FORM ITR-3 INDIAN INCOME TAX RETURN [For Individuals/HUFs being partners in firms and not carrying out business or profession under any proprietorship

Transcription

1 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) þ o Indvdual o HUF Road/Street/Post Offce Area/localty Date of Brth/ Formaton (DD/MM/YYYY) PERSONAL INFORMATION Do you have Aadhaar Number? (n case of ndvdual) oyes ono. If Yes, please provde Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) þ o Male o Female Country Resdental/Offce Phone Number wth STD code/ Moble No. 1 Moble No. 2 Employer Category(f n employment) (Tck) þ o Govt. o PSU o Others Emal Address-1 (self) Emal Address-2 Income Tax Ward/Crcle Passport No. (Indvdual)(If avalable) FILING STATUS (a) (b) (c) Return fled (Tck)[Please see nstructon number-7] oon or before due date-139(1), o After due date-139(4), o Revsed Return- 139(5), o Modfed return- 92CD, o under secton 119(2)(b), or In response to notce o 139(9)-Defectve, o 142(1), o 148, o 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) þ o Resdent o Non-Resdent o 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? o Yes o No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) þ o Yes o No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) þ o Yes o 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 TOTAL INCOME 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

2 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 COMPUTATION OF TAX LIABILITY 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 B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on Total Income (1a + 1b 1c) 2 Rebate under secton 87A (applcable f 13 of Part B-TI does not exceed 5 lakh) 2 3 Tax payable after rebate (1d - 2) 3 4 Surcharge on 3 (applcable f 13 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) 7a 7b 7c 9a 9b 9c 1a 1b 1c 1d 7d Page 2

3 TAXES PAID d Total Interest Payable (9a+9b+9c) 9d 10 Aggregate lablty (8 + 9d) Taxes Pad a Advance Tax (from column 5 of 18A) 11a b TDS (total of column 5 of 18B and column 8 of 18C) 11b c TCS (total of column 6 of 18D) 11c d Self-Assessment Tax (from column 5 of 18A) 11d e Total Taxes Pad (11a+11b+11c+11d) 11e 12 Amount payable (Enter f 10 s greater than 11e, else enter 0) Refund (If 11e s greater than 10) (Refund, f any, wll be drectly credted nto the bank account) 13 BANK ACCOUNT 14 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 þ ) 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 o 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 ] o 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 è 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 ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY 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) Page 3

4 C TDS ON OTHER INCOME D TCS ON INCOME 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 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 (6) of Schedule-TCS n 11c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETRUN FORM (PAGES S1 S11) AS APPLICABLE Page 4

5 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 SALARIES 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? o Yes o 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 HOUSE PROPERTY 2 (Tck) þ f let out o deemed let out o 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? o Yes o 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) þ f let out o deemed let out o Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I Page S1

6 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 FIRMS IN WHICH PARTNER Sl. No Total Name of the Frm PAN of the frm Whether the frm s lable for audt? (Y/N) Percentage Share n the proft of the frm Amount of share n the proft Captal balance on 31 st March n the frm Schedule BP INCOME FROM FIRMS 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 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) 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 Short-term Captal Gans A1e Page S2

7 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? o Yes o No o 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) term Captal Gans 1 From sale of land or buldng or both a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty a A2e A3a A3b A6 A7 Page S3

8 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 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) From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso under 3 secton 112(1) s applcable or unt of a Mutual Fund transferred on or before % wthout ndexaton beneft), () 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 4 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 Expendture wholly and exclusvely n connecton wth transfer b a b b b bv 1c B1e B2e Page S4

9 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? o Yes o No o 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 Type of Captal gan / Date Upto 15/9 () 16/9 to 15/12 () 16/12 to 15/3 () 16/3 to 31/3 (v) Page S5

10 NOTE 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. Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head Schedule OS OTHER SOURCES 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) 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 1d 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 year (Fll ths column only f ncome s zero or postve) CURRENT YEAR LOSS ADJUSTMENT h House property loss of the current year set off 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) House property (3c of Schedule HP) v Busness or professon (4v of Schedule BP) Page S6

11 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. BROUGHT FORWARD LOSS ADJUSTMENT CARRY FORWARD OF LOSS 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) Schedule VI-A TOTAL DEDUC TIONS Deductons under Chapter VI-A 1 Part B- Deducton n respect of certan payments a 80C b 80CCC Page S7

12 c 80CCD(1) (assessees contrbuton) e 80CCG g 80DD 80E k 80G m 80GGA d 80CCD(2) (employers contrbuton) f 80D h 80DDB j 80EE l 80GG n 80GGC 2 Part C, CA and D- Deducton n respect of certan ncomes/other deducton o 80QQB p 80RRB q 80TTA 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 DETAILS OF DONATIONS B Name and address of donee PAN of Donee Amount of donaton 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 C qualfyng lmt Name and address of donee PAN of Donee 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 Elgble Amount of donaton Elgble Amount of donaton 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) Schedule SI Income chargeable to tax at specal rates (please see nstructons No. 9 for rate of tax) Sl Secton þ Specal rate Income No (%) 1 111A (STCG on shares unts on whch STT pad) o 15 (3v of schedule BFLA) SPECIAL RATE 2 115AD (STCG for FIIs on securtes where STT not pad) o 30 (3v of schedule BFLA) provso (LTCG on lsted securtes/ unts wthout ndexaton) o 10 (part of 3v of schedule BFLA) Tax thereon Page S8

