 54/54B/54D/54EC/54F/54G/54GA/54GB (Specfy detals n tem D below) e Long-term Captal Gans on Immovable property (1c - 1d) B1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) d Deducton u/s 54EC/54F (Specfy detals n tem D below) e Long term captal gans from slump sale (2c-2d) B2e 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (3a bv) 3c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 3d e LTCG on bonds or debenture (3c 3d) B3e 2c 2d a b b b bv 1c 1d b b b bv 4 From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable () GDR of an Indan company referred n sec. 115ACA 5 6 a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 4d e Long-term Captal Gans on assets at B4 above (4c 4d) B4e For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 5a b Deducton under sectons 54EC/54F (Specfy detals n tem D below) 5b c LTCG on share or debenture (5a-5b) B5c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as referred n sec. 115AC, () securtes by FII as referred to n sec. 115AD a Full value of consderaton 6a 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 (6a bv) 6c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 6d e Long-term Captal Gans on assets at 6 above n case of NON-REESIDENT (6c 6d) B6e 7 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) 7a b Less deducton under secton 115F (Specfy detals n tem D below) 7b c Balance LTCG on sale of specfed asset (7a 7b) B7c d LTCG on sale of asset, other than specfed asset (computed wthout ndexaton) 7d e Less deducton under secton 115F (Specfy detals n tem D below) 7e f Balance LTCG on sale of asset, other than specfed asset (7d 7e) B7f Page S8

75 8 From sale of assets where B1 to B7 above are not applcable a Full value of consderaton 8a 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 (8a bv) 8c d Deducton under secton 54D/54EC/54F/54G/54GA (Specfy detals n tem D 8d e below) Long-term Captal Gans on assets at B8 above (8c-8d) B8e 9 Amount deemed to be long-term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. New asset acqured/constructed Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA B Amount utlsed Year n whch asset out of Captal acqured/constructed Gans account b Amount deemed to be long-term captal gans, other than at a 10 Total amount deemed to be long-term captal gans (X + X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 but not chargeable to tax n Inda as per DTAA Sl. I II Country name, code Whether Tax Resdency Artcle of DTAA Certfcate obtaned? Item B1 to B8 above n whch ncluded B1e/B2e/B3e/ B4e/ B5c/B6e/B7c/B7f/B8e/B9 B1e/B2e/B3e/ B4e/ B5c/B6e/B7c/B7f/B8e/B9 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 +B4e + B5c + B6e + B7c + B7f 11 + B8e+ B9-B10] (In case of loss take the fgure to 9x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A9 + B11) (take B11as nl, f loss) D Informaton about deducton clamed 1 In case of deducton u/s 54/54B/54D/54EC/54F/54G/54GA/115F gve followng detals a Secton under whch deducton clamed 1a amount of deducton Cost of new asset Date of ts acquston/constructon a dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date b Secton under whch deducton clamed 1b amount of deducton Cost of new asset Date of ts acquston/constructon b dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date c Total deducton clamed (1a + 1b) 2 In case of deducton u/s 54GB, furnsh PAN of the company E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A8 & B10 whch s chargeable under DTAA) a a b b 1c B9 B10 B11 C Sl. Type of Captal Gan Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss set off 15% 30% applcable rate Long term captal loss set off 10% 20% Current year s captal gans remanng after set off (7= ) Loss to be set off (Fll ths row f fgure computed s negatve) 15% (A3e+A4a) Short term 30% A5e captal gan v (A1e+A2c+A4b+ A6g applcable rate +A7) v Long term 10% (B4e+ + B6e+B7c) (A3e+A4a) A5e (A1e+A2c+A4 b+a6g +A7) (B4e+ B6e+B7c) (B1e+B2e+B3e + B5c+ B7f+B8e+B9) Page S9

76 OTHER SOURCES NOTE v captal gan (B1e+B2e+B3e+ B5c+ 20% B7f+B8e+B9) 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 5v of schedule BFLA, f any. Short-term captal gans taxable at the rate of 30% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at applcable rates Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% Enter value from tem 5x of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% Enter value from tem 5x of schedule BFLA, f any. Upto 15/9 () 16/9 to 15/12 () 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 16/3 to 31/3 (v) Schedule OS NOTE 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 Income by way of wnnngs from lotteres, crossword puzzles etc. 1d 1d v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. (u/s 115BB) Any other ncome chargeable to tax at the rate specfed under chapter XII/XII-A FOR NON-RESIDENTS- Income chargeable to be taxed under DTAA Sl. Country Artcle Rate of tax name, code of DTAA under DTAA I Whether TRC obtaned? 1d 1dv Correspondng secton of the Act whch prescrbes rate Amount of ncome II III Total amount of ncome chargeable to tax under DTAA v Income ncluded n 1e chargeable to tax at specal rate (1f +1f+1f) 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 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 4 of schedule CYLA) Income from other sources (other than from ownng and mantanng race horses) (1fv + 1) (enter 1 as 2 nl f negatve) 3 Income from the actvty of ownng race horses a Recepts 3a b Deductons under secton 57 n relaton to (3) 3b c Balance (3a 3b) (f negatve take the fgure to 10x 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 1e 1f 1f 1f 1fv 1g 1 2 3c Page S10

77 BROUGHT FORWARD LOSS ADJUSTMENT CURRENT YEAR LOSS ADJUSTMENT Schedule CYLA Detals of Income after set-off of current years losses Sl.No Head/ Source of Income Income of current year (Fll ths column only f ncome s zero or postve) Loss to be set off -> Salares (7 of Schedule S) House property (3c of Schedule HP) v Income from Busness (excludng speculaton proft and ncome from specfed busness) or professon House property loss of the current year set off Busness Loss (other than speculaton loss or specfed busness loss) of the current year set off Other sources loss (other than loss from ownng race horses) of the current year set off Current year s Income remanng after set off = (3c of Schedule (2v of tem E of (1 of Schedule-OS) HP) Schedule BP) (A37 of Schedule BP) v Speculatve Income (3 of tem E of schedule BP) v Specfed Busness Income (3 of tem E of schedule BP) v Short-term captal gan 15% v Short-term captal gan 30% x Short-term captal gan taxable at applcable rates x Long term captal gan 10% x x x Long term captal gan 20% Other sources (excludng proft from ownng race horses and amount chargeable to specal rate of tax) Proft from ownng and mantanng race horses xv Total loss set off xv Loss remanng after set-off ( - xv) (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) 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 Brought forward loss set Brought forward No. any, of current year s off deprecaton set losses as per 5 of off Schedule CYLA) Salares (5 of schedule CYLA) House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculaton ncome and ncome from specfed busness) v Speculaton Income Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5v of schedule CYLA) (5v of schedule CYLA) v Specfed Busness Income (5v of schedule CYLA) (B/f busness loss, other than speculaton or specfed busness loss) (B/f normal busness or speculaton loss) (B/f normal busness or specfed busness loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term or long- v Short-term captal gan (5v of schedule CYLA) 15% v Short-term captal gan (5v of schedule CYLA) 30% Short-term captal gan taxable at v applcable rates (5x of schedule CYLA) x Long-term captal gan (5x of schedule CYLA) 10% term captal loss) x Long term captal gan (B/f short-term or longterm captal loss) (5x of schedule CYLA) 20% Other sources ncome (excludng x proft from ownng and mantanng race horses and amount chargeable (5x of schedule CYLA) to specal rate of tax) x Proft from ownng and mantanng race horses (5x of schedule CYLA) (B/f loss from horse races) Total of brought forward loss set off ( v2 + v2+v2+ x v2+v2+x2+x2+x2) xv Current year s ncome remanng after set off Total ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5 +x5) Page S11

78 CARRY FORWARD OF LOSS Schedule CFL Detals of Losses to be carred forward to future years Sl. Assessment Year Date of House property No. Flng loss (DD/MM/ YYYY) Loss from busness other than loss from speculatve busness and specfed busness Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses v v v v v x x x x Total of earler year losses b/f Adjustment of above losses n Schedule BFLA (Current year losses) Total loss Carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2v of schedule BFLA) (B41 of schedule BP, f ve) (2v of schedule BFLA) (C47 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) (2x of schedule BFLA) (3c of schedule OS, f ve) Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought forward unabsorbed deprecaton Amount of deprecaton set-off aganst the current year ncome Balance carred forward to the next year Amount of brought forward unabsorbed allowance Amount of allowance set-off aganst the current year ncome Balance Carred forward to the next year (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Year v v Total (3x of BFLA) (4x of BFLA) Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount () () () I Accountng Polces II Valuaton of Inventores III Constructon Contracts IV Revenue Recognton V Tangble Fxed Assets VI Changes n Foregn Exchange Rates VII Government Grants VIII Securtes IX Borrowng Costs X Provsons, Contngent Labltes and Contngent Assets 11. Total Net effect (I+II+III+IV+V+VI+VII+VIII+IX+X) Page S12

79 DETAILS OF DONATIONS DEDUCTION U/S 10AA DEDUCTION U/S 10A Schedule 10A Deducton under secton 10A Deducton n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Total deducton under secton 10A (a+b) c Schedule 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce/provde servces c Total deducton under secton 10AA (a + b) Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G 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 Total B 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 Total E Total elgble amount of donatons (A + B + C + D) 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 Schedule 80-IA a b Deductons under secton 80-IA Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) Page S13

80 DEDUCTION U/S 80-IC c Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] c1 Undertakng no. 1 c2 Undertakng no. 2 Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] d1 Undertakng no. 1 d and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Cross-country natural d2 Undertakng no. 2 gas dstrbuton network] e Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) e Schedule 80-IB a b c d e f g h j Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] Deducton n the case of multplex theatre [Secton 80- IB(7A)] Deducton n the case of conventon centre [Secton 80- IB(7B)] Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] Deducton n the case of an undertakng developng and buldng housng projects [Secton 80-IB(10)] Deducton n the case of an undertakng operatng a cold chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n ntegrated busness of handlng, storage and transportaton of food grans [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n k operatng and mantanng a rural hosptal [Secton 80- IB(11B)] Deducton n the case of an undertakng engaged n l operatng and mantanng a hosptal n any area, other than excluded area [Secton 80-IB(11C) m Total deducton under secton 80-IB (Total of a1 to l2) a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f1 Undertakng no. 1 f2 Undertakng no. 2 g1 Undertakng no. 1 g2 Undertakng no. 2 h1 Undertakng no. 1 h2 Undertakng no. 2 1 Undertakng no. 1 2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBB of the undertakng) (10(v) of Form 10CCBB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) j1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) j2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) k1 Undertakng no. 1 (11(v) of From 10CCBC) k2 Undertakng no. 2 (11(v) of From 10CCBC) l1 Undertakng no. 1 (11(d) of From 10CCBD) l2 Undertakng no. 2 (11(d) of From 10CCBD) m Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c1 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Page S14

81 TOTAL DEDUCTIONS da Assam db Arunachal Pradesh dc Manpur dd Mzoram de Meghalaya df Nagaland dg Trpura da1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) da2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) db1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) db2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dc1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dc2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dd1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dd2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) de1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) de2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) df1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) df2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dg1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) dh e Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80C b 80CCC c 80CCD(1) e 80CCD(2) g 80D 80DDB k 80G d 80CCD(1B) f 80CCG h 80DD j 80E l 80GG m 80GGC Total Deducton under Part B (total of a to m) 1 2 Part C- Deducton n respect of certan ncomes n 80-IA (e of Schedule 80-IA) o 80-IAB p 80-IB (m of Schedule 80-IB) q 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) r 80-ID (tem 10(e) of Form 10CCBBA) s 80JJA t 80JJAA u 80QQB v 80RRB Total Deducton under Part C (total of n to v) 2 3 Part CA and D- Deducton n respect of other ncomes/other deducton w 80TTA x 80U Total Deducton under Part CA and D (total of w to x) 3 4 Total deductons under Chapter VI-A ( ) 4 Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 14 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) Deducton clamed under any secton ncluded n Chapter VIa A under the headng C. Deductons n respect of certan ncomes b Deducton clamed u/s 10AA 2a 2b Page S15

82 SPECIAL RATE Deducton clamed u/s 35AD as reduced by the amount of c deprecaton on assets on whch such deducton s clamed d Total Adjustment (2a+ 2b+ 2c) 2c 2d 3 Adjusted Total Income under secton 115JC(1) (1+2d) 3 4 Tax payable under secton 115JC [18.5% of (3)] (f 3 s greater than Rs. 20 lakhs) 4 Schedule AMTC Computaton of tax credt under secton 115JD 1 Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2 of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse 3 enter 0] 4 Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of AMT Credt Brought Forward) S. No. Assessment Year (A) AMT Credt v Current AY (enter 1-2, f 1>2 else enter 0) v Total Gross (B1) Set-off n earler assessment years (B2) Balance brought forward to the current assessment year (B3) = (B1) (B2) AMT Credt Utlsed durng the Current Assessment Year (C) 5 Amount of tax credt under secton 115JD utlsed durng the year [total of tem no 4 (C)] 5 6 Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4 (D)] 6 Balance AMT Credt Carred Forward (D)= (B3) (C) Income of specfed persons (spouse, mnor chld etc.) ncludable n ncome of the assessee (ncome of the mnor chld, n Schedule SPI 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. 7 for rate of tax) Sl Secton Specal rate Income No (%) () 1 111A (STCG on shares unts on whch where STT pad) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 5x of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5x of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5x of schedule BFLA) 6 115ACA (LTCG for an employee of specfed company on GDR) 10 (part of 5x of schedule BFLA) 7 115AD (LTCG for FIIs on securtes) 10 (part of 5x of schedule BFLA) 8 115E (LTCG for non-resdent ndan on specfed asset) 10 (part of 5x of schedule BFLA) (LTCG on others) 20 (5x 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 11 n foregn currency) 10 (part of 1f of schedule OS) A(b) (Income of a non-resdent from Royalty) 25 (part of 1f of schedule OS) 13 Chargeable under DTAA rate (part of 1f of schedule OS) Total Tax thereon () Page S16

83 INCOME FROM OUTSIDE INDIA PASS THROUGH INCOME EXEMPT INCOME FIRMS IN WHICH PARTNER Schedule IF Informaton regardng partnershp frms n whch you are partner Number of frms n whch you are partner Whether Sl. Name of the Frm PAN of the frm Whether the secton 92E frm s lable for s applcable No. audt? (Yes/No) to frm? (Yes/ No) Percentage Share n the proft of the frm Amount of share n the proft Captal balance on 31 st March n the frm 4 Total Schedule EI 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 rule 4 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any 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 outsde Inda (ncluded n PART B-TI) House Property Busness or Professon v Captal Gans v Other sources Salary Tax pad Tax payable on outsde Inda such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Total Page S17

84 DETAILS OF FOREIGN ASSETS TAX RELIEF FOR TAX PAID OUTSIDE INDIA 2 House Property Busness or Professon v Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Identfcaton (total of (c) of Schedule FSI n Number respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (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 FA Detals of Foregn Assets and Income from any source outsde Inda b Assessment year n whch tax relef allowed n 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- Owner/ Benefcal owner/ Benefcary Account Number 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 Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Country Nature of Name and Nature of Date snce Total Income Nature of Name and entty Address of Interest- held Investment accrued from Income Amount Schedule code the Entty Drect/ (at cost) (n such Interest where offered Benefcal rupees) owner/ Sl No Income taxable and offered n ths return Item number of schedule Benefcary (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 Page S18

85 DETAILS OF ASSET AND LIABILITY 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 Address of Name of the Account If (7) s yes, Income offered n ths No the account Number 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 If (8) s yes, Income offered n ths No Name and address of address of address of address of return code the trust trustees Settlor Benefcares Amount Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon If (6) s yes, Income offered n ths return Country Name 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) () () NOTE Please refer to nstructons for fllng out ths schedule. In case of an ndvdual, not beng an Indan ctzen, who s n Inda on a busness, employment or student vsa, an asset acqured durng any prevous year n whch he was non-resdent s not mandatory to be reported n ths schedule f no ncome s derved from that asset durng the current prevous year. Schedule 5A Name of the spouse PAN of the spouse Heads of Income Informaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code Income receved under the head Amount apportoned n the hands of the spouse Amount of TDS deducted on ncome at () TDS apportoned n the hands of spouse () () () (v) (v) 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Schedule AL A Partculars of Asset Asset and Lablty at the end of the year (other than those ncluded n Part A BS) (Applcable n a case where total ncome exceeds Rs. 50 lakh) 1 Immovable Asset Amount (Cost) (Rs.) a Land b Buldng 2 Movable Asset a Fnancal Asset Bank (ncludng all deposts) Shares and securtes Page S19

86 B Insurance polces v Loans and Advances gven v Cash n hand b Jewellery, bullon etc. c Archaeologcal collectons, drawngs, pantng, sculpture or any work of art d Vehcles, yachts, boats and arcraft 3 Total Lablty n relaton to Assets at A Page S20

87 AUDIT INFORMATION FILING STATUS PERSONAL INFORMATION FORM ITR-5 INDIAN INCOME TAX RETURN [For persons other than,- () ndvdual, () HUF, () company and (v) person flng Form ITR-7] (Please see Rule 12 of the Income-tax Rules,1962) (Also see attached nstructons) Assessment Year Part A-GEN Name GENERAL PAN Is there any change n the name? If yes, please furnsh the old name Lmted Lablty Partnershp Identfcaton Number (LLPIN) ssued by MCA, f applcable Flat/Door/Block No Name of Premses/Buldng/Vllage Date of formaton (DDMMYYYY) Road/Street/Post Offce Area/Localty Status (frm-1, local authorty- 2, cooperatve bank-3, other cooperatve socety-4, LLP-5, prvate dscretonary trust -6, any other AOP/BOI- 7, artfcal jurdcal person-8) Town/Cty/Dstrct State Pn code Income Tax Ward/Crcle Country Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Emal Address -1 Emal Address -2 Return fled [Please see nstructon number-6] On or before due date-139(1), After due date-139(4), Revsed Return-139(5), (a) Modfed return- 92CD under secton 119(2)(b), OR In response to notce 139(9)- Defectve 142(1) A 153C If revsed/n response to notce for Defectve/Modfed, (b) then enter Recept No and Date of flng orgnal return (DD/MM/YYYY) / / (c) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of advance prcng agreement / / (d) Resdental Status (Tck) Resdent Non-Resdent (e) Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes No (f) In the case of non-resdent, s there a permanent establshment (PE) n Inda (Tck) Yes No (g) Whether you are an FII / FPI? Yes/No (h) If yes, please provde SEBI Regn. No. Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) Permanent Account Number (PAN) of the representatve a Whether lable to mantan accounts as per secton 44AA? (Tck) Yes No b Whether lable for audt under secton 44AB? (Tck) Yes No c If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton- () Date of furnshng of the audt report (DD/MM/YYYY) / / () Name of the audtor sgnng the tax audt report () (v) (v) Membershp no. of the audtor Name of the audtor (propretorshp/ frm) Permanent Account Number (PAN) of the audtor (propretorshp/ frm) Page 1