13 4 112(1)(c)() (LTCG for non-resdent on unlsted securtes) o 10 (part of 3v of schedule BFLA) 5 115AC (LTCG for non-resdent on bonds/gdr) o 10 (part of 3v of schedule BFLA) 6 115ACA (LTCG for an employee of specfed company on GDR) o 10 (part of 3v of schedule BFLA) 7 115AD (LTCG for FIIs on securtes) o 10 (part of 3v of schedule BFLA) 8 115E (LTCG for non-resdent ndan on specfed asset) o 10 (part of 3v of schedule BFLA) (LTCG on others) o 20 (3v of schedule BFLA) BB (Wnnngs from lotteres, puzzles, races, games etc.) o 30 (1f of schedule OS) 115AC (Income of a non-resdent from bonds or GDR purchased 11 o 10 (part of 1f of schedule OS) n foregn currency) 12 Chargeable under DTAA rate o (part of 1f of schedule OS) 13 o Total Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income) 1 Interest ncome 1 2 Dvdend ncome 2 EXEMPT INCOME 3 Long-term captal gans from transactons on whch Securtes Transacton Tax s pad 3 4 Gross Agrcultural recepts (other than ncome to be excluded under rule 7A, 7B or 8 of I.T. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years Net Agrcultural ncome for the year ( ) (enter nl f loss) 4 5 Share n the total ncome of frm/aop/boi etc. 5 6 Others, ncludng exempt ncome of mnor chld 6 7 Total ( ) 7 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 2 Salary House Property Busness or Professon v Captal Gans v Other sources 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) 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) Page S9

14 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) () DETAILS OF FOREIGN ASSETS () 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 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) () () Page S10

15 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 Schedule 5A 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. 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 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. 25 lakh) A Partculars of Asset Amount (Cost) (Rs.) DETAILS OF ASSET AND LIABILITY B 1 Immovable Asset a Land b Buldng 2 Movable Asset a 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 arcrafts 3 Total Lablty n relaton to Assets at A Page S11

16 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) þ o Indvdual o HUF PERSONAL INFORMATION Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Do you have Aadhaar Number? (n case of ndvdual) oyes ono. If Yes, please provde Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) þ Resdental/Offce Phone Number wth STD code / Moble No. 1 Country o Male o Female Moble No. 2 Employer Category (f n employment) (Tck) þ o Govt. o PSU o Others Emal Address-1 (self) Emal Address-2 Income Tax Ward/Crcle Passport No. (Indvdual) (If avalable) FILING STATUS (a) (b) (c) Return fled (Tck)[Please see nstructon number-7] o On or Before due date -139(1) o After due date -139(4) o Revsed Return- 139(5), o Modfed return- 92CD o under secton 119(2)(b), or In response to notce o 139(9)-Defectve o 142(1) o 148 o 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) þ oresdent o Non-Resdent o 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? o Yes o No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) þ o Yes o No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) þ o Yes o 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) þ o Yes o No (a) Are you lable to mantan accounts as per secton 44AA? (Tck) þ o Yes o No AUDIT INFORMATION (b) Are you lable for audt under secton 44AB? (Tck) þ o Yes o No (c) For Offce Use Only If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) þ o Yes o 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 Recept No Date Seal and Sgnature of recevng offcal Page 1

17 (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 SOURCES OF FUNDS APPLICATION OF FUNDS 1 Propretor s fund BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2015 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 Equty Shares, ncludng share applcaton money b A B C 1a 1b 1c 1d a 1c 2c 1e Page 2

18 NO ACCOUNT CASE 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, 2015, 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 d Amount of the cash balance 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 6d Page 3

19 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 CREDITS TO PROFIT AND LOSS ACCOUNT DEBITS TO PROFIT AND LOSS ACCOUNT 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 Unon excse duty v v v x xa xb xc v Bv 1C 2x 3v 5v Page 4

20 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 v 14v 14v 14v 14v x Contrbuton to any other fund 14x x Any other beneft to employees n respect of whch an expendture has been ncurred 14x 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 ( + ) 25 Hotel, boardng and Lodgng 25 7v 14x 15v Page 5

21 PROVISIONS FOR TAX AND APPROPRIATIONS NO ACCOUNT CASE 26 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 d Net proft 53d 36v 36v 38 39v 43 Page 6

22 Part A- OI OTHER INFORMATION Other Informaton (optonal n a case not lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) þ o mercantle o cash 2 Is there any change n method of accountng (Tck) þ o Yes o No Effect on the proft because of devaton, f any, n the method of accountng employed n the 3 3 prevous year from accountng standards prescrbed under secton 145A 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) þ o Yes o 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 c Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] 7c 6m 6n 6o 6p 6q 4d 6r 5f Page 7