88 SOURCES OF FUNDS NATURE OF BUSINESS PARTNERS/ MEMBERS/TRUST INFORMATION d e A (v) Date of audt report If lable to furnsh other audt report under the Income-tax Act, menton the date of furnshng of the audt report? (DD/MM/YY) (Please see Instructon 6()) 9292E If lable to audt under any Act other than the Income-tax Act, menton the Act, secton and date of furnshng the audt report? Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) Whether there was any change durng the prevous year n the partners/members of the frm/aop/boi (Tck) Yes No (In case of socetes and cooperatve banks gve detals of Managng Commttee) If Yes, provde the followng detals Sl. Name of the Partner/member Admtted/Retred Date of admsson/retrement Percentage of share (f determnate) JC B Is any member of the AOP/BOI a foregn company? (Tck) Yes No C If Yes, menton the percentage of share of the foregn company n the AOP/BOI D E Whether total ncome of any member of the AOP/BOI (excludng hs share from such assocaton or body) exceeds the maxmum amount whch s not chargeable to tax n the case of that member? (Tck) Yes No Partculars of persons who were partners/ members n the frm/aop/boi or settlor/trustee/benefcary n the trust on 31 st day of March, 2016 or date of dssoluton Desgnated Partner Name and Percentage of share Status Rate of Remuneraton S.No PAN Identfcaton Number, (see nstructon Interest on Address (f determnate) pad/ payable n case partner n LLP no. 6()) Captal (1) (2) (3) (4) (5) (6) (7) (8) Nature of busness or professon, f more than one busness or professon ndcate the three man actvtes/ products S.No. Code [Please see nstructon No.7()] Descrpton () () Part A-BS A Sources of Funds BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2016 (fll tems A and B n a case where regular books of accounts are mantaned, otherwse fll tem C) 1 Partners / members fund a Partners / members captal b Reserves and Surplus Revaluaton Reserve b Captal Reserve b Statutory Reserve b v Any other Reserve v Credt balance of Proft and loss account bv v Total (b + b + b + bv + bv) c Total partners / members fund (a + bv) 2 Loan funds a Secured loans Foregn Currency Loans a Rupee Loans A From Banks bv A a bv 1c Page 2

89 APPLICATION OF FUNDS B From others C Total ( A + B) Total secured loans (a + C) b Unsecured loans (ncludng deposts) B C a Foregn Currency Loans b Rupee Loans A From Banks From persons specfed n secton 40A(2)(b) B of the I. T. Act C From others D Total Rupee Loans ( A + B + C) Total unsecured loans (b + D) c Total Loan Funds (a + b) 3 Deferred tax lablty 3 A B C D b 2c 4 Advances From persons specfed n secton 40A(2)(b) of the I. T. Act From others Total Advances ( + ) 4 5 Sources of funds (1c + 2c ) 5 B Applcaton of funds 1 Fxed assets a Gross: Block b Deprecaton c Net Block (a b) d Captal work-n-progress e Total (1c + 1d) 2 Investments a Long-term nvestments 1a 1b 1c 1d 1e Investment n property Equty nstruments A Lsted equtes B Unlsted equtes C Total Preference shares v Government or trust securtes A B C v v Debenture or bonds v v Mutual funds v v Others v v Total Long-term nvestments ( + C + + v + v + v + v) b Short-term nvestments Equty nstruments A Lsted equtes A B Unlsted equtes B C Total C Preference shares av Government or trust securtes v Debenture or bonds v Mutual funds v Others v v v v Total Short-term nvestments (C v + v + v) c Total nvestments (av + bv) bv 2c 3 Current assets, loans and advances Page 3

90 a Current assets Inventores A Raw materals B Work-n-progress C Fnshed goods Stock-n-trade (n respect of goods acqured D for tradng) Stores/consumables ncludng packng E materal F Loose tools G Others H Total (A + B + C + D + E + F + G) Sundry Debtors A Outstandng for more than one year A B Others B C Total Sundry Debtors C Cash and bank balances A Balance wth banks B Cash-n-hand C Others D Total Cash and cash equvalents (A + B + C) v Other Current Assets v Total current assets (H +C + D + av) av b Loans and advances Advances recoverable n cash or n knd or for value to be receved Deposts, loans and advances to corporate and others Balance wth Revenue Authortes v Total (b + b + b) v Loans and advances ncluded n bv whch s c Total (av + bv) a for the purpose of busness or professon b not for the purpose of busness or professon d Current labltes and provsons Current labltes A Sundry Credtors 1 Outstandng for more than one year 1 2 Others 2 A B C D E F G b b b va vb 3 Total (1 + 2) A3 B Lablty for leased assets C Interest Accrued and due on borrowngs D Interest accrued but not due on borrowngs E Income receved n advance F Other payables G Total (A3 + B + C + D + E + F) Provsons A Provson for Income Tax B Provson for Wealth Tax Provson for Leave C encashment/superannuaton/gratuty D Other Provsons E Total (A + B + C + D) Total (E + E) B C D E F A B C D A B C H D av bv 3c G E d Page 4

91 CREDITS TO PROFIT AND LOSS ACCOUNT NO ACCOUNT CASE e Net current assets (3c d) 4 a Mscellaneous expendture not wrtten off or adjusted 4a b Deferred tax asset Debt balance n Proft and loss account/ accumulated c balance d Total (4a + 4b + 4c) 5 Total, applcaton of funds (1e + 2c + 3e +4d) 5 C In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton as on 31 st day of March, 2016, n respect of busness or professon 1 Amount of total sundry debtors C1 2 Amount of total sundry credtors C2 3 Amount of total stock-n-trade C3 4 Amount of the cash balance C4 4b 4c 3e 4d Proft and Loss Account for the fnancal year (fll tems 1 to 52 n a case where regular books of accounts are Part A-P& L mantaned, otherwse fll tem 53) 1 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a a b c Total (a + b) c v Total ( + + c) Av Dutes, taxes and cess receved or recevable n respect of goods and servces sold or B suppled Unon Excse dutes Servce tax VAT/ Sales tax v Any other duty, tax and cess v Total ( v) C Total Revenue from operatons (Av + Bv) 2 Other ncome Rent Commsson Dvdend ncome v Interest ncome b v Proft on sale of fxed assets v Proft on sale of nvestment beng securtes chargeable v v to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Proft on account of currency fluctuaton x Agrcultural ncome x Any other ncome (specfy nature and amount) a b c Total (xa + xb) x Total of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Raw materal Work-n-progress Fnshed goods Total ( ) v v v x xa xb xc Bv 1C 2x 3v Page 5

92 DEBITS TO PROFIT AND LOSS ACCOUNT 4 Total of credts to proft and loss account (1C + 2x + 3v) 4 5 Openng Stock Raw materal Work-n-progress Fnshed goods v Total ( ) 6 Purchases (net of refunds and duty or tax, f any) 6 7 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty v Unon excse duty v Servce tax v VAT/ Sales tax v Any other tax, pad or payable v Total ( v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores and spare parts 9 10 Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages Bonus Rembursement of medcal expenses v Leave encashment v Leave travel benefts v Contrbuton to approved superannuaton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed gratuty fund v 7v 7v 7v v 14v 14v 14v 14v x Contrbuton to any other fund 14x x Any other beneft to employees n respect of whch an 14x expendture has been ncurred Total compensaton to employees ( v + 14v + 14v + 14v + 14v + x 14x + 14x) Whether any compensaton, ncluded n 14x, pad to x non-resdents xa Yes / No If Yes, amount pad to non-resdents xb 15 Insurance Medcal Insurance 15 Lfe Insurance 15 Keyman s Insurance 15 Other Insurance ncludng factory, offce, car, goods, v etc. 15v v Total expendture on nsurance ( v) 16 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson 5v 7v 14x 15v Page 6

93 Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 23 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 24 Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 25 Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty Servce tax VAT/ Sales tax v Cess v Any other rate, tax, duty or cess ncl STT and CTT v v Total rates and taxes pad or payable ( v + 36v) 37 Audt fee Salary/Remuneraton to Partners of the frm (total of col. (8) of tem E of Partner s/members nformaton under Part A-Gen) 39 Other expenses (specfy nature and amount) Total ( + ) Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s 40 clamed and amount) 40 Others (more than Rs. 1 lakh) where v PAN s not avalable v Others (amounts less than Rs. 1 lakh) v 40v v Total Bad Debt ( v + 40v) 41 Provson for bad and doubtful debts Other provsons 42 Proft before nterest, deprecaton and taxes [4 (5v v + 8 to x + 15v + 16 to to v v )] 44 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company a To Partners 36v a v v Page 7

94 OTHER INFORMATION NO ACCOUNT CASE PROVISIONS FOR TAX AND APPROPRIATIONS b To others Pad n Inda, or pad to a resdent a To Partners b To others Total (a + b + a + b) 45 Deprecaton and amortsaton Proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Transferred to reserves and surplus Balance carred to balance sheet n partner s account (51 52) In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton for prevous year n respect of busness or professon a Gross recepts 54a b Gross proft 54b c Expenses 54c d Net proft 54d b a b 44 Part A- OI Other Informaton (optonal n a case not lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No Effect on the proft because of devaton, f any, as per Income Computaton Dsclosure 3 Standards notfed under secton 145(2) [column 11() of Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value added tax, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year d any other tem of ncome e captal recept, f any f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to non-fulflment of condton specfed n relevant clausesa Premum pad for nsurance aganst rsk of damage or destructon of stocks or store [36(1)()] 6a Premum pad for nsurance on the health of employees b [36(1)(b)] 6b Any sum pad to an employee as bonus or commsson for c servces rendered, where such sum was otherwse payable 6c to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed d captal [36(1)()] 6d e Amount of dscount on a zero-coupon bond [36(1)(a)] 6e f Amount of contrbutons to a recognsed provdent fund [36(1)(v)] 6f g Amount of contrbutons to an approved superannuaton fund [36(1)(v)] 6g Amount of contrbuton to a penson scheme referred to n h secton 80CCD [36(1)(va)] 6h 5a 5b 5c 5d 5e 3 4d 5f Page 8

95 Amount of contrbutons to an approved gratuty fund [36(1)(v)] j Amount of contrbutons to any other fund Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up k under ESI Act or any other fund for the welfare of employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] 6n Expendture for the purposes of promotng famly o 6o plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of p transacton n securtes f such ncome s not ncluded n 6p busness ncome [36(1)(xv)] Expendture for purchase of sugarcane n excess of the q 6q government approved prce [36(1)(xv)] r Any other dsallowance 6r s Total amount dsallowable under secton 36 (total of 6a to 6r) Total number of employees employed by the company (mandatory n case company has t recognzed Provdent Fund) deployed n Inda deployed outsde Inda Total 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] 7a b Expendture of personal nature [37(1)] 7b c Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] 7c d Expendture on advertsement n any souvenr, brochure, tract, pamphlet or the lke, publshed by a poltcal party 7d [37(2B)] e Expendture by way of penalty or fne for volaton of any law for the tme beng n force 7e f Any other penalty or fne 7f g Expendture ncurred for any purpose whch s an offence or whch s prohbted by law 7g h Amount of any lablty of a contngent nature 7h Any other amount not allowable under secton 37 7 j Total amount dsallowable under secton 37 (total of 7a to 7) 8 A. Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 Amount dsallowable under secton 40 (a)(), on a account of non-complance wth the provsons of Aa Chapter XVII-B Amount dsallowable under secton 40(a)(a) on b account of non-complance wth the provsons of Ab Chapter XVII-B Amount dsallowable under secton 40(a)() on c account of non-complance wth the provsons of Ac Chapter XVII-B d Amount of tax or rate leved or assessed on the bass of Ad profts [40(a)()] e Amount pad as wealth tax [40(a)(a)] Ae Amount pad by way of royalty, lcense fee, servce fee f etc. as per secton 40(a)(b) Amount of nterest, salary, bonus, commsson or g remuneraton pad to any partner or member [40(b)] h Any other dsallowance Total amount dsallowable under secton 40(total of Aa to Ah) Any amount dsallowed under secton 40 n any precedng prevous year but allowable B. durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A a Amounts pad to persons specfed n secton 40A(2)(b) 6 6j 6k 6l 6m Af Ag Ah 9a 6s 7j 8A 8B Page 9

96 QUANTITATIVE DETAILS Amount pad otherwse than by account payee cheque or b account payee bank draft under secton 40A(3) 100% dsallowable c Provson for payment of gratuty [40A(7)] any sum pad by the assessee as an employer for settng up d or as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance f Total amount dsallowable under secton 40A Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng 10 the prevous year Any sum n the nature of tax, duty, cess or fee under any a law 10a Any sum payable by way of contrbuton to any provdent b fund or superannuaton fund or gratuty fund or any other 10b fund for the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered 10c Any sum payable as nterest on any loan or borrowng d from any publc fnancal nsttuton or a State fnancal 10d corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank 10e f Any sum payable towards leave encashment 10f g Total amount allowable under secton 43B (total of 10a to 10f) Any amount debted to proft and loss account of the prevous year but dsallowable under 11 secton 43B a Any sum n the nature of tax, duty, cess or fee under any 11a law b Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other 11b fund for the welfare of employees c Any sum payable to an employee as bonus or commsson 11c for servces rendered d Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal 11d corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng 11e from any scheduled bank f Any sum payable towards leave encashment 11f g Total amount dsallowable under Secton 43B(total of 11a to 11f) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty 12a b Servce tax 12b c VAT/sales tax 12c d Any other tax 12d e Total amount outstandng (total of 12a to 12d) 12e 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA or 33AC Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss account (net) 9b 9c 9d 9e 9f 10g 11g 15 Part A QD Quanttatve detals (optonal n a case not lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern 6 Raw materals a Openng stock 6a b Purchases durng the prevous year 6b Page 10

97 TOTAL INCOME c Consumpton durng the prevous year d Sales durng the prevous year e Closng stock f Yeld fnshed products g Percentage of yeld h Shortage/ excess, f any 7 Fnshed products/ By-products a openng stock b purchase durng the prevous year c quantty manufactured durng the prevous year d sales durng the prevous year e closng stock f shortage/ excess, f any 6c 6d 6e 6f 6g 6h 7a 7b 7c 7d 7e 7f Part B - TI Computaton of total ncome 1 Income from house property (4c of Schedule-HP) (enter nl f loss) 1 2 Profts and gans from busness or professon Profts and gans from busness other than speculatve busness 2 and specfed busness (A36 of Schedule-BP)(enter nl f loss) Profts and gans from speculatve busness (B40 of Schedule 2 BP) (enter nl f loss and carry ths fgure to Schedule CFL) Profts and gans from specfed busness (C46 of Schedule BP) 2 (enter nl f loss and carry ths fgure to Schedule CFL) v Total ( ) (enter nl, f loss and carry ths fgure of loss to Schedule CYLA) 3 Captal gans a Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chargeable at applcable rate (7v of tem E of schedule CG) v Total Short-term (a + a + a) b Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) b Total Long-term (b + b) (enter nl f loss) c Total captal gans (3av + 3b) (enter nl f loss) 4 Income from other sources a from sources other than from ownng and mantanng race 4a horses and ncome chargeable to tax at specal rate (1 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate (1fv of Schedule OS) 4b c from ownng and mantanng race horses (3c of Schedule OS) (enter nl f loss) d Total (4a + 4b + 4c) 5 Total (1 + 2v + 3c +4d) 5 6 Losses of current year to be set off aganst 5 (total of 2x,3x and 4x of Schedule CYLA) 6 7 Balance after set off current year losses (5 6) (total of column 5 of schedule CYLA + 4b) 7 8 Brought forward losses to be set off losses aganst 7 (total of 2x, 3 x and 4x of Schedule BFLA) 8 9 Gross Total ncome (7 8) (also 5x of Schedule BFLA + 4b) 9 10 Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA (c of Schedule 10A +c of Schedule 10AA) Deductons under Chapter VI-A a Part-B of Chapter VI-A [1 of Schedule VI-A and lmted upto (9-10)] a a a 3av b Part-C of Chapter VI-A [2 of Schedule VI-A and lmted upto (9-10-2)] c Total (12a + 12b) [lmted upto (9-10)] 13 Total ncome ( c) 13 b b 4c 2v 3c 4d 12a 12b 12c Page 11

98 BANK ACCOUNT TAXES PAID AND BANK DETAILS COMPUTATION OF TAX LIABILITY 14 Income 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 (13-14) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of x of Schedule CFL) Deemed total ncome under secton 115JC (3 of Schedule AMT) 18 Part B - TTI Computaton of tax lablty on total ncome 1 a Tax payable on deemed total ncome under secton 115JC (4 of Schedule AMT) 1a b Surcharge on (a) above (applcable f 3 of schedule AMT exceeds 1 crore) c Educaton Cess, ncludng secondary and hgher educaton cess on 1a+1b above d Total Tax Payable on deemed total ncome (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on 16 of Part B-TI b Tax at specal rates (total of col. () of Schedule-SI) c Rebate on agrcultural ncome [applcable f (13-14) of Part B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on total ncome (2a+2b -2c)) e Surcharge on 2d (applcable f 13 of Part B-TI exceeds 1 crore) f Educaton cess, ncludng secondary and hgher educaton cess on 2d+2e g Gross tax lablty (2d + 2e + 2f) 3 Gross tax payable (hgher of 1d or 2g) 3 4 Credt under secton 115JD of tax pad n earler years (applcable f 2g s more than 1d) (5 of Schedule AMTC) 5 Tax payable after credt under secton 115JD (3-4) 5 6 Tax relef a Secton 90/90A (2 of Schedule TR) b Secton 91(3 of Schedule TR) c Total (6a + 6b) 7 Net tax lablty (5 6c) (enter zero, f negatve) 7 8 Interest 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 (8a+8b+8c) 9 Aggregate lablty (7 + 8d) 9 10 Taxes Pad a Advance Tax (from column 5 of 15A) b TDS (total of column 8 of 15B) c TCS (total of column 7 of 15C) d Self-Assessment Tax (from column 5 of 15A) e Total Taxes Pad (10a+10b+10c+10d) 11 Amount payable (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (refund, f any, wll be drectly credted nto the bank account) 12 2a 2b 2c 6a 6b 8a 8b 8c 10a 10b 10c 10d 1b 1c 1d 2d 2e 2f 2g 4 6c 8d 10e 13 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. Sl. IFS Code of Name of the Bank the Bank Account Number (the number should be 9 dgts or more as per CBS system of the bank ) Savngs/ Indcate the account n whch you prefer to get Current/ your refund credted, f any (tck one account ) Cash Credt Page 12

99 TCS ON INCOME TDS ON INCOME ADVANCE/ SELF ASSESSMENT TAX 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] Yes No VERIFICATION I, (full name n block letters), 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 the 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 ncome-tax for the prevous year relevant to the assessment year I further declare that I am makng ths return n my capacty as and I am also competent to make ths return and verfy t. I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here 15 TAX PAYMENTS A B 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) NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A or Form 26QB ssued by Deductor(s)] Sl No Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) TDS of the current fn. year Amount out of (6) or (7) beng Amount out of clamed ths Year (only f (6) or (7) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch deducted b/f (1) (2) (3) (4) (5) (6) (7) (8) (9) C NOTE Please enter total of column (8) of Schedule-TDS n 10b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl Name of the Collector Unclamed TCS brought No forward (b/f) Tax Deducton and Tax Collecton Account Number of the Collector TCS of the current fn. year Amount out of (5) or (6) beng Amount out of clamed ths Year (only f (5) or (6) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch collected b/f (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) of Schedule-TCS n 10c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1-S18) AS APPLICABLE Page 13

100 INCOME FROM BUSINESS OR PROFESSI ON HOUSE PROPERTY SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule HP Detals of Income from House Property (Please refer nstructons) Address of property 1 Town/ Cty State PIN Code 1 Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property 2 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 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) 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 No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) f Annual value of the property owned (own percentage share x 2e) g 30% of 2f 2g h Interest payable on borrowed captal 2h Total (2g + 2h) j Income from house property 2 (2f 2) 3 Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA b Arrears of rent receved durng the year under secton 25B after deductng 30% c Total (1j + 2j + 3a + 3b) 2a 2e 2f 2 2j 3a 3b 3c Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 46 & 54d of Part A-P&L ) 1 Net proft or loss from speculatve busness ncluded n 1 (enter ve 2a 2a sgn n case of loss) Page S1

101 2b Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) Income/ recepts credted to proft and loss a House property 3a 3 account consdered under other heads of b Captal gans 3b ncome c Other sources 3c 4 Proft or loss ncluded n 1, whch s referred to n secton 44AD/ 44AE/ 44B/44BB/44BBA/44BBB/ 44D/ 44DA/ 44DB/ Chapter-XII- G/ Frst Schedule of Income-tax Act 4 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nature and amount) Total (c + c) 5c d Total exempt ncome (5a + 5b + 5c) 5d 6 Balance (1 2a 2b 3a - 3b 3c 4 5d) a House property 7a Expenses debted to proft and loss account consdered under other heads of ncome b Captal gans 7b c Other sources 7c Expenses debted to proft and loss account whch relate to exempt ncome 8 9 Total (7a + 7b + 7c + 8) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act Deprecaton allowable under secton 32(1)() and 32(1)(a) (column 6 of Schedule-DEP) 12 Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) 12 Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) 13 Amounts debted to the proft and loss account, to the extent 14 dsallowable under secton 36 (6s of PartA-OI) 14 Amounts debted to the proft and loss account, to the extent 15 dsallowable under secton 37 (7j of PartA-OI) 15 Amounts debted to the proft and loss account, to the extent 16 dsallowable under secton 40 (8A of PartA-OI) 16 Amounts debted to the proft and loss account, to the extent 17 dsallowable under secton 40A (9f of PartA-OI) 17 Any amount debted to proft and loss account of the prevous 18 year but dsallowable under secton 43B (11g of PartA-OI) 18 Interest dsallowable under secton 23 of the Mcro, Small and 19 Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AC/ 32AD/ 33AB/ ABA/35ABB/ 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ 80-IA 22 Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DB Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch assessee s a partner) 25 Total ( ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD 27 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem 28 x(4) of Schedule ESR) (f amount deductble under secton 35 or 28 35CCC or 35CCD s lower than amount debted to P&L account, t wll go to tem 24) c c 24 2b 12 Page S2

102 Any amount dsallowed under secton 40 n any precedng 29 prevous year but allowable durng the prevous year(8b of Part A-OI) Any amount dsallowed under secton 43B n any precedng 30 prevous year but allowable durng the prevous year(10g of Part A-OI) 31 Deducton under secton 35AC a Amount, f any, debted to proft and loss account b Amount allowable as deducton c Excess amount allowable as deducton (31b 31a) 32 Any other amount allowable as deducton Total ( c+32) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AD 35 Secton 44AE Secton 44B v Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v 35v 35v 35v v Secton 44DA 35 v (tem 4 of Form 3CE) x Secton 44DB x Frst Schedule of Income-tax Act x Total (35 to 35x) 35x Net proft or loss from busness or professon other than speculatve and specfed busness ( x) Net Proft or loss from busness or professon other than speculatve busness and specfed 37 busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same A37 fgure as n 36) (If loss take the fgure to 2 of tem E) B Computaton of ncome from speculatve busness 38 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DB Deductons n accordance wth secton 28 to 44DB Income from speculatve busness ( ) (f loss, take the fgure to 6x of schedule CFL) B41 35x C Computaton of ncome from specfed busness under secton 35AD 42 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DB Deductons n accordance wth secton 28 to 44DB (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 45 Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) or 35AD(1A) 46 35x 47 Income from Specfed Busness (45 46) (f loss, take the fgure to 7x of schedule CFL) C47 D Inco D Income chargeable under the head Profts and gans from busness or professon (A37+B41+C47) D me E char Intra head set off of busness loss of current year gea Income of current year (Fll ths column Busness ncome remanng after ble Busness loss set off Sl. undtype of Busness ncome only f fgure s zero or postve) set off er (1) (2) (3) = (1) (2) the Loss to be set off (Fll ths row (A37) hea only f fgure s negatve) d Income from speculatve Pro (B41) busness fts Income from specfed and (C47) busness gan v s Total loss set off ( + ) (A3 v Loss remanng after set off ( v) 7+B 41+ C47 ) Page S a 31b 31c 44

103 DEPRECIATION ON OTHER ASSETS DEPRECIATION ON PLANT AND MACHINERY Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton Schedule DPM under any other secton) 1 Block of assets Plant and machnery 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result n negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton* ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50* ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) () () () (v) (v) (v) (v) Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Buldng Furnture and Intangble Shps fttngs assets 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result n negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton* ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets () () () (v) (v) (v) Page S4

104 SUMMARY OF DEPRECIATION ON ASSETS 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) Summary of deprecaton on assets (Other than assets on whch full captal expendture s allowable as deducton under Schedule DEP any other secton) 1 Plant and machnery a Block enttled for 15 per cent 1a ( Schedule DPM - 14 ) b Block enttled for 30 per cent 1b ( Schedule DPM - 14 ) c Block enttled for 40 per cent 1c ( Schedule DPM - 14 ) d Block enttled for 50 per cent 1d ( Schedule DPM - 14 v) e Block enttled for 60 per cent 1e ( Schedule DPM - 14 v) f Block enttled for 80 per cent 1f ( Schedule DPM 14 v) g Block enttled for 100 per cent 1g ( Schedule DPM - 14 v) h Total deprecaton on plant and machnery ( 1a + 1b + 1c + 1d+ 1e + 1f + 1g ) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 14) b Block enttled for 10 per cent (Schedule 2b DOA- 14) c Block enttled for 100 per cent 2c (Schedule DOA- 14) d Total deprecaton on buldng (total of 2a + 2b + 2c) Furnture and fttngs(schedule DOA- 14 v) 3 Intangble assets (Schedule DOA- 14 v) 4 Shps (Schedule DOA- 14 v) 5 Total deprecaton ( 1h+2d+3+4+5) 6 1h 2d Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery a Block enttled for 15 per cent 1a (Schedule DPM - 16) b Block enttled for 30 per cent (Schedule 1b DPM 16) c Block enttled for 40 per cent(schedule 1c DPM - 16) d Block enttled for 50 per cent 1d (Schedule DPM - 16v) e Block enttled for 60 per cent 1e (Schedule DPM 16v) f Block enttled for 80 per cent (Schedule 1f DPM 16v) g Block enttled for 100 per cent 1g (Schedule DPM 16v) h Total ( 1a +1b + 1c + 1d + 1e + 1f + 1g) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 16) b Block enttled for 10 per cent (Schedule 2b DOA- 16) c Block enttled for 100 per cent 2c (Schedule DOA- 16) d Total ( 2a + 2b + 2c) 2d 3 Furnture and fttngs ( Schedule DOA- 16v) 3 1h Page S5

105 Short-term Captal Gans 4 Intangble assets (Schedule DOA- 16v) 4 5 Shps (Schedule DOA- 16v) 5 6 Total ( 1h+2d+3+4+5) 6 Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nature referred to n secton (1) Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) 35(1)() v v v v v x x 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Items 4, 5 & 8 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 a of Captal Gans (a or a) b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b + b) bv c Balance (a bv) 1c d Deducton under secton 54D/ 54G/54GA (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) 3 4 b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (3a bv) 3c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 3d e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a b STCG on transactons on whch securtes transacton tax (STT) s not pad For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 5 115AD a Full value of consderaton 5a b Deductons under secton 48 A2c A4b Page S6

106 Long-term Captal Gans Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total ( + + ) c Balance (5a bv) d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) e Short-term captal gan on securtes (other than those at A3 above) by an FII (5c +5d) 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a Full value of consderaton 6a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (6a bv) 6c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng 6d out of sale of such asset to be gnored (Enter postve value only) e Deemed short term captal gans on deprecable assets (6 of schedule- DCG) 6e f Deducton under secton 54D/54G/54GA 6f g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e 6f) A6g 7 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year Secton under whch n whch asset deducton clamed n transferred that year New asset acqured/constructed b b b bv 5c 5d Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account D/54G/54GA b Amount deemed to be short term captal gans u/s 54D/54G/54GA, other than at a Amount deemed to be short term captal gans (X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 8 FOR NON-RESIDENTS- STCG ncluded n A1-A7 but not chargeable to tax n Inda as per DTAA Sl. Country name, code I II Artcle of DTAA Whether Tax Resdency Certfcate obtaned? III Total amount of STCG not chargeable to tax n Inda as per DTAA Item No. A1 to A7 above n whch ncluded A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7 A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7 Amount of STCG 9 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7 A8) A9 B Long-term captal gan (LTCG) (Items 5, 6 & 9 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 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 54D/54EC/54G/54GA (Specfy detals n tem D d below) 1d e Long-term Captal Gans on Immovable property (1c - 1d) 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) 2c a a b b b bv 1c A5e A7 A8 B1e Page S7

107 d Deducton u/s 54EC 2d e Long term captal gans from slump sale (2c-2d) 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (3a bv) 3c d Deducton under sectons 54EC (Specfy detals n tem D below) 3d e LTCG on bonds or debenture (3c 3d) B2e B3e From sale of lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c d Deducton under sectons 54EC (Specfy detals n tem D below) 4d e Long-term Captal Gans on assets at B4 above (4c 4d) B4e For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 5a b Deducton under sectons 54EC (Specfy detals n tem D below) 5b c LTCG on share or debenture (5a-5b) B5c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () unts referred n sec. 115AB, () bonds or GDR as referred n sec. 115AC, (v) securtes by FII as referred to n sec. 115AD a Full value of consderaton 6a 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 (6a bv) 6c d Deducton under sectons 54EC (Specfy detals n tem D below) 6d e Long-term Captal Gans on assets at 6 above n case of NON-REESIDENT (6c 6d) B6e 7 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 secton 54D/54EC/54G/54GA (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 Amount deemed to be long-term captal gans, other than at a Amount deemed to be long-term captal gans (X + b) B8 Page S8

108 OTHER SOURCES 9 FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 but not chargeable to tax n Inda as per DTAA Sl. I II Country name, code Whether Tax Resdency Artcle of DTAA Certfcate obtaned? Item B1 to B8 above n whch ncluded B1e/B2e/B3e/ B4e/ B5c/B6e/B7e/B8 B1e/B2e/B3e/ B4e/ B5c/B6e/B7e/B8 Amount of LTCG III Total amount of LTCG not chargeable to tax n Inda as per DTAA Total long term captal gan [B1e +B2e+ B3e +B4e + B5c + B6e + B7e+ B8-B9] (In case of loss take the 10 fgure to 9x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A9+ B10) (take B10 as nl, f loss) D Informaton about deducton clamed 1 In case of deducton u/s 54B/54D/54EC/54G/54GA gve followng detals a Secton under whch deducton clamed 1a amount of deducton Cost of new asset Date of ts acquston/constructon a dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date b Secton under whch deducton clamed 1b amount of deducton Cost of new asset Date of ts acquston/constructon b dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date c Total deducton clamed (1a + 1b) E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A8 & B9 whch s chargeable under DTAA) Sl. Type of Captal Gan Loss to be set off (Fll ths row f computed fgure s negatve) Gan of current year (Fll ths column only f computed fgure s postve) 15% (A3e+A4a) Short term 30% A5e captal gan (A1e+A2c+A4b+A v applcable rate 6g +A7) v 10% (B4e+ + B6e) Long term captal gan v 20% (B1e+B2e+B3e+ B5c+ 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 NOTE Type of Captal gan / Date Short-term captal gans taxable at the rate of 15% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at the rate of 30% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at applcable rates Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% Enter value from tem 5x of schedule BFLA, f any. Short term captal loss set off a a b b 1c Long term captal loss set off 15% 30% applcable rate 10% 20% B9 B10 C Current year s captal gans remanng after set off (7= ) (A3e+A4a) A5e (A1e+A2c+A4b +A6g +A7) (B4e+ + B6e) Upto 15/9 () (B1e+B2e+B3 e+ B5c+ B7e+B8) 16/9 to 15/12 () 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 b Interest, Gross c Rental ncome from machnery, plants, buldngs, etc., Gross Others, Gross (excludng ncome from ownng race d horses)menton the source 1a 1b 1c Page S9

109 CURRENT YEAR LOSS ADJUSTMENT Income by way of wnnngs from lotteres, crossword puzzles etc. v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc (u/s 115BB) Any other ncome chargeable to tax at the rate specfed under chapter XII/XII-A FOR NON-RESIDENTS- Income chargeable to be taxed under DTAA Sl. Country Artcle of Rate of tax Whether TRC Correspondng secton of the Amount of name, code DTAA under DTAA obtaned? Act whch prescrbes rate ncome I II III Total amount of ncome chargeable to tax under DTAA 1f v Income ncluded n 1e chargeable to tax at specal rate (1f +1f+1fv) 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 4 of schedule CYLA) Income from other sources (other than from ownng and mantanng race horses) (1fv + 1) (enter1 as 2 nl, f negatve) 1d 1d 1d 1dv 3 Income from the actvty of ownng 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 10x of Schedule CFL) 4 Income under the head Income from other sources (2 + 3c) (take 3c as nl f negatve) 4 h 1e 1f 1f 1 2 3c Schedule CYLA Detals of Income after Set off of current year losses Sl.No Head/ Source of Income Income of current year (Fll ths column only f ncome s zero or postve) Loss to be set off House property (4c of Schedule HP) Busness (excludng speculaton ncome and ncome from specfed busness) House property loss of the current year set off Busness Loss (other than speculaton or specfed busness loss) of the current year set off Other sources loss (other than loss from race horses and amount chargeable to specal rate of tax) of the current year set off Current year s Income remanng after set off = (A37 of Schedule BP) v Speculaton ncome (3 of tem E of Sch. BP) v Specfed busness ncome u/s 35AD (3 of tem E of Sch. BP) v Short-term captal gan (7 of tem E of schedule 15% CG) v Short-term captal gan (7 of tem E of schedule 30% CG) v Short-term captal gan taxable at (7v of tem E of schedule applcable rates CG) x Long term captal gan (7v of tem E of schedule 10% CG) x Long term captal gan (7v of tem E of schedule 20% CG) x Other sources (excludng proft from ownng race horses and amount (1 of schedule OS) chargeable to specal rate of tax) x Proft from ownng and mantanng race horses (3c of schedule OS) x Total loss set off (+ + v+ v+ v+ v+ v+ x+ x+ x+ x) xv Loss remanng after set-off ( - x) (4c of Schedule HP) (2v of tem E of Schedule BP) (1 of Schedule-OS) Page S10

110 CARRY FORWARD OF LOSS BROUGHT FORWARD LOSS ADJUSTMENT 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 Brought forward loss set Brought forward No. any, of current year s off deprecaton set losses as per 5 of off Schedule CYLA) House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculaton ncome and ncome from specfed busness) Speculaton Income v Specfed Busness Income Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5 of schedule CYLA) (5v of schedule CYLA) (5v of schedule CYLA) (B/f busness loss, other than speculaton or specfed busness loss) (B/f normal busness or speculaton loss) (B/f normal busness or specfed busness loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term captal loss) (B/f short-term or longterm captal loss) (B/f short-term or longterm captal loss) v Short-term captal gan 15% (5v of schedule CYLA) v Short-term captal gan (5v of schedule CYLA) 30% v Short-term captal gan taxable at (5v of schedule CYLA) applcable rates Long-term captal gan v 10% (5x of schedule CYLA) x Long term captal gan 20% (5x of schedule CYLA) Other sources ncome (excludng x proft from ownng and mantanng race horses and amount chargeable (5x of schedule CYLA) to specal rate of tax) x Proft from ownng and mantanng race horses (5x of schedule CYLA) (B/f loss from horse races) x Total of brought forward loss set off x Current year s ncome remanng after set off Total ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5) Schedule CFL Detals of Losses to be carred forward to future years Sl. Assessment Year Date of House property No. Flng loss (DD/MM/ YYYY) Loss from busness other than loss from speculatve busness and specfed busness Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses v v v v v x x x x Total of earler year losses b/f Adjustment of above losses n Schedule BFLA (Current year losses) Total loss Carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2 of schedule BFLA) (B41 of schedule BP, f ve) (2v of schedule BFLA) (C47 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought forward unabsorbed deprecaton Amount of deprecaton set-off aganst the current year ncome Balance carred forward to the next year Amount of brought forward unabsorbed allowance Amount of allowance set-off aganst the current year ncome (2x of schedule BFLA) (3c of schedule OS, f ve) Balance Carred forward to the next year (1) (2) (3) (4) (5) (6) (7) (8) Page S11

111 DETAILS OF DONATIONS DEDUCTION U/S 10AA DEDUCTION U/S 10A v Current Assessment Year v Total (3x of BFLA) (4x of BFLA) Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount () () () I Accountng Polces II Valuaton of Inventores III Constructon Contracts IV Revenue Recognton V Tangble Fxed Assets VI Changes n Foregn Exchange Rates VII Government Grants VIII Securtes IX Borrowng Costs X Provsons, Contngent Labltes and Contngent Assets 11. Total Net effect (I+II+III+IV+V+VI+VII+VIII+IX+X) Schedule 10A Deducton under secton 10A Deducton n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Total deducton under secton 10A (a+b) c Schedule 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce/provde servces c Total deducton under secton 10AA (a + b + c + d) Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G Detals of donatons enttled for deducton under secton 80G Donatons enttled for 100% deducton wthout A qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton B Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Page S12

112 Total Donatons enttled for 100% deducton subject to C qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton 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 Total E Total donatons (A + B + C + D) Schedule 80-IA a b c d e Deductons under secton 80-IA Deducton n respect of profts of an enterprse referred to n secton 80-IA(4)() [Infrastructure faclty] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Crosscountry natural gas dstrbuton network] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2 + e1 + e2) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) f Schedule 80-IB a b c d e f Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] Deducton n the case of multplex theatre [Secton 80- IB(7A)] Deducton n the case of conventon centre [Secton 80- IB(7B)] Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f1 Undertakng no. 1 f2 Undertakng no. 2 g Deducton n the case of an undertakng developng and g1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBB of the undertakng) (10(v) of Form 10CCBB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Page S13

113 TOTAL DEDUCTIONS DEDUCTION U/S 80-IC h j buldng housng projects [Secton 80-IB(10)] g2 Undertakng no. 2 Deducton n the case of an undertakng operatng a cold chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n ntegrated busness of handlng, storage and transportaton of food grans [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n operatng and mantanng a rural hosptal [Secton 80- k IB(11B)] Deducton n the case of an undertakng engaged n operatng and mantanng a hosptal n any area, other l than excluded area [Secton 80-IB(11C) m Total deducton under secton 80-IB (Total of a1 to l2) h1 Undertakng no. 1 h2 Undertakng no. 2 1 Undertakng no. 1 2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) j1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) j2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) k1 Undertakng no. 1 (11(v) of From 10CCBC) k2 Undertakng no. 2 (11(v) of From 10CCBC) l1 Undertakng no. 1 (11(d) of From 10CCBD) l2 Undertakng no. 2 (11(d) of From 10CCBD) m Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East da Assam db Arunachal Pradesh dc Manpur dd Mzoram de Meghalaya df Nagaland dg Trpura da1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) da2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) db1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) db2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dc1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dc2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dd1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dd2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) de1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) de2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) df1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) df2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dg1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c1 Undertakng no. 2 dh e (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80G b 80GGC Total Deducton under Part B (a + b) 1 2 Part C- Deducton n respect of certan ncomes c 80-IA (f of Schedule 80-IA) d 80-IAB e 80-IB (m of Schedule 80-IB) f 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) g 80-ID (tem 10(e) of Form 10CCBBA) h 80JJA Page S14

114 SPECIAL RATE 80JJAA j 80LA (9 of Annexure to Form 10CCF) k 80P Total Deducton under Part C (total of c to k) 2 3 Total deductons under Chapter VI-A (1 + 2) 3 Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 13 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) a Deducton Clamed under any secton ncluded n Chapter VI-A under the headng C. Deductons n respect of certan ncomes b Deducton Clamed u/s 10AA c Deducton clamed u/s 35AD as reduced by the amount of deprecaton on assets on whch such deducton s clamed d Total Adjustment (2a+ 2b+ 2c) 3 Adjusted Total Income under secton 115JC(1) (1+2d) 3 Tax payable under secton 115JC [18.5% of (3)] (In the case of Indvdual, HUF, AOP, BOI, AJP ths s 4 4 applcable f 3 s greater than Rs. 20 lakhs) 2a 2b 2d Schedule AMTC Computaton of tax credt under secton 115JD 1 Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2g of Part-B-TTI) 2 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse 3 3 enter 0] Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above 4 and cannot exceed the sum of AMT Credt Brought Forward) S.No Assessment Year (AY) AMT Credt (A) v Current AY (enter 1 - v 2, f 1>2 else enter 0) v Total Gross (B1) Set-off n earler assessment years (B2) Balance brought forward to the current assessment year (B3) = (B1) (B2) 5 Amount of tax credt under secton 115JD utlsed durng the year [total of tem no. 4 (C)] 5 6 Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4 (D)] 6 AMT Credt Utlsed durng the Current Assessment Year (C) Balance AMT Credt Carred Forward (D)= (B3) (C) Schedule SI Income chargeable to tax at specal rates [Please see nstructon Number-7() for secton and rate of tax] Sl Secton/Descrpton Specal rate Income No (%) () 1 111A (STCG on shares/equty orented MF on whch STT pad) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 5v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5v of schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (part of 5v of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5v of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (part of 5v of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) Tax thereon () Page S15

115 INCOME FROM OUTSIDE INDIA AND TAX RELIEF PASS THROUGH INCOME EXEMPT INCOME 9 115AC (Income of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 30 (part of 1f of schedule OS) A(b) (Income of a non-resdent from Royalty) 25 (part of 1f of schedule OS) 13 Chargeable under DTAA rate (part of 1f of schedule OS) 14 Total 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 Gross Agrcultural recepts (other than ncome to be excluded under rule 4 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any Schedule FSI Sl. Country Code Taxpayer Identfcaton Number 1 House Property 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 Busness or Professon Captal Gans v Other sources Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Total 2 House Property Busness or Professon Page S16

116 DETAILS OF FOREIGN ASSETS TAX RELIEF FOR TAX PAID OUTSIDE INDIA Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Detals Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Identfcaton (total of (c) of Schedule FSI n Number respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (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. b Assessment year n whch tax relef allowed n Inda 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- Owner/ Benefcal owner/ Benefcary Account Number 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 Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Sl Nature of Date snce Nature of Income taxable and offered n ths return No entty held Income Country Name and code Name and Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Income accrued from such Interest 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 Address of Date of Nature of Income taxable and offered n ths return No the Property acquston Income Country Name and code Ownershp- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Income derved from the property Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the prevous year Sl No Nature of Asset Date of acquston Nature of Income Income taxable and offered n ths return Country Name and code Ownershp- Drect/ Benefcal owner/ Benefcary (1) (2) (3) (4) () Total Investment (at cost) (n rupees) Income derved from the asset Amount Schedule where offered Item number of schedule (5) (6) (7) (8) (9) (10) (11) Page S17

117 () 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 Account Number If (7) s yes, Income offered n ths return Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () F Detals of trusts, created under the laws of a country outsde Inda, n whch you are a trustee, benefcary or settlor Sl Country Name and Name and Name and Name and Date Whether If (8) s yes, If (8) s yes, Income offered n ths return No Name and address of address of address of address of snce ncome derved Income Amount Schedule Item number of code the trust trustees Settlor Benefcares poston s taxable n derved from where offered schedule held your hands? the trust (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 Item number of where offered schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule. Page S18

118 AUDIT INFORMATION FILING STATUS PERSONAL INFORMATION FORM ITR-6 INDIAN INCOME TAX RETURN [For Companes other than companes clamng exempton under secton 11] (Please see rule 12 of the Income-tax Rules,1962) (Also see attached nstructons) Assessment Year Part A-GEN Name GENERAL PAN Is there any change n the company s name? If yes, please furnsh the old name Corporate Identty Number (CIN) ssued by MCA Flat/Door/Block No Name of Premses/Buldng/Vllage Date of ncorporaton (DD/MM/YYYY) / / Road/Street/Post Offce Area/Localty Type of company (Tck any one) () Domestc Company () Foregn Company Town/Cty/Dstrct State Country Pn code If a publc company wrte 6, and f prvate company wrte 7 (as defned n secton 3 of The Company Act) Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Income Tax Ward/Crcle Emal Address-1 Emal Address-2 (a) (b) (c) Return fled(tck)[please see nstructon number-5] 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 In response to notce 139(9)- Defectve, 142(1), 148, 153A, 153C If revsed/n response to defectve/modfed, then enter Recept No and Date of flng orgnal / / return (DD/MM/YYYY) If fled, n response to 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) Resdent Non-Resdent (e) In the case of non-resdent, s there a permanent establshment (PE) n Inda (Tck) Yes No (f) Whether you are an FII / FPI? Yes/No If yes, please provde SEBI Regn. No. (g) Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes No (h) Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve assessee (2) Address of the representatve assessee (3) Permanent Account Number (PAN) of the representatve assessee (a) Whether lable to mantan accounts as per secton 44AA? (Tck) Yes No (b) Whether lable for audt under secton 44AB? (Tck) Yes No (c) (d) If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) Yes No If Yes, furnsh the followng nformaton below (1) Menton the date of furnshng of audt report (DD/MM/YYYY) (2) Name of the audtor sgnng the tax audt report (3) Membershp no. of the audtor (4) Name of the audtor (propretorshp/ frm) (5) Permanent Account Number (PAN) of the audtor (propretorshp/ frm) (6) Date of audt report If lable to furnsh other audt report under the Income-tax Act, menton the date of furnshng the audt report? (DD/MM/YY) (Please see Instructon 5()) Page 1

119 NATURE OF COMPANY AND ITS BUSINESS SHAREHOLDERS INFORMATION KEY PERSONS BUSINESS ORGANISATION HOLDING STATUS 92E 115JB (e) Menton the Act, secton and date of furnshng the audt report under any Act other than the Income-tax Act Act and secton (DD/MM/YY) Act and secton (DD/MM/YY) (a) Nature of company (wrte 1 f holdng company, wrte 2 f a subsdary company, wrte 3 f both, wrte 4 f any other) (b) If subsdary company, menton the detals of the Holdng Company PAN Name of Holdng Company Address of Holdng Company Percentage of Shares held (c) If holdng company, menton the detals of the subsdary companes PAN Name of Subsdary Company Address of Subsdary Company Percentage of Shares held (a) In case of amalgamatng company, menton the detals of amalgamated company Address of Amalgamated Company PAN Name of Amalgamated Company (b) In case of amalgamated company, menton the detals of amalgamatng company Address of Amalgamatng Company PAN Name of Amalgamatng Company (c) In case of demerged company, menton the detals of resultng company PAN Name of Resultng Company Address of Resultng Company (d) In case of resultng company, menton the detals of demerged company PAN Name of Demerged Company Address of Demerged Company Partculars of Managng Drector, Drectors, Secretary and Prncpal offcer(s) who have held the offce durng the prevous year Drector Identfcaton S.No. Name Desgnaton Resdental Address PAN Number (DIN) ssued by MCA, n case of Drector Partculars of persons who were benefcal owners of shares holdng not less than 10% of the votng power at any tme of the prevous year S.No. Name and Address Percentage of shares held PAN Nature of company (Tck) 1 Whether a publc sector company as defned n secton 2(36A) of the Income-tax Act Yes No 2 Whether a company owned by the Reserve Bank of Inda Yes No Whether a company n whch not less than forty percent of the shares are held (whether sngly or taken together) by the Government or the Reserve Bank of Inda or a corporaton owned by that Bank Whether a bankng company as defned n clause (c) of secton 5 of the Bankng Regulaton Yes No Act,1949 Yes No Whether a scheduled Bank beng a bank ncluded n the Second Schedule to the Reserve Bank of Inda Act Yes No Whether a company regstered wth Insurance Regulatory and Development Authorty (establshed under sub-secton (1) of secton 3 of the Insurance Regulatory and Development Authorty Act, 1999) Yes No 7 Whether a company beng a non-bankng Fnancal Insttuton Yes No Nature of busness or professon, f more than one busness or professon ndcate the three man actvtes/ products Page 2

120 EQUITY AND LIABILITIES S.No. Code [Please see nstructon No.7()] Descrpton () () () I Part A-BS BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2016 Equty and Labltes 1 Shareholder s fund A B Share captal Authorsed A Issued, Subscrbed and fully Pad up Subscrbed but not fully pad v Total (A + A) Reserves and Surplus Captal Reserve Captal Redempton Reserve Securtes Premum Reserve v Debenture Redempton Reserve v Revaluaton Reserve v Share optons outstandng amount v v Other reserve (specfy nature and amount) a b c Total (va + vb) Surplus.e. Balance n proft and loss account (Debt balance to be shown as ve fgure) Total (B + B + B + Bv + Bv + Bv + Bv + Bv) (Debt balance to be shown as ve x fgure) C Money receved aganst share warrants D Total Shareholder s fund (Av + Bx + 1C) 2 Share applcaton money pendng allotment Pendng for less than one year Pendng for more than one year Total ( + ) 2 3 Non-current labltes A Long-term borrowngs Bonds/ debentures A A B B B Bv Bv Bv va vb Bv Bv a Foregn currency a b Rupee b c Total (a + b) c Term loans a Foregn currency a b Rupee loans 1 From Banks b1 2 From others b2 3 Total (b1 + b2) b3 c Total Term loans (a + b3) c Deferred payment labltes v Deposts from related partes (see nstructons) v Other deposts v Loans and advances from related partes (see nstructons) Av Bx 1C 1D v v v Page 3

121 v Other loans and advances v Long term maturtes of fnance lease oblgatons x Total Long term borrowngs (c + c + + v + v + v + v + v) B Deferred tax labltes (net) C Other long-term labltes Trade payables Others Total Other long-term labltes ( + ) D Long-term provsons Provson for employee benefts Others Total ( + ) E Total Non-current labltes (3A + 3B + 3C + 3D) 4 Current labltes A Short-term borrowngs Loans repayable on demand a From Banks b From Non-Bankng Fnance Companes c From other fnancal nsttutons d From others e Total Loans repayable on demand (a + b + c + d) Deposts from related partes (see nstructons) Loans and advances from related partes (see nstructons) v Other loans and advances v Other deposts v Total Short-term borrowngs (e v + v) B Trade payables Outstandng for more than 1 year Others Total Trade payables ( + ) C Other current labltes Current maturtes of long-term debt Current maturtes of fnance lease oblgatons Interest accrued but not due on borrowngs v Interest accrued and due on borrowngs v Income receved n advance v Unpad dvdends Applcaton money receved for allotment of v securtes and due for refund and nterest accrued Unpad matured deposts and nterest accrued v thereon Unpad matured debentures and nterest accrued x thereon x Other payables x Total Other current labltes ( v + v + v + v + v + x + x) D Short-term provsons Provson for employee beneft Provson for Income-tax Provson for Wealth-tax v Proposed Dvdend v Tax on dvdend v Other v Total Short-term provsons ( v + v + v) a b c d v v v v v x x v v v v v 3A 3B 3C 3D 3E e v v 4A 4B 4C 4D Page 4

122 II E Total Current labltes (4A + 4B + 4C + 4D) Total Equty and labltes (1D E + 4E) ASSETS 1 Non-current assets A Fxed assets Tangble assets a Gross block a b Deprecaton b c Imparment losses c d Net block (a b - c) d Intangble assets a Gross block a b Amortzaton b c Imparment losses c d Net block (a b - c) d Captal work-n-progress v Intangble assets under development v Total Fxed assets (d + d + + v) B Non-current nvestments Investment n property Investments n Equty nstruments a Lsted equtes b Unlsted equtes c Total (a + b) Investments n Preference shares v Investments n Government or trust securtes v Investments n Debenture or bonds v Investments n Mutual funds v Investments n Partnershp frms v Others Investments x Total Non-current nvestments ( + c + + v + v + v + v + v) Bx C Deferred tax assets (Net) D Long-term loans and advances Captal advances Securty deposts Loans and advances to related partes (see nstructons) v Other Loans and advances v Total Long-term loans and advances ( v) v Long-term loans and advances ncluded n Dv whch s a for the purpose of busness or professon b not for the purpose of busness or professon vb gven to shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft c vc of such shareholder as per secton 2(22)(e) of I.T. Act E Other non-current assets Long-term trade recevables a Secured, consdered good b Unsecured, consdered good c Doubtful d Total Other non-current assets (a + b + c) Others v a b c v v v v v v va a b c d C 4E I Av Dv Page 5

123 Total (d + ) Non-current assets ncluded n E whch s due from shareholder, beng the benefcal owner of share, or v from any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act F Total Non-current assets (Av + Bx + C + Dv + E) 2 Current assets A Current nvestments Investment n Equty nstruments a Lsted equtes b Unlsted equtes c Total (a + b) Investment n Preference shares Investment n government or trust securtes v Investment n debentures or bonds v Investment n Mutual funds v Investment n partnershp frms v Other nvestment v Total Current nvestments (c v + v + v + v) B Inventores Raw materals Work-n-progress Fnshed goods Stock-n-trade (n respect of goods acqured for v tradng) v Stores and spares v Loose tools v Others v Total Inventores ( v + v + v + v) C Trade recevables Outstandng for more than 6 months Others Total Trade recevables ( + + ) D Cash and cash equvalents Balances wth Banks Cheques, drafts n hand Cash n hand v Others v Total Cash and cash equvalents ( v) E Short-term loans and advances Loans and advances to related partes (see nstructons) Others Total Short-term loans and advances ( + ) v Short-term loans and advances ncluded n E whch s a for the purpose of busness or professon b not for the purpose of busness or professon c F Other current assets gven to a shareholder, beng the benefcal owner of share, or to any concern or on behalf/ beneft of such shareholder as per secton 2(22)(e) of I.T. Act G Total Current assets (Av + Bv + C + Dv + E + F) Total Assets (1F + 2G) v a b c v v v v v v v v v va vb vc E 1F Av Bv C Dv E F 2G II Page 6

124 DEBITS TO PROFIT AND LOSS ACCOUNT CREDITS TO PROFIT AND LOSS ACCOUNT Proft and Loss Account for the fnancal year (fll tems 1 to 52 n a case where regular books of accounts Part A-P& L are mantaned, otherwse fll tem 53) 1 Revenue from operatons A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of products/goods Sale of servces Other operatng revenues (specfy nature and amount) a b c Total (a + b) v Interest (n case of fnance company) v Other fnancal servces (n case of fnance v company v v Total ( + + c + v + v) Av Dutes, taxes and cess receved or recevable n respect of goods and servces sold or B suppled Unon Excse dutes Servce tax VAT/ Sales tax v Any other duty, tax and cess v Total ( v) C Total Revenue from operatons (Av + Bv) 2 Other ncome Interest ncome (n case of a company, other than a fnance company) Dvdend ncome Proft on sale of fxed assets Proft on sale of nvestment beng securtes chargeable v v to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Rent v Commsson v Proft on account of currency fluctuaton x Agrcultural ncome x Any other ncome (specfy nature and amount) a b c Total (xa + xb) x Total of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Raw materal Work-n-progress Fnshed goods Total ( ) 4 Total of credts to proft and loss account (1C + 2x + 3v) 4 5 Openng Stock Raw materal Work-n-progress Fnshed goods v Total ( ) 6 Purchases (net of refunds and duty or tax, f any) 6 7 Dutes and taxes, pad or payable, n respect of goods and servces purchased a b c v v v v x xa xb xc Bv 1C 2x 3v 5v Page 7

125 Custom duty Counter velng duty Specal addtonal duty v Unon excse duty v Servce tax v VAT/ Sales tax v Any other tax, pad or payable v Total ( v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores and spare parts 9 10 Power and fuel Rents Repars to buldng Repars to plant, machnery or furnture Compensaton to employees Salares and wages Bonus Rembursement of medcal expenses v Leave encashment v Leave travel benefts v Contrbuton to approved superannuaton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed gratuty fund v 7v 7v 7v v 14v 14v 14v 14v x Contrbuton to any other fund 14x x Any other beneft to employees n respect of whch an 14x expendture has been ncurred Total compensaton to employees ( v + 14v + 14v + 14v + 14v + x 14x + 14x) Whether any compensaton, ncluded n 14x, pad to x non-resdent xa Yes / No If Yes, amount pad to non-resdents xb 15 Insurance Medcal Insurance 15 Lfe Insurance 15 Keyman s Insurance 15 Other Insurance ncludng factory, offce, car, goods, v etc. 15v v Total expendture on nsurance ( v) 16 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 23 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 7v 14x 15v Page 8

126 PROVISIONS FOR TAX AND APPROPRIATION S 24 Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 25 Hotel, boardng and Lodgng Travelng expenses other than on foregn travelng Foregn travelng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty 36 Servce tax VAT/ Sales tax v Cess v Any other rate, tax, duty or cess ncl. STT and CTT v v Total rates and taxes pad or payable ( v + 36v) 37 Audt fee Other expenses (specfy nature and amount) Total ( + ) 38 Bad debts wrtten off (specfy PAN of the person, f t s avalable, for whom Bad Debt for amount of Rs lakh or more s clamed and amount) Others (more than Rs. 1 lakh) where v PAN s not avalable v Others (amounts less than Rs. 1 lakh) v 39v v Total Bad Debt ( v + 39v) 40 Provson for bad and doubtful debts Other provsons 41 Proft before nterest, deprecaton and taxes [4 (5v v + 8 to x + 15v + 16 to to v v )] 43 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 44 Deprecaton and amortzaton Proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) 50 36v 24 36v 39v Page 9

127 OTHER INFORMATION NO ACCOUNT CASE 51 Appropratons Transfer to reserves and surplus Proposed dvdend/ Interm dvdend Tax on dvdend/ Tax on dvdend for earler years v Any other appropraton v Total ( v) 52 Balance carred to balance sheet (50 51v) In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton for prevous year n respect of busness or professon a Gross recepts b Gross proft c Expenses d Net proft v 51v 53a 53b 53c 53d Part A- OI Other Informaton (optonal n a case not lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) mercantle cash 2 Is there any change n method of accountng (Tck) Yes No Effect on the proft because of devaton, f any, as per Income Computaton Dsclosure 3 Standards notfed under secton 145(2) [column 11() of Schedule ICDS] 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value added tax, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year d any other tem of ncome e captal recept, f any f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to non-fulflment of condton specfed n relevant clauses- Premum pad for nsurance aganst rsk of damage or a destructon of stocks or store [36(1)()] 6a Premum pad for nsurance on the health of employees b [36(1)(b)] 6b Any sum pad to an employee as bonus or commsson for c servces rendered, where such sum was otherwse payable 6c to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed d captal [36(1)()] 6d e Amount of dscount on a zero-coupon bond [36(1)(a)] 6e f Amount of contrbutons to a recognsed provdent fund [36(1)(v)] 6f Amount of contrbutons to an approved superannuaton g fund [36(1)(v)] 6g Amount of contrbuton to a penson scheme referred to n h secton 80CCD [36(1)(va)] 6h Amount of contrbutons to an approved gratuty fund [36(1)(v)] 6 j Amount of contrbutons to any other fund 6j Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up k under ESI Act or any other fund for the welfare of 6k employees to the extent not credted to the employees account on or before the due date [36(1)(va)] 5a 5b 5c 5d 5e 3 4d 5f Page 10

128 l Amount of bad and doubtful debts [36(1)(v)] m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] Expendture for the purposes of promotng famly o plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of p transacton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] q Any other dsallowance r Total amount dsallowable under secton 36 (total of 6a to 6q) Total number of employees employed by the company (mandatory n case company has s recognzed Provdent Fund) deployed n Inda deployed outsde Inda Total 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] 7a b Expendture of personal nature [37(1)] 7b c Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] 7c d Expendture on advertsement n any souvenr, brochure, tract, pamphlet or the lke, publshed by a poltcal party 7d [37(2B)] e Expendture by way of penalty or fne for volaton of any law for the tme beng n force 7e f Any other penalty or fne 7f g Expendture ncurred for any purpose whch s an offence or whch s prohbted by law h Expendture ncurred on corporate socal responsblty (CSR) 7h Amount of any lablty of a contngent nature 7 j Any other amount not allowable under secton 37 7j k Total amount dsallowable under secton 37 (total of 7a to 7j) 8 A. Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 Amount dsallowable under secton 40 (a)(), on a account of non-complance wth the provsons of Aa Chapter XVII-B Amount dsallowable under secton 40(a)(a) on b account of non-complance wth the provsons of Ab Chapter XVII-B Amount dsallowable under secton 40(a)() on c account of non-complance wth the provsons of Ac Chapter XVII-B d Amount of tax or rate leved or assessed on the bass of Ad profts [40(a)()] e Amount pad as wealth tax [40(a)(a)] Ae Amount pad by way of royalty, lcense fee, servce fee f etc. as per secton 40(a)(b) Amount of nterest, salary, bonus, commsson or g remuneraton pad to any partner or member [40(b)] h Any other dsallowance Total amount dsallowable under secton 40(total of Aa to Ah) Any amount dsallowed under secton 40 n any precedng prevous year but allowable B. durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A a Amounts pad to persons specfed n secton 40A(2)(b) 9a Amount pad otherwse than by account payee cheque or b account payee bank draft under secton 40A(3) 100% dsallowable c Provson for payment of gratuty [40A(7)] any sum pad by the assessee as an employer for settng up d or as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance f Total amount dsallowable under secton 40A 6l 6m 6n 6o 6p 6q Af Ag Ah 9b 9c 9d 9e 7g 6r 7k 8A 8B 9f Page 11

129 QUANTITATIVE DETAILS 10 Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng the prevous year Any sum n the nature of tax, duty, cess or fee under any a law 10a Any sum payable by way of contrbuton to any provdent b fund or superannuaton fund or gratuty fund or any other 10b fund for the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered 10c Any sum payable as nterest on any loan or borrowng d from any publc fnancal nsttuton or a State fnancal 10d corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank 10e f Any sum payable towards leave encashment 10f g Total amount allowable under secton 43B (total of 10a to 10f) Any amount debted to proft and loss account of the prevous year but dsallowable under 11 secton 43B a Any sum n the nature of tax, duty, cess or fee under any 11a law b Any sum payable by way of contrbuton to any provdent fund or superannuaton fund or gratuty fund or any other 11b fund for the welfare of employees c Any sum payable to an employee as bonus or commsson 11c for servces rendered d Any sum payable as nterest on any loan or borrowng from any publc fnancal nsttuton or a State fnancal 11d corporaton or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng 11e from any scheduled bank f Any sum payable towards leave encashment 11f g Total amount dsallowable under Secton 43B(total of 11a to 11f) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Any other tax e Total amount outstandng (total of 12a to 12d) 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA or 33AC Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss account (net) 12a 12b 12c 12d 10g 11g 12e 15 Part A QD Quanttatve detals (optonal n a case not lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern 6 Raw materals a Openng stock 6a b Purchases durng the prevous year 6b c Consumpton durng the prevous year 6c d Sales durng the prevous year 6d e Closng stock 6e f Yeld fnshed products 6f g Percentage of yeld 6g h Shortage/ excess, f any 6h Page 12

130 TOTAL INCOME 7 Fnshed products/ By-products a openng stock b purchase durng the prevous year c quantty manufactured durng the prevous year d sales durng the prevous year e closng stock f shortage/ excess, f any 7a 7b 7c 7d 7e 7f Part B - TI Computaton of total ncome 1 Income from house property (4c of Schedule-HP) (enter nl f loss) 1 2 Profts and gans from busness or professon Profts and gans from busness other than speculatve busness and specfed busness (A37 of Schedule-BP) (enter nl f loss) 2 Profts and gans from speculatve busness (B42 of Schedule- 2 BP) (enter nl f loss and take the fgure to schedule CFL) Profts and gans from specfed busness (C48 of Schedule 2 BP)(enter nl f loss and take the fgure to schedule CFL) v Total ( ) 3 Captal gans a Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) Short-term chargeable at applcable rate (7v of tem E of schedule CG) v Total Short-term (a + a + a) b Long-term Long-term 10% (7v of tem E of schedule CG) b Long-term 20% (7v of tem E of schedule CG) Total Long-term (b + b) (enter nl f loss) c Total captal gans (3av + 3b) (enter nl f loss) 4 Income from other sources from sources other than from ownng and mantanng race a horses and ncome chargeable to tax at specal rate (1 of Schedule OS) (enter nl f loss) 4a b Income chargeable to tax at specal rate (1fv of Schedule OS) 4b c from ownng and mantanng race horses (3c of Schedule OS) (enter nl f loss) 4c d Total (4a + 4b + 4c) 5 Total (1 + 2v + 3c + 4d) 5 6 Losses of current year to be set off aganst 5 (total of 2x, 3x and 4x of Schedule CYLA) 6 7 Balance after set off current year losses (5 6) (total of column 5 of schedule CYLA + 4b) 7 8 Brought forward losses to be set off aganst 7 (total of 2x, 3x and 4x of Schedule BFLA) 8 9 Gross Total ncome (7 8) (5x of Schedule BFLA + 4b) 9 10 Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA (e of Sch. 10A + e of Sch. 10AA) Deductons under Chapter VI-A a Part-B of Chapter VI-A [1 of Schedule VI-A and lmted upto (9-10)] a a a 3av b Part-C of Chapter VI-A [2 of Schedule VI-A and lmted upto (9-10-2)] c Total (12a + 12b) [lmted upto (9-10)] 13 Total ncome ( c) Income chargeable to tax at specal rates (total of () of schedule SI) Income chargeable to tax at normal rates (13-14) Net agrcultural ncome(4 of Schedule EI) Losses of current year to be carred forward (total of x of Schedule CFL) Deemed total ncome under secton 115JB (7 of Schedule MAT) 18 b b 2v 3c 4d 12a 12b 12c Page 13

131 BANK ACCOUNT TAXES PAID COMPUTATION OF TAX LIABILITY Part B - TTI Computaton of tax lablty on total ncome 1 a Tax Payable on deemed total Income under secton 115JB (8 of Schedule MAT) 1a b Surcharge on (a) above c Educaton cess, ncludng secondary and hgher educaton cess on (1a+1b) above d Total Tax Payable u/s 115JB (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on 15 of Part B-TI b Tax at specal rates (total of col. () of Schedule-SI) d Tax Payable on Total Income (2a + 2b) e Surcharge on 2d f Educaton cess, ncludng secondary and hgher educaton cess on (2d+2e) g Gross tax lablty (2d+2e+2f) 3 Gross tax payable (hgher of 1d and 2g) 3 4 Credt under secton 115JAA of tax pad n earler years (f 2g s more than 1d) ( 5 of Schedule MATC) 5 Tax payable after credt under secton 115JAA [ (3-4)] 5 6 Tax relef e a Secton 90/90A(2 of Schedule TR) b Secton 91(3 of Schedule TR) c Total (6a + 6b) 7 Net tax lablty (5 6c) (enter zero f negatve) 7 8 Interest 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 (8a+8b+8c) 9 Aggregate lablty (7 + 8d) 9 10 Taxes Pad a Advance Tax (from column 5 of 15A) b TDS (total of column 8 of 15B) c TCS (total of column 7 of 15C) d Self-Assessment Tax (from column 5 of 15A) e Total Taxes Pad (10a+10b+10c + 10d) 11 Amount payable (9-10e) (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (Refund, f any, wll be drectly credted nto the bank account) 12 2a 2b 6a 6b 8a 8b 8c 10a 10b 10c 10d 1b 1c 1d 2d 2e 2f 2g 4 6c 8d 10e 13 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. Sl. IFS Code of Name of Account Number (the number should be 9 Cash Credt/ Indcate the account n whch you prefer to get the Bank the Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] Yes No Page 14

132 TCS ON INCOME TDS ON INCOME ADVANCE/ SELF ASSESSMENT TAX 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 the 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 ncome-tax for the prevous year relevant to the assessment year I further declare that I am makng ths return n my capacty as and I am also competent to make ths return and verfy t. I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here 15 TAX PAYMENTS A B 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) NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A or Form 26QB ssued by Deductor(s)] Sl No Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) TDS of the current fn. year Amount out of (6) or (7) beng Amount out of clamed ths Year (only f (6) or (7) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch deducted b/f (1) (2) (3) (4) (5) (6) (7) (8) (9) C NOTE Please enter total of column (8) of Schedule-TDS n 10b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl Name of the Collector Unclamed TCS brought No forward (b/f) Tax Deducton and Tax Collecton Account Number of the Collector TCS of the current fn. year Amount out of (5) or (6) beng Amount out of clamed ths Year (only f (5) or (6) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch collected b/f (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) of Schedule-TCS n 10c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (PAGES S1- S19) AS APPLICABLE Page 15

133 INCOME FROM BUSINESS OR PROFESSION HOUSE PROPERTY SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule HP Detals of Income from House Property (Please refer nstructons) Address of property 1 Town/ Cty State PIN Code 1 Is the property co-owned? Yes No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (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) 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 No (f YES please enter followng detals) Assessee s percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) f Annual value of the property owned (own percentage share x 2e) g 30% of 2f 2g h Interest payable on borrowed captal 2h Total (2g + 2h) j Income from house property 2 (2e 2h) 3 Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA b Arrears of rent receved durng the year under secton 25B after deductng 30% c Total (1j + 2j + 3a + 3b) Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 45 and 53 of Part A-P&L ) 1 Net proft or loss from speculatve busness ncluded n 1 (enter ve 2a sgn n case of loss) 2a Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 2b (enter ve sgn n case of loss) 2b 3 Income/ recepts credted to proft and loss a House property 3a 2a 2e 2f 2 2j 3a 3b 3c Page S1

134 account consdered under other heads of b Captal gans 3b ncome c Other sources 3c 4 Proft or loss ncluded n 1, whch s referred to n secton 44AE/44B/44BB/44BBA/44BBB/ 44D/44DA/ Chapter-XII-G/ Frst Schedule of Income-tax Act 4 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nature and amount) c Total (c + c) 5c d Total exempt ncome (5a + 5b + 5c) 5d 6 Balance (1 2a 2b 3a - 3b 3c 4 5d) a House property Expenses debted to proft and loss account consdered under other heads of ncome b Captal gans c Other sources Expenses debted to proft and loss account whch relate to exempt ncome 9 Total (7a + 7b + 7c + 8) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act Deprecaton allowable under secton 32(1)() and 32(1)(a) (tem 6 of Schedule-DEP) 12 Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) 12 Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) 13 Amounts debted to the proft and loss account, to the extent 14 dsallowable under secton 36 (6r of PartA-OI) 14 Amounts debted to the proft and loss account, to the extent 15 dsallowable under secton 37 (7k of PartA-OI) 15 Amounts debted to the proft and loss account, to the extent 16 dsallowable under secton 40 (8A of PartA-OI) 16 Amounts debted to the proft and loss account, to the extent 17 dsallowable under secton 40A (9f of PartA-OI) 17 Any amount debted to proft and loss account of the prevous year 18 but dsallowable under secton 43B (11g of PartA-OI) Interest dsallowable under secton 23 of the Mcro, Small and Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 32AC/ 32AD/ 33AB/ 33ABA/ 35ABB/ 21 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ 80-IA Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DA Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch company s a partner) 25 Total ( ) Deducton allowable under secton 32(1)() Deducton allowable under secton 32AD Amount allowable as deducton under secton 32AC Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem x(4) of Schedule 29 ESR) (f amount deductble under secton 35 or 35CCC or 35CCD s lower than amount debted to P&L account, t wll go to tem 24) Any amount dsallowed under secton 40 n any precedng prevous 30 year but allowable durng the prevous year(8b of PartA-OI) Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng the prevous year(10g of PartA-OI) Deducton under secton 35AC c 7a 7b 7c Page S2

135 DEPRECIATIO N ON PLANT AND MACHINERY a Amount, f any, debted to proft and loss account b Amount allowable as deducton 32b c Excess amount allowable as deducton (31b 31a) 32c 33 Any other amount allowable as deducton Total ( c+33) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AE 36 Secton 44B Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v Secton 44DA 36v (tem 4 of Form 3CE) v Chapter-XII-G (tonnage) 36v (total of col. 7 of tem 10 of Form 66) x Frst Schedule of Income-tax Act x Total (36 to 36x) 36x Net proft or loss from busness or professon other than speculatve and specfed busness ( x) Net Proft or loss from busness or professon other than speculatve busness and specfed 38 busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same A38 fgure as n 36) (If loss take the fgure to 2 of tem E) B Computaton of ncome from speculatve busness 39 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Income from speculatve busness ( ) (f loss, take the fgure to 6x of schedule CFL) B v 36v 36v 36x C Computaton of ncome from specfed busness under secton 35AD 43 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 46 Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) or 35AD(1A) Income from Specfed Busness (46 45) (f loss, take the fgure to 7x of schedule CFL) C48 D Inco D Income chargeable under the head Profts and gans from busness or professon (A37+B42+C48) D char E gea Intra head set off of busness loss of current year ble Income of current year (Fll ths column Busness ncome remanng after und Busness loss set off Sl. Type of Busness ncome only f fgure s zero or postve) set off er (1) (2) (3) = (1) (2) the hea Loss to be set off (Fll ths row (A37) d only f fgure s negatve) ProIncome from speculatve fts busness (B42) and Income from specfed ganbusness (C48) s v Total loss set off ( + ) (A3 v Loss remanng after set off ( v) 7+B 41+ C47 Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton Schedule DPM ) under any other secton) 1 Block of assets Plant and machnery 2 Rate (%) Wrtten down value on the frst day of prevous year 32a () () () (v) (v) (v) (v) 45 Page S3

136 DEPRECIATION ON OTHER ASSETS 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7 8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Buldng Furnture and Intangble Shps fttngs assets 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50* ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* ( ) (enter 0 f result s negatve) () () () (v) (v) (v) Page S4

137 SUMMARY OF DEPRECIATION ON ASSETS Summary of deprecaton on assets (Other than on assets on whch full captal expendture s allowable as deducton Schedule DEP under any other secton) 1 Plant and machnery Block enttled for 15 per cent a ( Schedule DPM - 14 ) Block enttled for 30 per cent b ( Schedule DPM - 14 ) Block enttled for 40 per cent c ( Schedule DPM - 14 ) Block enttled for 50 per cent d ( Schedule DPM - 14 v) Block enttled for 60 per cent e ( Schedule DPM - 14 v) Block enttled for 80 per cent f ( Schedule DPM 14 v) Block enttled for 100 per cent g ( Schedule DPM - 14 v) h Total deprecaton on plant and machnery ( 1a + 1b + 1c + 1d+ 1e + 1f + 1g ) 2 Buldng a Block enttled for 5 per cent (Schedule DOA- 14) b Block enttled for 10 per cent (Schedule DOA- 14) c Block enttled for 100 per cent (Schedule DOA- 14) d Total deprecaton on buldng (2a+2b+2c) 3 Furnture and fttngs(schedule DOA- 14 v) 3 4 Intangble assets (Schedule DOA- 14 v) 4 5 Shps (Schedule DOA- 14 v) 5 6 Total deprecaton ( 1h+2d+3+4+5) 6 Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery a Block enttled for 15 per cent 1a (Schedule DPM - 16) b Block enttled for 30 per cent (Schedule 1b DPM 16) c Block enttled for 40 per cent(schedule 1c DPM - 16) d Block enttled for 50 per cent 1d (Schedule DPM - 16v) e Block enttled for 60 per cent 1e (Schedule DPM 16v) f Block enttled for 80 per cent (Schedule 1f DPM 16v) g Block enttled for 100 per cent 1g (Schedule DPM 16v) h Total ( 1a +1b + 1c + 1d + 1e + 1f + 1g) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 16) b Block enttled for 10 per cent (Schedule 2b DOA- 16) c Block enttled for 100 per cent 2c (Schedule DOA- 16) d Total ( 2a + 2b + 2c) 3 Furnture and fttngs ( Schedule DOA- 16v) 3 4 Intangble assets (Schedule DOA- 16v) 4 5 Shps (Schedule DOA- 16v) 5 6 Total ( 1h+2d+3+4+5) 6 1a 1b 1c 1d 1e 1f 1g 2a 2b 2c 1h 2d 1h 2d Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nature referred to n secton (1) Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) Page S5

138 Short-term Captal Gans v v v v v x x 35(1)() 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Items 4, 5 & 8 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 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 54D/ 54G/54GA (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on 3 whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (3a bv) 3c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 3d e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to 4 be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a b STCG on transactons on whch securtes transacton tax (STT) s not pad A4b For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 5 115AD a Full value of consderaton 5a 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 ( + + ) c Balance (5a bv) d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) b b b bv 5c 5d A2c Page S6

139 Long-term Captal Gans e Short-term captal gan on securtes (other than those at A3 above) by an FII (5c +5d) 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a Full value of consderaton 6a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (6a bv) 6c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such asset to be gnored (Enter postve value only) 6d e Deemed short term captal gans on deprecable assets (6 of schedule- 6e DCG) f Deducton under secton 54D/54G/54GA 6f g STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d + 6e 6f) A6g 7 Amount deemed to be short-term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? Yes No Not applcable. If yes, then provde the detals below Sl. Prevous year Secton under whch n whch asset deducton clamed n transferred that year New asset acqured/constructed Year n whch asset Amount utlsed out of acqured/constructed Captal Gans account D/54G/54GA b Amount deemed to be short-term captal gans u/s 54D/54G/54GA, other than at a Total Amount deemed to be short-term captal gans u/s 54D/54G/54GA (ax + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 8 FOR NON-RESIDENTS- STCG ncluded n A1-A7 but not chargeable to tax n Inda as per DTAA Sl. Country Artcle of Whether Tax Resdency Item No.A1 to A7 above n Amount of name, code DTAA Certfcate obtaned? whch ncluded STCG I A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7 II III Total amount of STCG not chargeable to tax n Inda as per DTAA A1e/A2c/A3e/A4a/A4b/A5e/A6g/A7 9 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6g+A7-A8) A9 B Long-term captal gan (LTCG) (Items 5, 6 & 9 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 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) 1c d Deducton under secton 54D/54EC/54G/54GA (Specfy detals n tem D below) 1d e Long-term Captal Gans on Immovable property (1c - 1d) 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) d Deducton u/s 54EC e Long term captal gans from slump sale (2c-2d) 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 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) 2c 2d a a b b b bv 3a b b b bv A5e A7 A8 B1e B2e Page S7

140 c Balance (3a bv) d Deducton under sectons 54EC (Specfy detals n tem D below) e LTCG on bonds or debenture (3c 3d) 3c 3d B3e 4 From sale of lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable 5 6 a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c d Deducton under sectons 54EC (Specfy detals n tem D below) 4d e Long-term Captal Gans on assets at B4 above (4c 4d) B4e For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 5a b Deducton under sectons 54EC (Specfy detals n tem D below) 5b c LTCG on share or debenture (5a-5b) B5c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () unts referred n sec. 115AB, () bonds or GDR as referred n sec. 115AC, (v) securtes by FII as referred to n sec. 115AD a Full value of consderaton 6a 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 (6a bv) 6c d Deducton under sectons 54EC (Specfy detals n tem D below) 6d e Long-term Captal Gans on assets at 6 above n case of NON-REESIDENT (6c 6d) B6e 7 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 secton 54D/54EC/54G/54GA (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? Yes No Not applcable. If yes, then provde the detals below Sl. New asset acqured/constructed Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA Amount utlsed Year n whch asset out of Captal acqured/constructed Gans account b Amount deemed to be long-term captal gans, other than at a 9 Total amount deemed to be long-term captal gans (X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 but not chargeable to tax n Inda as per DTAA Sl. I II Country name, code Whether Tax Resdency Artcle of DTAA 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 n Inda as per DTAA Total long term captal gan [B1e +B2e+ B3e +B4e + B5c + B6e + B7e+ B8-B9] (In case of loss take the 10 fgure to 9x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A9 + B10) (take B10 as nl, f loss) B8 B9 B10 C Page S8

141 OTHER SOURCES D Informaton about deducton clamed 1 In case of deducton u/s 54B/54D/54EC/54G/54GA gve followng detals a Secton under whch deducton clamed 1a amount of deducton Cost of new asset Date of ts acquston/constructon a dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date b Secton under whch deducton clamed 1b amount of deducton Cost of new asset Date of ts acquston/constructon b dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date c Total deducton clamed (1a + 1b) 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 Loss to be set off (Fll ths row f fgure computed s negatve) Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss set off 15% 30% applcable rate a a b b 1c Long term captal loss set off Current year s captal gans remanng after 10% 20% set off (7= ) (A3e+A4a) A5e (A1e+A2c+A4b +A6g +A7) (B4e+ + B6e) (B1e+B2e+B3e+ B5c+ B7e+B8) 15% (A3e+A4a) Short term captal 30% A5e v gan applcable (A1e+A2c+A4b+A6g rate +A7) v Long term 10% (B4e+ + B6e) captal v gan 20% (B1e+B2e+B3e+ B5c+ 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 5v of schedule BFLA, f any. Short-term captal gans taxable at the rate of 30% Enter value from tem 5v of schedule BFLA, f any. Short-term captal gans taxable at applcable rates Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 10% Enter value from tem 5v of schedule BFLA, f any. Long- term captal gans taxable at the rate of 20% Enter value from tem 5x of schedule BFLA, f any. Upto 15/6 () 16/6 to 15/9 () 16/9 to 15/12 16/12 to 15/3 () (v) 16/3 to 31/3 (v) 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 Income by way of wnnngs from lotteres, crossword puzzles etc. 1d 1d v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Income by way of wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc (u/s 115BB) Any other ncome chargeable to tax at the rate specfed under chapter XII/XII-A FOR NON-RESIDENTS- Income chargeable to be taxed under DTAA 1d 1dv 1e 1f 1f Page S9

142 BROUGHT FORWARD LOSS ADJUSTMENT CURRENT YEAR LOSS ADJUSTMENT Sl. Country Artcle of name, code DTAA I Rate of tax Whether TRC under DTAA obtaned? Correspondng secton of the Amount of Act whch prescrbes rate ncome II III Total amount of ncome chargeable to tax under DTAA 1f 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 4 of schedule CYLA) Income from other sources (other than from ownng and mantanng race horses) (1fv + 1) (enter1 as 2 nl, f negatve) 3 Income from the actvty of ownng 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 10x of Schedule CFL) 4 Income under the head Income from other sources (2 + 3c) (take 3c as nl f negatve) 4 h 1 2 3c Schedule CYLA Detals of Income after Set off of current year losses Sl.No Head/ Source of Income Income of current year (Fll ths column only f ncome s zero or postve) House property loss of the current year set off Loss to be set off (4c of Schedule HP) House property (4c of Schedule HP) Busness (excludng speculaton ncome and ncome from specfed busness) Busness Loss (other than speculaton or specfed busness loss) of the current year set off Other sources loss (other than loss from race horses and amount chargeable to specal rate of tax) of the current year set off Current year s Income remanng after set off = (A37 of Schedule BP) v Speculaton ncome (3 of tem E of Sch. BP) v Specfed busness ncome u/s 35AD (3 of tem E of Sch. BP) v Short-term captal gan (7 of tem E of schedule 15% CG) v Short-term captal gan (7 of tem E of schedule 30% CG) v Short-term captal gan taxable at (7v of tem E of schedule applcable rates CG) x Long term captal gan (7v of tem E of schedule 10% CG) x Long term captal gan (7v of tem E of schedule 20% CG) x Other sources (excludng proft from ownng race horses and amount (1 of schedule OS) chargeable to specal rate of tax) x Proft from ownng and mantanng race horses (3c of schedule OS) x Total loss set off (+ + v+ v+ v+ v+ v+ x+ x+ x+ x) xv Loss remanng after set-off ( - x) (2v of tem E of Schedule BP) (1 of Schedule-OS) Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years Sl. Head/ Source of Income Income after set off, f Brought forward loss set Brought forward No. any, of current year s off deprecaton set losses as per 5 of off Schedule CYLA) House property (5 of schedule CYLA) (B/f house property loss) Busness (excludng speculaton ncome and ncome from specfed busness) Speculaton Income Brought forward allowance under secton 35(4) set off Current year s ncome remanng after set off (5 of schedule CYLA) (5v of schedule CYLA) (B/f busness loss, other than speculaton or specfed busness loss) (B/f normal busness or speculaton loss) Page S10

143 CARRY FORWARD OF LOSS v Specfed Busness Income (5v of schedule CYLA) (B/f normal busness or specfed busness loss) v Short-term captal gan (B/f short-term captal (5v of schedule CYLA) 15% loss) v Short-term captal gan (B/f short-term captal (5v of schedule CYLA) 30% loss) v Short-term captal gan taxable at (B/f short-term captal (5v of schedule CYLA) applcable rates loss) Long-term captal gan (B/f short-term or longterm captal loss) v (5x of schedule CYLA) 10% x Long term captal gan (B/f short-term or longterm captal loss) (5x of schedule CYLA) 20% x Other sources ncome (excludng proft from ownng and mantanng race horses and amount chargeable (5x of schedule CYLA) to specal rate of tax) x Proft from ownng and mantanng race horses (5x of schedule CYLA) (B/f loss from horse races) x Total of brought forward loss set off x Current year s ncome remanng after set off Total ( v5+v5 + v5 + v5 + v5 + x5 + x5 + x5) Schedule CFL Detals of Losses to be carred forward to future years Sl. Assessment Year Date of House property No. Flng loss (DD/MM/ YYYY) Loss from busness other than loss from speculatve busness and specfed busness Loss from speculatve busness Loss from specfed busness Short-term captal loss Long-term Captal loss Loss from ownng and mantanng race horses v v v v v x x x x Total of earler year losses b/f Adjustment of above losses n Schedule BFLA (Current year losses) Total loss Carred forward to future years (2 of schedule BFLA) (2xv of schedule CYLA) (2 of schedule BFLA) (3xv of schedule CYLA) (2 of schedule BFLA) (B42 of schedule BP, f ve) (2v of schedule BFLA) (C48 of schedule BP, f ve) (2v+3v+4v) of tem E of schedule CG) ((5v+6v) of tem E of schedule CG) (2x of schedule BFLA) (3c of schedule OS, f ve) Schedule UD Unabsorbed deprecaton and allowance under secton 35(4) Sl No Assessment Year Deprecaton Allowance under secton 35(4) Amount of brought forward unabsorbed deprecaton Amount of deprecaton set-off aganst the current year ncome Balance carred forward to the next year Amount of brought forward unabsorbed allowance Amount of allowance set-off aganst the current year ncome Balance Carred forward to the next year (1) (2) (3) (4) (5) (6) (7) (8) Current Assessment Year v Total (3x of BFLA) (4x of BFLA) Page S11

144 DETAILS OF DONATIONS DEDUCTION U/S 10AA DEDUCTION U/S 10A Schedule ICDS Effect of Income Computaton Dsclosure Standards on proft Sl. No. ICDS Amount () () () I Accountng Polces II Valuaton of Inventores III Constructon Contracts IV Revenue Recognton V Tangble Fxed Assets VI Changes n Foregn Exchange Rates VII Government Grants VIII Securtes IX Borrowng Costs X Provsons, Contngent Labltes and Contngent Assets 11. Total Net effect (I+II+III+IV+V+VI+VII+VIII+IX+X) Schedule 10A Deducton under secton 10A Deducton n respect of unts located n Specal Economc Zone Sl Undertakng a Undertakng No.1 b Undertakng No.2 Assessment year n whch unt begns to manufacture/produce Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Total deducton under secton 10A (a+b) c Schedule 10AA Deducton under secton 10AA Deductons n respect of unts located n Specal Economc Zone Sl Assessment year n whch unt begns to Undertakng manufacture/produce/provde servces a Undertakng No.1 b Undertakng No.2 c Total deducton under secton 10AA (a + b) Sl a b Amount of deducton (tem 17 of Annexure A of Form 56F for Undertakng 1) (tem 17 of Annexure A of Form 56F for Undertakng 2) c Schedule 80G Detals of donatons enttled for deducton under secton 80G A Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton B v Total Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton v Total C Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Page S12

145 DEDUCTION U/S 80-IA v Total D Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton v Total E Total donatons (Av + Bv + Cv + Dv) Schedule 80-IA a b c d e Deductons under secton 80-IA Deducton n respect of profts of an enterprse referred to n secton 80-IA(4)() [Infrastructure faclty] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Telecommuncaton servces] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)() [Industral park and SEZs] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Power] Deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Revval of power generatng plant] and deducton n respect of profts of an undertakng referred to n secton 80-IA(4)(v) [Crosscountry natural gas dstrbuton network] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f Total deductons under secton 80-IA (a1 + a2 + b1 + b2 + c1 + c2+ d1 + d2+ e1 + e2) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) (tem 30 of Form 10CCB of the undertakng) f Schedule 80-IB a b c d e f g h Deductons under secton 80-IB Deducton n respect of ndustral undertakng located n Jammu & Kashmr [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward states specfed n Eghth Schedule [Secton 80-IB(4)] Deducton n respect of ndustral undertakng located n ndustrally backward dstrcts [Secton 80-IB(5)] Deducton n the case of multplex theatre [Secton 80- IB(7A)] Deducton n the case of conventon centre [Secton 80- IB(7B)] Deducton n the case of company carryng on scentfc research [Secton 80-IB(8A)] Deducton n the case of undertakng whch begns commercal producton or refnng of mneral ol [Secton 80-IB(9)] Deducton n the case of an undertakng developng and buldng housng projects [Secton 80-IB(10)] a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c2 Undertakng no. 2 d1 Undertakng no. 1 d2 Undertakng no. 2 e1 Undertakng no. 1 e2 Undertakng no. 2 f1 Undertakng no. 1 f2 Undertakng no. 2 g1 Undertakng no. 1 g2 Undertakng no. 2 h1 Undertakng no. 1 h2 Undertakng no. 2 Deducton n the case of an undertakng operatng a cold 1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBA of the undertakng) (10(v) of Form 10CCBB of the undertakng) (10(v) of Form 10CCBB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Page S13

146 TOTAL DEDUCTIONS DEDUCTION U/S 80-IC j k chan faclty [Secton 80-IB(11)] Deducton n the case of an undertakng engaged n processng, preservaton and packagng of fruts, vegetables, meat, meat products, poultry, marne or dary products [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n ntegrated busness of handlng, storage and transportaton of food grans [Secton 80-IB(11A)] Deducton n the case of an undertakng engaged n l operatng and mantanng a rural hosptal [Secton 80- IB(11B)] Deducton n the case of an undertakng engaged n m operatng and mantanng a hosptal n any area, other than excluded area [Secton 80-IB(11C) n Total deducton under secton 80-IB (Total of a1 to m2) 2 Undertakng no. 2 j1 Undertakng no. 1 j2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) k1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) k2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) l1 Undertakng no. 1 (11(v) of From 10CCBC) l2 Undertakng no. 2 (11(v) of From 10CCBC) m1 Undertakng no. 1 (11(d) of From 10CCBD) m2 Undertakng no. 2 (11(d) of From 10CCBD) n Schedule 80-IC or 80-IE Deductons under secton 80-IC or 80-IE a Deducton n respect of undertakng located n Skkm b Deducton n respect of undertakng located n Hmachal Pradesh c Deducton n respect of undertakng located n Uttaranchal d Deducton n respect of undertakng located n North-East da Assam db Arunachal Pradesh dc Manpur dd Mzoram de Meghalaya df Nagaland dg Trpura da1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) da2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) db1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) db2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dc1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dc2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dd1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dd2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) de1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) de2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) df1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) df2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dg1 Undertakng no. 1 (30 of Form 10CCB of the undertakng) dg2 Undertakng no. 2 (30 of Form 10CCB of the undertakng) dh Total deducton for undertakngs located n North-east (total of da1 to dg2) e Total deducton under secton 80-IC or 80-IE (a + d + c + dh) a1 Undertakng no. 1 a2 Undertakng no. 2 b1 Undertakng no. 1 b2 Undertakng no. 2 c1 Undertakng no. 1 c1 Undertakng no. 2 dh e (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) (30 of Form 10CCB of the undertakng) Schedule VI-A Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80G b 80GGB c 80GGA d 80GGC Total Deducton under Part B (a + b + c +d) 1 2 Part C- Deducton n respect of certan ncomes e 80-IA (f of Schedule 80-IA) f 80-IAB g 80-IB (n of Schedule 80-IB) h 80-IC/ 80-IE (e of Schedule 80-IC/ 80-IE) 80-ID (tem 10(e) of Form 10CCBBA) j 80JJA k 80JJAA (10 of Annexure to Form 10DA) l 80LA (9 of Annexure to Form 10CCF) Page S14

147 PASS THROUGH INCOME EXEMPT INCOME SPECIAL RATE Total Deducton under Part C (total of e to l) 2 3 Total deductons under Chapter VI-A (1 + 2) 3 Schedule SI Income chargeable to tax at specal rates [Please see nstructon Number-7() for secton and rate of tax] Sl Secton/Descrpton Specal rate Income No (%) () 1 111A (STCG on shares/equty orented MF on whch STT pad) 15 (5v of schedule BFLA) 2 115AD (STCG for FIIs on securtes where STT not pad) 30 (5v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) 10 (part of 5v of schedule BFLA) 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) 10 (part of 5v of schedule BFLA) 5 115AB (LTCG for non-resdent on unts referred n secton115ab) 10 (part of 5v of schedule BFLA) 6 115AC (LTCG for non-resdent on bonds/gdr) 10 (part of 5v of schedule BFLA) 7 115AD (LTCG for FII on securtes) 10 (part of 5v of schedule BFLA) (LTCG on others) 20 (5x of schedule BFLA) 9 115AC (Income of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) BBD (Dvdend receved from specfed foregn company) 15 (part of 1f of schedule OS) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) 30 (part of 1f of schedule OS) A(b) (Income of a foregn company from Royalty) 25 (part of 1f of schedule OS) 14 Chargeable under DTAA rate (part of 1f of schedule OS) 15 Total 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 Gross Agrcultural recepts (other than ncome to be excluded under rule 4 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any Page S15

148 MINIMUM ALTERNATE TAX Schedule MAT Computaton of Mnmum Alternate Tax payable under secton 115JB Whether the Proft and Loss Account s prepared n accordance wth the provsons of Parts II of Schedule III to the 1 Companes Act, 2013 (If yes, wrte Y, f no wrte N ) If 1 s no, whether proft and loss account s prepared n accordance wth the provsons of the Act governng such company 2 (If yes, wrte Y, f no wrte N ) Whether, for the Proft and Loss Account referred to n tem 1 above, the same accountng polces, accountng standards 3 and same method and rates for calculatng deprecaton have been followed as have been adopted for preparng accounts lad before the company at ts annual general body meetng? (If yes, wrte Y, f no wrte N ) 4 Proft after tax as shown n the Proft and Loss Account (enter tem 48 of Part A-P&L) 4 5 Addtons (f debted n proft and loss account) Income-tax pad or payable or ts provson a ncludng the amount of deferred tax and the provson thereof b Reserve (except reserve under secton 33AC) c Provsons for unascertaned lablty d Provsons for losses of subsdary companes e Dvdend pad or proposed 5e f Expendture related to exempt ncome under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt 5f under secton 10(38)] g Expendture related to share n ncome of AOP/ BOI on whch no ncome-tax s payable as per secton 86 5g h Expendture n case of foregn company referred to n 5h clause (fb) of explanaton 1 to secton 115JB Notonal loss on transfer of certan captal assets or unts referred to n clause (fc) of explanaton 1 to 5 secton 115JB j Deprecaton attrbutable to revaluaton of assets 5j k Gan on transfer of unts referred to n clause (k) of explanaton 1 to secton 115JB 5k l Others (ncludng resdual unadjusted tems and provson for dmnuton n the value of any asset) 5l m Total addtons (5a+5b+5c+5d+5e+5f+5g+5h+5+5j+5k+5l) 6 Deductons a Amount wthdrawn from reserve or provsons f 6a credted to Proft and Loss account b Income exempt under sectons 10, 11 or 12 [exempt 6b ncome excludes ncome exempt under secton 10(38)] c Amount wthdrawn from revaluaton reserve and 6c credted to proft and loss account to the extent t does not exceed the amount of deprecaton attrbutable to revaluaton of asset d Share n ncome of AOP/ BOI on whch no ncometax 6d s payable as per secton 86 credted to Proft and Loss account e Income n case of foregn company referred to n 6e clause (d) of explanaton 1 to secton 115JB f Notonal gan on transfer of certan captal assets or 6f unts referred to n clause (e) of explanaton 1 to secton 115JB g Loss on transfer of unts referred to n clause (f) of 6g explanaton 1 to secton 115JB h Loss brought forward or unabsorbed deprecaton 6h whchever s less Proft of sck ndustral company tll net worth s equal to or exceeds accumulated losses 6 j Others (ncludng resdual unadjusted tems and the 6j amount of deferred tax credted to P&L A/c) k Total deductons (6a+6b+6c+6d+6e+6f+6g+6h+6+6j) 7 Book proft under secton 115JB (4+ 5m 6k) 7 5a 5b 5c 5d 5m 6k 8 Tax payable under secton 115JB [18.5% of (7)] 8 Page S16

149 TAX ON BUY BACK OF SHARES DIVIDEND DISTRIBUTION TAX MAT CREDIT Schedule MATC Computaton of tax credt under secton 115JAA 1 Tax under secton 115JB n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (2g of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse enter 0] 3 4 Utlsaton of MAT credt Avalable [Sum of MAT credt utlsed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of MAT Credt Brought Forward ] S.No Assessment Year MAT Credt (A) v v v v v x x x (enter 1-2, f 1>2 else enter 0) x Total Gross (B1) Set-off n earler years (B2) Balance Brought forward (B3)=(B2)-(B1) MAT Credt Utlsed durng the Current Year (C) 5 Amount of tax credt under secton 115JAA utlsed durng the year [enter 4(C)x] 5 6 Amount of MAT lablty avalable for credt n subsequent assessment years [enter 4(D)x] 6 Balance MAT Credt Carred Forward (D)= (B3) (C) Schedule- DDT Detals of tax on dstrbuted profts of domestc companes and ts payment Sl Descrpton Detals of 1 st Detals of 2 nd Detals of 3 rd dvdend dvdend dvdend () () () (v) (v) 1 Date of declaraton or dstrbuton or payment, whchever s earlest, of dvdend by domestc company (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) 2 Rate of dvdend, declared, dstrbuted or pad 3 Amount of dvdend declared, dstrbuted or pad 4 Amount of reducton as per secton 115-O(1A) 5 Tax payable on dvdend declared, dstrbuted or pad Addtonal a payable under secton 115-O on (3-4) b Surcharge on a c Educaton cess on (a+b) d Total tax payable (a+b+c) 6 Interest payable under secton 115P 7 Addtonal ncome-tax and nterest payable (5d + 6) 8 Tax and nterest pad 9 Net payable/refundable (7-8) 10 Date(s) of depost of dvdend dstrbuton tax 11 Name of Bank and Branch 12 BSR Code 13 Seral number of challan 14 Amount deposted Date 1 Date 2 Date 1 Date 2 Date 1 Date 2 (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ YYYY) YYYY) YYYY) YYYY) YYYY) YYYY) Schedule- BBS Detals of tax on dstrbuted ncome of a domestc company on buy back of shares, not lsted on stock exchange Sl Descrpton Detals of 1 st buyback back back Detals of 2 nd buy- Detals of 3 rd buy- () () () (v) (v) 1 Date of payments of any consderaton to the shareholder on buy back of share (DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) 2 Amount of consderaton pad by the company on buyback of shares 3 Amount receved by the company for ssue of such shares Page S17

150 TAX RELIEF FOR TAX PAID OUTSIDE INDIA INCOME FROM OUTSIDE INDIA AND TAX RELIEF 4 Dstrbuted Income of the company (2 3) 5 Tax payable on dstrbuted ncome Addtonal a payable under secton 115QA on 4 b Surcharge on a c Educaton cess on (a+b) d Total tax payable (a+b+c) 6 Interest payable under secton 115QB 7 Addtonal ncome-tax and nterest payable (5d + 6) 8 Tax and nterest pad 9 Net payable/refundable (7-8) 10 Date(s) of depost of tax on dstrbuton ncome 11 Name of Bank and Branch 12 BSR Code 13 Seral number of challan 14 Amount deposted Date 1 Date 2 Date 1 Date 2 Date 1 Date 2 (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ (DD/MM/ YYYY) YYYY) YYYY) YYYY) YYYY) YYYY) Schedule FSI Sl. Country Code Taxpayer Identfcaton Number 1 House Property 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 Busness or Professon Captal Gans v Other sources Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Total 2 House Property Busness or Professon Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Identfcaton (total of (c) of Schedule FSI n Number respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (a) (b) (c) (d) (e) Total Total Tax relef avalable n respect of country where DTAA s applcable (secton 90/90A) (Part of 2 total of 1(d)) Total Tax relef avalable n respect of country where DTAA s not applcable (secton 91) (Part of total 3 of 1(d)) Whether any tax pad outsde Inda, on whch tax relef was allowed n Inda, has been 4 refunded/credted by the foregn tax authorty durng the year? If yes, provde the detals below a Amount of tax refunded NOTE Please refer to the nstructons for fllng out ths schedule. b Assessment year n whch tax relef allowed n Inda Yes/No Page S18

151 DETAILS OF FOREIGN ASSETS 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- Owner/ Benefcal owner/ Benefcary Account Number 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 Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () B Detals of Fnancal Interest n any Entty held (ncludng any benefcal nterest) at any tme durng the prevous year Country Nature of Name and Date Nature of Name and entty Address of snce held Income Amount code the Entty Sl No Nature of Interest- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Income accrued from such Interest Income taxable and offered n ths return 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 Address of Date of Nature of Income taxable and offered n ths return No the Property acquston Income Country Name and code Ownershp- Drect/ Benefcal owner/ Benefcary Total Investment (at cost) (n rupees) Income derved from the property Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) () () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the prevous year Sl No Nature of Asset Date of acquston Nature of Income Income taxable and offered n ths return Amount Country Name and code Ownershp- Drect/ Benefcal owner/ Benefcary (1) (2) (3) (4) () () Total Investment (at cost) (n rupees) Income derved from the asset Schedule where offered Item number of schedule (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 Account Number If (7) s yes, Income offered n ths return Name of the Insttuton n whch the account s held Address of the Insttuton Name of the account holder Peak Balance/ Investment durng the year (n rupees) Whether ncome accrued s taxable n your hands? If (7) s yes, Income accrued n the account Amount Schedule Item number of where offered 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 return No Name and address of address of address of address of snce ncome derved Income Amount Schedule Item number code the trust trustees Settlor Benefcares poston s taxable n derved from where offered of schedule held your hands? the trust (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 Item number where offered of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) () () NOTE Please refer to nstructons for fllng out ths schedule Page S19

152 FILING STATUS PERSONAL INFORMATION FORM ITR-7 INDIAN INCOME TAX RETURN [For persons ncludng companes requred to furnsh return under sectons 139(4A) or 139(4B) or 139(4C) or 139(4D) or 139(4E) or 139(4F)] (Please see rule 12 of the Income-tax Rules,1962) (Also see attached nstructons for gudance) Assessment Year Part A-GEN Name (as mentoned n deed of creaton/ establshng/ ncorporaton/ formaton) PAN Flat/Door/Block No Name Of Premses/Buldng/Vllage Date of formaton/ncorporaton (DD/MM/YYYY) / / Road/Street/Post Offce Area/Localty Status (see nstructons para 11b) Town/Cty/Dstrct State Pn code Offce Phone Number wth STD code/moble No. 1 Fax Number/Moble No. 2 Income Tax Ward/Crcle Emal Address 1 Emal Address 2 Detals of the projects/nsttutons run by you Sl. Name of the project/nsttuton Nature of actvty (see nstructon para 11d) Classfcaton (see nstructons para 11d) Approval/ Notfcaton/ Regstraton No. Approvng/ regsterng Authorty Secton under whch exempton clamed, f any (see nstructon para 11e) (a) Return fled[please see nstructon no.-6] 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 In response to notce u/s 139(9)- defectve, 142(1), 148, 153A, 153C (b) Return furnshed under secton 139(4A) 139(4B) 139(4C) 139(4D) 139(4E) (c) (d) If revsed/n response to defectve/modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of advance prcng agreement (e) Resdental status? (Tck) Resdent Non-resdent (f) (g) / / / / Whether any ncome ncluded n total ncome for whch for whch clam under secton 90/90A/91 has been made? Yes No [applcable n the case of resdent] [f yes, ensure to fll Schedule FSI and Schedule TR] Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? Yes No (h) In the case of non-resdent, s there a permanent establshment (PE) n Inda (Tck) Yes No () For Offce Use Only Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) Permanent Account Number (PAN) of the representatve For Offce Use Only Recept No. Date Seal and Sgnature of recevng offcal Page 1

153 OTHER DETAILS A Where, n any of the projects/nsttutons run by you, one of the chartable purposes s advancement of any other object of general publc utlty then,- a b whether there s any actvty n the nature of trade, commerce or busness referred to n provso to secton 2(15)? Yes No If yes, then percentage of recept from such actvty vs-à-vs total recepts % whether there s any actvty of renderng any servce n relaton to any trade, commerce or busness for any consderaton as referred to n provso to secton 2(15)? Yes No If yes, then percentage of recept from such actvty vs-à-vs total recepts % If a or b s YES, the aggregate annual recepts from such actvtes n respect of that nsttuton Sl. Name of the project/insttuton Amount of aggregate annual recepts from such actvtes a b B Unversty/ Educatonal Insttuton/ Hosptal/ Other Insttuton elgble for exempton u/s 10(23C)(ab), 10(23C)(ac) 10(23C)(ad) and 10(23C)(ae) Tck, f applcable Secton Name of the Unversty/ Educatonal Insttuton/ Hosptal/ Other Insttuton Aggregate annual recepts (Rs.) 10(23C)(ab) 10(23C)(ac) 10(23C)(ad) 10(23C)(ae) C Whether Regstered u/s 12A/12AA? Yes No If yes, then enter Regstraton No. Commssoner/Drector of Income-tax (Exemptons) who granted regstraton Date of Regstraton (DD/MM/YYYY) / / v Whether actvty s,- chartable, relgous or both? Please tck as applcable. D Whether approval obtaned under secton 35? Yes No If yes, then enter the relevant clause of secton 35 and Regstraton No. Date of Approval (DD/MM/YYYY) / / v Approvng Authorty v Whether research s,- Scentfc, Socal Scence or Statstcal? Please tck as applcable v In case of busness actvty n research, whether t s Incdental or Not ncdental? Please tck as applcable Whether approval obtaned u/s 80G? Yes No E F If yes, then enter Approval No. Date of Approval (DD/MM/YYYY) / / Is there any change n the objects/actvtes durng the Year on the bass of whch approval/regstraton was granted? Yes No If yes, date of such change (DD/MM/YYYY) / / G Whether a poltcal party as per secton 13A? (f yes, please fll schedule LA) Yes No If yes, then whether regstered? Yes No Page 2

154 STATEMENT OF INCOME AUDI T INFORMATION If yes, then enter regstraton number under secton 29A of the Representaton of People Act, 1951 H Whether an Electoral Trust? (f yes, please fll schedule ET) Yes No If yes, then enter approval number? Date of Approval (DD/MM/YYYY) / / I Whether regstered under Foregn Contrbuton (Regulaton) Act, 2010 (FCRA)? Yes No If yes, then enter Regstraton No. Date of Regstraton (DD/MM/YYYY) / / v a Total amount of foregn contrbuton receved durng the year, f any Rs. b Specfy the purpose for whch the above contrbuton s receved J Whether lable to tax at maxmum margnal rate under secton 164? Yes No K Is ths your frst return? Yes No Are you lable for audt? (Tck) Yes No, If yes, furnsh followng nformaton- Secton under whch you are lable for audt (specfy secton). Please menton date of audt report. (DD/MM/YY) (see Instructon 6()) 12A a Name of the audtor sgnng the tax audt report b Membershp No. of the audtor c Name of the audtor (propretorshp/ frm) d Permanent Account Number (PAN) of the propretorshp/ frm e Date of audt report f Date of furnshng of the audt report / / (DD/MM/YYYY). Part B TI STATEMENT OF INCOME FOR THE PERIOD ENDED ON 31 ST MARCH Income from house property [3c of Schedule HP] (enter nl f loss) 1 2 Profts and gans of busness or professon [as per tem No. E 35 of schedule BP] 2 3 Income under the head Captal Gans a Short term (A5 of schedule CG) 3a b Long term (B3 of schedule CG) (enter nl f loss ) 3b c Total captal gans (3a + 3b) (enter nl f loss ) 4 Income from other sources [as per tem No. 4 of Schedule OS] 4 5 Voluntary Contrbutons (C of schedule VC) 5 6 Gross ncome [ c ] 6 If regstered under secton 12A/12AA, fll out tems 7 to 13 7 Aggregate of ncome referred to n secton u/s 11 and 12 derved durng the prevous year to the extent that s ncluded n 6 above 7 8 Voluntary contrbuton formng part of corpus as per secton 11(1)(d) [(A + B) of schedule VC] 8 9 Applcaton of ncome for chartable or relgous purposes Amount appled to chartable or relgous purposes n Inda durng the prevous year - Revenue Account 9 Amount appled to chartable or relgous purposes n Inda durng the prevous year Captal Account [Excludng applcaton from Borrowed Funds and amount exempt u/s 9 11(1A)] Amount appled to chartable or relgous purposes n Inda durng the prevous year - Captal Account (Repayment of Loan) 9 v Amount deemed to have been appled to chartable or relgous purposes n Inda durng the prevous year as per clause (2) of Explanaton to secton 11(1) 9v a If (v) above applcable, whether opton Form No. 9A has been furnshed to the Assessng Offcer Yes No 3c Page 3

155 TAX LIABILITY b If yes, date of furnshng Form No. 9A (DD/MM/YYYY) / / v Amount accumulated or set apart for applcaton to chartable or relgous purposes to the extent t does not exceed 15 per cent of ncome derved from property held n trust/ 9v nsttuton under secton 11(1)(a)/11(1)(b) [restrcted to the maxmum of 15% of (7-8) above] v Amount n addton to amount referred to n (v) above, accumulated or set apart for specfed purposes f all the condtons n secton 11(2) and 11(5) are fulflled (fll out schedule I) v v Amount elgble for exempton under secton 11(1)(c) 9v a Approval number and date of approval by the Board v Total [ v+9v+9v+9v] 10 Addtons Income chargeable under secton 11(1B) 10 Income chargeable under secton 11(3) 10 Income n respect of whch exempton under secton 11 s not avalable by vrtue of provsons of secton 13 Beng anonymous donaton at D of schedule VC to the extent appled for chartable a purpose b Other than (a) above v Income chargeable under secton 12(2) 10v v Total [ a+10b+10v] 10v 11 Income chargeable u/s 11(4) [as per tem no. E36 of Schedule BP] Total (6 8-9v + 10v + 11) 12 Amount of ncome exempt under any clause of secton 10, to the extent that s ncluded n above 13 Amount elgble for exempton under secton 10(21), 10(22B), 10(23A), 10(23B), 10(23C)(v), 14 10(23C)(v), 10(23C)(v), 10(23C)(va) 14 Amount elgble for exempton under secton 10(23C)(ab), 10(23C)(ac), 10(23C)(ad), 15 10(23C)(ae), 10(24), 10(46), 10(47) Amount elgble for exempton under any clause, other than those at 14 and 15, of secton Income chargeable under secton 11(3) read wth secton 10(21) 17 Income clamed/ exempt under secton 13A or 13B n case of a Poltcal Party or Electoral Trust 18 (fll Schedule LA or ET) Income chargeable to tax (6 8-9v + 10v ) Losses of current year to be set off aganst 19 (total of 2x, 3x and 4x of Schedule CYLA) Gross Total Income (19-20) Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA Deductons under chapter VIA (lmted to 21-22) Total Income [ ] Income whch s ncluded n 25 and chargeable to tax at specal rates (total of () of schedule SI) Net Agrcultural ncome for rate purpose Aggregate Income ( ) [applcable f (25-26) exceeds maxmum amount not chargeable to tax] Anonymous donatons, ncluded n 28, to be taxed under secton 30% (D of schedule VC) 30 Income chargeable at maxmum margnal rates 30 9v 10a 10b 29 Part B - TTI Computaton of tax lablty on total ncome 1a Tax Payable on deemed total Income under secton 115JB or 115JC as applcable (7 of 1 Schedule MAT/ 4 of Schedule AMT) 1b Surcharge on (a) above 1c Educaton Cess on (1a+1b) above 1d Total Tax Payable u/s 115JB or 115JC as applcable (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on ( ) of Part B-TI b Tax at specal rates (total of () of Schedule-SI) Tax on anonymous donaton u/s on 29 of Part c B-TI 2a 2b 2c 1a 1b 1c 1d Page 4

156 BANK ACCOUNT TAXES PAID d Tax at maxmum margnal rate on 30 of Part B-TI e Rebate on agrcultural ncome [applcable f (25-26) of Part B-TI exceeds maxmum amount not chargeable to tax] f Tax Payable on Total Income (2a + 2b+2c+2d 2e) 3 Surcharge on 2f 3 4 Educaton cess, ncludng secondary and hgher educaton cess on (2f+3) 4 5 Gross tax lablty (2f+3+4) 5 6 Gross tax payable (hgher of 5 and 1d) 6 7 Credt under secton 115JAA/115JD of tax pad n earler years (f 5 s more than 1d) (5 of Schedule MATC/AMTC) 8 Tax payable after credt under secton 115JAA/115JD [ (6 7)] 8 9 Tax relef a Secton 90/90A (2 of Schedule TR) b Secton 91 (3 of Schedule TR) c Total (9a + 9b) 10 Net tax lablty (8 9c) Interest payable a For default n furnshng the return (secton 234A) 9a 9b 11a b For default n payment of advance tax (secton 234B) 11b c For deferment of advance tax (secton 234C) d Total Interest Payable (11a+11b+11c) 12 Aggregate lablty ( d) Taxes Pad a Advance Tax (from column 5 of 18A) b TDS (total of column 8 of 18B) c TCS (total of column 7 of 18C) d Self-Assessment Tax (from column 5 of 18A) e Total Taxes Pad (13a+13b+13c + 13d) 14 Amount payable (Enter f 12 s greater than 13e, else enter 0) Refund(If 13e s greater than 12) (refund, f any, wll be drectly credted nto the bank account) 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. Sl. IFS Code of Name of Account Number (the number should be 9 the Bank the Bank dgts or more as per CBS system of the bank ) 11c 13a 13b 13c 13d 2d 2e Savngs/ Current/ Cash Credt 2f 7 9c 11d 13e Indcate the account n whch you prefer to get your refund credted, f any (tck one account ) 17 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 the schedules, statements, etc. accompanyng t 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 ncome-tax for the prevous year relevant to the assessment year I further declare that I am makng ths return n my capacty as and I am also competent to make ths return and verfy t. I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here Page 5

157 TCS ON INCOME TDS ON INCOME ADVANCE/ SELF ASSESSMENT TAX 18 TAX PAYMENTS A B Detals of payments of Advance Tax and Self-Assessment Tax Sl BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) No (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 13a & 13d 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] Sl No Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) TDS of the current fn. year Amount out of (6) or (7) beng Amount out of clamed ths Year (only f (6) or (7) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch deducted b/f (1) (2) (3) (4) (5) (6) (7) (8) (9) C NOTE Please enter total of column (8) of Schedule-TDS n 13b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl Name of the Collector Unclamed TCS brought No forward (b/f) Tax Deducton and Tax Collecton Account Number of the Collector TCS of the current fn. year Amount out of (5) or (6) beng Amount out of clamed ths Year (only f (5) or (6) beng correspondng ncome s beng carred offered for tax ths year) forward Fn. Year n Amount whch collected b/f (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) of Schedule-TCS n 13c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETURN FORM (S1 to S12) AS APPLICABLE Page 6

158 DETAILS OF INVESTMENT OF FUNDS SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule I Detals of amounts accumulated / set apart wthn the meanng of secton 11(2) Year of accumulaton (F.Yr.) Amount accumulated n the year of accumulaton Purpose of accumulaton Amount appled for chartable/ relgous purposes upto the begnnng of the prevous year Amount nvested or deposted n the modes specfed n secton 11(5) Amounts appled for chartable or relgous purpose durng the prevous year Balance amount avalable for applcaton (7) = (2) - (4) (6) (1) (2) (3) (4) (5) (6) (7) (8) Amount deemed to be ncome wthn meanng of sub-secton (3) of secton 11 Total Schedule J Statement showng the nvestment of all funds as on the last day of the prevous year A Balance n the corpus fund as on the last day of the prevous year Rs. Balance n the non-corpus fund as on the last day of the year B Detals of nvestment/deposts made under secton 11(5) Sl No Rs. Mode of nvestment as per secton 11(5) Date of nvestment Date of maturty Amount of nvestment Maturty amount (1) (2) (3) (4) (5) (6) Investment n Government Savng Scheme Post Offce Savng Bank Depost n Schedule Bank or co-operatve socetes as per secton 11(5)() v Investment n UTI v Any Other v TOTAL C Investment held at any tme durng the prevous year (s) n concern (s) n whch persons referred to n secton 13(3) have a substantal nterest Sl Name and address Where the concern Number of Class of Nomnal Income from Whether the amount n col (6) No of the concern s a company shares held shares value of the exceeds 5 percent of the (tck as applcable held the nvestment captal of the concern durng nvestment the prevous year (tck as applcable ) (1) (2) (3) (4) (5) (6) (7) (8) Yes No Yes No Yes No Yes No Yes No Yes No v Yes No Yes No v Yes No Yes No Page S1

159 TOTAL D Other nvestments as on the last day of the prevous year Sl No Name and address of the concern Whether the concern s a company (tck as applcable ) Class of shares held Number of shares held Nomnal value of nvestment (1) (2) (3) (4) (5) (6) Yes No Yes No Yes No v Yes No v TOTAL E Voluntary contrbutons/donatons receved n knd but not converted nto nvestments n the specfed modes u/s 11(5) wthn the tme provded Sl.N Name and address of the Value of Amount out of (3) nvested Balance to be treated as o donor contrbuton/donaton n modes prescrbed under ncome under secton 11(3) secton 11(5) (1) (2) (3) (4) (5) v TOTAL Schedule K Statement of partculars regardng the Author(s) / Founder(s) / Trustee(s) / Manager(s), etc., of the Trust or Insttuton A Name(s) of author(s) / founder(s) / Settlor(s) and address(es), f alve Sl. Name and address PAN B Name(s) of the person(s) who was / were trustee(s) / manager(s) durng the prevous year(s) Sl. Name and address PAN C Name(s) of the person(s) who has / have made substantal contrbuton to the trust / nsttuton n terms of secton 13(3)(b) Sl. Name and address PAN Name(s) of relatve(s) of author(s), founder(s), trustee(s), manager(s), and substantal contrbutor(s) and where any D such author, founder, trustee, manager or substantal contrbutor s a Hndu undvded famly, also the names of the members of the famly and ther relatves Sl. Name and address PAN Page S2

160 HOUSE PROPERTY ELECTORAL TRUST POLITICAL PARTY Schedule LA Poltcal Party 1 Whether books of account were mantaned? (tck as applcable ) Yes No 2 Whether record of each voluntary contrbuton n excess of twenty thousand rupees (ncludng name and address of the person who has made such contrbuton) were Yes No mantaned? (tck as applcable ) 3 Whether the accounts have been audted? (tck as applcable ) Yes No If yes, date of audt (DD/MM/YYYY) 4 Whether the report under sub-secton (3) of secton 29C of the Representaton of the People Act, 1951 for the fnancal year has been submtted?(tck as applcable ) 5 If yes, then date of submsson of the report (DD/MM/YYYY) / / Yes No / / Schedule ET Electoral Trust 1 Whether books of account were mantaned? (tck as applcable ) Yes No 2 Whether record of each voluntary contrbuton (ncludng name, address and PAN of the person who has made such contrbuton along wth the mode of contrbuton) were mantaned? (tck as applcable ) Yes No 3 Whether record of each person (ncludng name, address and PAN of such person) to whom voluntary contrbuton has been dstrbuted was mantaned? (tck as applcable ) Yes No 4 Whether the accounts have been audted? (tck as applcable ) Yes No If yes, date of audt (DD/MM/YYYY ) 5 Whether the report as per rule 17CA(14) furnshed to the Commssoner of Income-tax or Drector of Income-tax?(tck as applcable ) 6 Detals of voluntary contrbuton Openng balance as on 1 st Aprl Voluntary contrbuton receved durng the year Total ( + ) v Amount dstrbuted to Poltcal partes v v Amount spent on managng the affars of the Trust v v Total (v + v) v v Closng balance as on 31 st March ( v) v / / Yes No 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 deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two f let out for part of the year) b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2)of the Act) f 30% of 1e 1f g Interest payable on borrowed captal 1g h Total (1f + 1g) Income from house property 1 (1f 1) 1a 1e 1h 1 Page S3

161 CAPITAL GAINS 2 Address of property 2 Town/ Cty State PIN Code Is the property co-owned? Yes No (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner(s) (optonal) Percentage Share n Property I II (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved/ recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) f 30% of 2f 2f g Interest payable on borrowed captal 2g h Total (2f + 2g) Income from house property 2 (2e 2h) 3 Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA b Arrears of rent receved durng the year under secton 25B after deductng 30% c Total ( a + 3b ) (f negatve take the fgure to 2 of schedule CYLA) 2a 2e 2h 2 3a 3b 3c Schedule CG Captal Gans A Short-term captal gan 1 From assets (shares/unts) where secton 111A s applcable (STT pad) a Full value of consderaton 1a b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (1a bv) 1c d Loss, f any, to be gnored under secton 94(7) or 1d 94(8) (Enter postve value only) e Short-term captal gan (1c +1d) 2 From assets where secton 111A s not applcable 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 bv) 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) 2e 3 Deemed short term captal gan on deprecable assets A3 4 Exempton u/s 11(1A) A4 5 Total short term captal gan (A1e + 2e + A3 - A4) A5 B Long term captal gan 1 From asset where provso under secton 112(1) s not applcable a Full value of consderaton b Deductons under secton 48 1a A1e Page S4

162 OTHER SOURCES Cost of acquston after ndexaton b Cost of mprovement after ndexaton b Expendture on transfer b v Total (b + b +b) bv c Balance (1a bv) 1c d Exempton u/s 11(1A) 1d e Long-term captal gans where provso under secton 112(1) s not applcable (1c 1d) B1e 2 From asset where provso under secton 112(1) s applcable (wthout ndexaton) a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture on transfer b v Total (b + b +b) bv c Balance (2a bv) 2c d Exempton u/s 11(1A) 2d e Long-term captal gans where provso under secton 112(1) s applcable (2c 2d) B2e 3 Total (1e long 1f) term captal gan (B1e + B2e) B3 C Income chargeable under the head CAPITAL GAINS (A5 + B3) (enter B3 as nl, f loss) C 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 Others, Gross (excludng ncome from ownng race d horses)menton the source Income from wnnngs from lotteres, crossword puzzles 1d etc. 1d v Total (1d + 1d+ 1d) e Total (1a + 1b + 1c + 1dv) f Income ncluded n 1e chargeable to tax at specal rate (to be taken to schedule SI) Income from wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc. (u/s 115BB) Any other ncome under chapter XII/XII-A Income ncluded n 1e chargeable to tax at specal rate (1f +1f) g Gross amount chargeable to tax at normal applcable rates (1e-1f) h Deductons under secton 57(other than those relatng to ncome under 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 4 of schedule CYLA) 2 Income from other sources (other than from ownng race horses) (1f + 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 (3) 3b c Balance (3a 3b) 4 Income under the head Income from other sources (2 + 3c) (take 3c as nl f negatve) 4 1d 1dv h 1e 1 1f 1f 1g 1 3c Schedule- VC Voluntary Contrbutons A Local Corpus fund donaton A Other than corpus fund donaton A Voluntary contrbuton local (A + A) A Page S5

163 INCOME FROM BUSINESS OR PROFESSION B Foregn contrbuton Corpus fund donaton B Other than corpus fund donaton B Foregn contrbuton (B + B) B C Total Contrbutons (A + B) C D Schedule OA Anonymous donatons, ncluded n C, chargeable u/s 115BBC Aggregate of such anonymous donatons receved 5% of total donatons receved at C or 1,00,000 whchever s hgher Anonymous donatons chargeable u/s 30% ( ) General Do you have any ncome under the head busness and professon? Yes No (f yes please enter followng detals) 1 Nature of Busness or professon (refer to the nstructons) 1 2 Number of branches Method of accountng employed n the prevous year (Tck) mercantle cash 3 Is there any change n method of accountng (Tck) Yes 4 Effect on the proft because of devaton, f any, n the method of accountng employed n the prevous year from accountng standards prescrbed under secton 145A 6 Method of valuaton of closng stock employed n the prevous year 6 a b Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) Yes No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 6d Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account Net proft or loss from speculatve busness ncluded n 1 (enter ve sgn n case of loss) Net proft or loss from Specfed Busness u/s 35AD ncluded n 1 (enter ve sgn n case of loss) Proft or loss ncluded n 1, whch s referred to n 4 4 secton 44AD/44AE 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome 5c d Total exempt ncome 6 Balance ( d) 6 Expenses debted to proft and loss account 7 7 consdered under other heads of ncome 8 Expenses debted to proft and loss account whch relate to exempt ncome 9 Total (7 + 8) 9 10 Adjusted proft or loss (6+9) Deemed ncome under secton 33AB/33ABA/35ABB 11 Any other tem or tems of addton under secton to 44DA 13 Any other ncome not ncluded n proft and loss 13 account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch company s a partner) 14 Total ( ) Deducton allowable under secton 32(1)() d 8 Page S6

164 CURRENT YEAR LOSS ADJUSTMENT 16 Any other amount allowable as deducton Total ( ) Income (14 17) Profts and gans of busness or professon deemed to be under - Secton 44AD 19 Secton 44AE Total (19 to 19) 20 Net proft or loss from busness or professon other than speculatve and specfed busness ( ) 21 Net Proft or loss from busness or professon other than speculatve busness and specfed busness after applyng rule 7A, 7B or 7C, f applcable (If rule 7A, 7B or 7C s not applcable, enter same fgure as n 20) B Computaton of ncome from speculatve busness 24 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Proft or loss from speculatve busness ( ) (enter nl f loss) B27 C Computaton of ncome from specfed busness under secton 35AD C 28 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA 29 Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 31 Proft or loss from specfed busness ( ) Deductons n accordance wth secton 35AD(1) or 35AD(1A) Proft or loss from specfed busness (31-32) (enter nl f loss) 33 D Income chargeable under the head Profts and gans D (A21+B27+C33) D34 E Computaton of ncome chargeable to tax under secton 11(4) 35 Income as shown n the accounts of busness under takng [refer secton 11(4)] E35 36 Income chargeable to tax under secton 11(4) [D34-E35] E A21 Schedule CYLA Detals of Income after set-off of current years losses Sl.No Head/ Source of Income of current House property loss of Busness Loss Income year the current year set off (other than speculaton or (Fll ths column specfed busness loss) of only f ncome s the current year set off zero or postve) Total loss Total loss (3c of Schedule HP) (A21 of Schedule-BP) Loss to be adjusted -> House property Busness (excludng speculaton ncome and ncome from specfed busness) Speculaton ncome v Specfed busness ncome v 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 x Total loss set-off x Loss remanng after 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 Total loss (1 of Schedule-OS) = Page S7

165 MINIMUM ALTERNATE TAX Schedule MAT Computaton of Mnmum Alternate Tax payable under secton 115JB Whether the Proft and Loss Account s prepared n accordance wth the provsons of Parts II of Schedule III to the 1 Companes Act, 2013 (If yes, wrte Y, f no wrte N ) Whether, for the Proft and Loss Account referred to n tem 1 above, the same accountng polces, accountng 2 standards and same method and rates for calculatng deprecaton have been followed as have been adopted for preparng accounts lad before the company at ts annual general body meetng? (If yes, wrte Y, f no wrte N 3 Proft after tax as shown n the Proft and Loss Account 3 4 Addtons (f debted n proft and loss account) Income Tax pad or payable or ts provson a ncludng the amount of deferred tax and the provson therefor b Reserve (except reserve under secton 33AC) c Provsons for unascertaned lablty d Provsons for losses of subsdary companes e Dvdend pad or proposed Expendture related to exempt ncome under sectons f 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] g Expendture related to share n ncome of AOP/ BOI on whch no ncome-tax s payable as per secton 86 h Expendture n case of foregn company referred to n clause (fb) of explanaton 1 to secton 115JB Notonal loss on transfer of certan captal assets or unts referred to n clause (fc) of explanaton 1 to secton 115JB j Deprecaton attrbutable to revaluaton of assets Gan on transfer of unts referred to n clause (k) of k explanaton 1 to secton 115JB Others (ncludng resdual unadjusted tems and l provson for dmnuton n the value of any asset) m Total addtons (4a+4b+4c+4d+4e+4f+4g+4h+4+4j+4k+4l) 5 Deductons a Amount wthdrawn from reserve or provsons f credted to Proft and Loss account b Income exempt under sectons 10, 11 or 12 [exempt ncome excludes ncome exempt under secton 10(38)] c Amount wthdrawn from revaluaton reserve and credted to proft and loss account to the extent t does not exceed the amount of deprecaton attrbutable to revaluaton of asset d Share n ncome of AOP/ BOI on whch no ncometax s payable as per secton 86 credted to Proft and Loss account e Income n case of foregn company referred to n clause (d) of explanaton 1 to secton 115JB f Notonal gan on transfer of certan captal assets or unts referred to n clause (e) of explanaton 1 to secton 115JB g Loss on transfer of unts referred to n clause (f) of explanaton 1 to secton 115JB h Loss brought forward or unabsorbed deprecaton whchever s less Proft of sck ndustral company tll net worth s equal to or exceeds accumulated losses j Others (ncludng resdual unadjusted tems and the amount of deferred tax credted to P&L A/c) k Total deductons (5a+5b+5c+5d+5e+5f+5g+5h+5+5j) 6 Book proft under secton 115JB (3+ 4m 5k) 6 4a 4b 4c 4d 4e 4f 4g 4h 4 4j 4k 4l 5a 5b 5c 5d 5e 5f 5g 5h 5 5j 4m 5k 7 Tax payable under secton 115JB [18.5% of (6)] 7 Page S8

166 MAT CREDIT Schedule MATC Computaton of tax credt under secton 115JAA 1 Tax under secton 115JB n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (5 of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse enter 0] 3 4 Utlsaton of MAT credt Avalable [Sum of MAT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of MAT Credt Brought Forward ] S.No Assessment Year MAT Credt (A) v v v v v x x x (enter 1-2, f 1>2 else enter 0) x Total Gross (B1) Set-off n earler years (B2) Balance Brought forward (B3)=(B2)-(B1) MAT Credt Utlsed durng the Current Year (C) 5 Amount of tax credt under secton 115JAA utlsed durng the year [enter 4(C)x] 5 6 Amount of MAT lablty avalable for credt n subsequent assessment years [enter 4(D)x] 6 Balance MAT Credt Carred Forward (D)= (B3) (C) Schedule AMT Computaton of Alternate Mnmum Tax payable under secton 115JC 1 Total Income as per tem 25 of PART-B-TI 1 2 Adjustment as per secton 115JC(2) a Deducton Clamed under any secton ncluded n Chapter VI-A under the headng C. Deductons n respect of certan ncomes b Deducton Clamed u/s 10AA c Deducton clamed u/s 35AD as reduced by the amount of deprecaton on assets on whch such deducton s clamed d Total Adjustment (2a+ 2b+2c) 3 Adjusted Total Income under secton 115JC(1) (1+2d) 3 4 Tax payable under secton 115JC [18.5% of (3)] (In the case of Indvdual, HUF, AOP, BOI, AJP ths s applcable f 3 s greater than Rs. 20 lakhs) 2a 2b 2c 2d 4 Schedule AMTC Computaton of tax credt under secton 115JD 1 Tax under secton 115JC n assessment year (1d of Part-B-TTI) 1 2 Tax under other provsons of the Act n assessment year (5 of Part-B-TTI) 2 3 Amount of tax aganst whch credt s avalable [enter (2 1) f 2 s greater than 1, otherwse 3 enter 0] 4 Utlsaton of AMT credt Avalable (Sum of AMT credt utlzed durng the current year s subject to maxmum of amount mentoned n 3 above and cannot exceed the sum of AMT Credt Brought Forward) S.No Assessment Year (AY) AMT Credt (A) Gross (B1) Set-off n earler years (B2) Balance brought forward (B3) = (B1) (B2) AMT Credt Utlsed durng the Current Year (C) Balance AMT Credt Carred Forward (D)= (B3) (C) Page S9

167 INCOME FROM OUTSIDE INDIA AND TAX RELIEF SPECIAL RATE PASS THROUGH INCOME v Current AY (enter 1 - v 2, f 1>2 else enter 0) v Total 5 Amount of tax credt under secton 115JD utlsed durng the year [total of tem no 4C] 5 6 Amount of AMT lablty avalable for credt n subsequent assessment years [total of 4D] 6 Schedule PTI Sl. Pass Through Income detals from busness trust or nvestment fund as per secton 115UA, 115UB Name of busness trust/ PAN of the busness Sl. Head of ncome Amount of nvestment fund trust/ nvestment 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 NOTE Please refer to the nstructons for fllng out ths schedule. TDS on such amount, f any Schedule SI Income chargeable to tax at specal rates [Please see nstructon] Sl Secton Specal rate No (%) 1 111A (STCG on shares where STT pad) provso (LTCG on lsted securtes/ unts wthout ndexaton) (LTCG on others) BB (Wnnngs from lotteres, puzzles, races, games etc.) BBE (Income under secton 68, 69, 69A, 69B, 69C or 69D) Total Income () Tax thereon () Schedule FSI Sl. Country Code Taxpayer Identfcaton Number 1 House Property Detals of Income from outsde Inda and tax relef Sl. Head of ncome Income from Tax pad outsde Inda outsde (ncluded n Inda PART B-TI) Busness or Professon Captal Gans v Other sources Tax payable on such ncome under normal provsons n Inda Tax relef avalable n Inda (e)= (c) or (d) whchever s lower Relevant artcle of DTAA f relef clamed u/s 90 or 90A (a) (b) (c) (d) (e) (f) Page S10

168 DETAILS OF FOREIGN ASSETS TAX RELIEF FOR TAX PAID OUTSIDE INDIA Total 2 House Property Busness or Professon Captal Gans v Other sources Total NOTE Please refer to the nstructons for fllng out ths schedule. Schedule TR Summary of tax relef clamed for taxes pad outsde Inda 1 Detals of Tax relef clamed Country Code Taxpayer Total taxes pad outsde Inda Identfcaton (total of (c) of Schedule FSI n Number respect of each country) Total tax relef avalable (total of (e) of Schedule FSI n respect of each country) Secton under whch relef clamed (specfy 90, 90A or 91) (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. b Assessment year n whch tax relef allowed n Inda 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- Owner/ Benefcal owner/ Benefcary Account Number 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 Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () 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 Name and code entty Address of the Entty Nature of Interest- Drect/ Benefcal owner/ Benefcary Date snce held Total Investment (at cost) (n rupees) Income Nature of accrued from Income such Interest Income taxable and offered n ths return Amount Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () C Detals of Immovable Property held (ncludng any benefcal nterest) at any tme durng the 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) () Page S11

169 () D Detals of any other Captal Asset held (ncludng any benefcal nterest) at any tme durng the prevous year Sl No Nature of Asset 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 asset 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 Address of Name of the Account If (7) s yes, Income offered n ths No the account Number 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 If (8) s yes, Income offered n ths No Name and address of address of address of address of return code the trust trustees Settlor Benefcares Amount Date snce poston held Whether ncome derved s taxable n your hands? If (8) s yes, Income derved from the trust Schedule where offered Item number of schedule (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) () () G Sl No Detals of any other ncome derved from any source outsde Inda whch s not ncluded n,- () tems A to F above and, () ncome under the head busness or professon If (6) s yes, Income offered n ths return Country Name 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) () () NOTE Please refer to nstructons for fllng out ths schedule. Page S12

170 Sd/- (Ekta Jan) Deputy Secretary to the Government of Inda F.No /2/2016-TPL Issued by: Mnstry of Fnance (Department of Revenue) (Central Board of Drect Taxes) New Delh Note.- The prncpal rules were publshed n the Gazette of Inda, Extraordnary, Part-II, Secton 3, Sub-secton () vde notfcaton number S.O.969(E), dated the 26 th March, 1962 and last amended by the Income-tax (8 th Amendment) Rules, 2016, vde notfcaton number S.O. No.1206(E), dated 23 rd March, ** ** ** Informaton on ths page s provded by Shakun & Company (Servces) Prvate Lmted, New Delh, Inda to ts subscrbers aganst the annual subscrpton. Non-subscrbers may vst for more detals.