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 2 0 1 6-1 7 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
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 3 4 5 6 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
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
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
II E Total Current labltes (4A + 4B + 4C + 4D) Total Equty and labltes (1D + 2 + 3E + 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
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
DEBITS TO PROFIT AND LOSS ACCOUNT CREDITS TO PROFIT AND LOSS ACCOUNT Proft and Loss Account for the fnancal year 2015-16 (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 (3 + 3 + 3) 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 (5 + 5 + 5) 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 3 3 3 5 5 5 Bv 1C 2x 3v 5v Page 7
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 (7 + 7 + 7 + 7v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores and spare parts 9 10 Power and fuel 10 11 Rents 11 12 Repars to buldng 12 13 Repars to plant, machnery or furnture 13 14 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 7 7 7 7v 7v 7v 7v 14 14 14 14v 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 (14 + 14 + 14 + 14v + 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 (15 + 15 + 15 + 15v) 16 Workmen and staff welfare expenses 16 17 Entertanment 17 18 Hosptalty 18 19 Conference 19 20 Sales promoton ncludng publcty (other than advertsement) 20 21 Advertsement 21 22 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 22 23 Page 8
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 25 26 Travelng expenses other than on foregn travelng 26 27 Foregn travelng expenses 27 28 Conveyance expenses 28 29 Telephone expenses 29 30 Guest House expenses 30 31 Club expenses 31 32 Festval celebraton expenses 32 33 Scholarshp 33 34 Gft 34 35 Donaton 35 36 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 36 36 36v v Total rates and taxes pad or payable (36 + 36 + 36 + 36v + 36v) 37 Audt fee 37 38 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. 39 1 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) 39 39 39 39v 39v v Total Bad Debt (39 + 39 + 39 + 39v + 39v) 40 Provson for bad and doubtful debts 40 41 Other provsons 41 Proft before nterest, deprecaton and taxes [4 (5v + 6 + 7v + 8 to 13 + 14x + 15v + 16 to 42 21 + 22 + 23 + 24 + 25 to 35 + 36v + 37 + 38 + 39v + 40 + 41)] 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 44 45 Proft before taxes (42 43 44) 45 46 Provson for current tax 46 47 Provson for Deferred Tax and deferred lablty 47 48 Proft after tax (45-46 - 47) 48 49 Balance brought forward from prevous year 49 50 Amount avalable for appropraton (48 + 49) 50 36v 24 36v 39v 42 43 Page 9
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 (51 + 51 + 51 + 51v) 52 Balance carred to balance sheet (50 51v) 52 53 In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton for prevous year 2015-16 n respect of busness or professon a Gross recepts b Gross proft c Expenses d Net proft 51 51 51 51v 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
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
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 13 14 Any amount of proft chargeable to tax under secton 41 14 15 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
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 (2 + 2+2) 3 Captal gans a Short term Short-term chargeable @ 15% (7 of tem E of schedule CG) Short-term chargeable @ 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 chargeable @ 10% (7v of tem E of schedule CG) b Long-term chargeable @ 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 9 10 11 Deducton u/s 10A or 10AA (e of Sch. 10A + e of Sch. 10AA) 11 12 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 (9 11-12c) 13 14 Income chargeable to tax at specal rates (total of () of schedule SI) 14 15 Income chargeable to tax at normal rates (13-14) 15 16 Net agrcultural ncome(4 of Schedule EI) 16 17 Losses of current year to be carred forward (total of x of Schedule CFL) 17 18 Deemed total ncome under secton 115JB (7 of Schedule MAT) 18 b b 2v 3c 4d 12a 12b 12c Page 13
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) 11 12 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
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 2016-17. 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
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
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) 6 7 8 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) 10 11 Deprecaton and amortsaton debted to proft and loss account 11 12 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 (12 + 12) 13 Proft or loss after adjustment for deprecaton (10 +11 12) 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) 18 19 Interest dsallowable under secton 23 of the Mcro, Small and Medum Enterprses Development Act,2006 20 Deemed ncome under secton 41 20 Deemed ncome under secton 32AC/ 32AD/ 33AB/ 33ABA/ 35ABB/ 21 35AC/ 40A(3A)/ 33AC/ 72A/ 80HHD/ 80-IA 21 22 Deemed ncome under secton 43CA 22 23 Any other tem of addton under secton 28 to 44DA 23 24 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 (14 + 15 + 16 + 17 + 18 + 19 + 20 + 21+22 +23+24) 25 26 Deducton allowable under secton 32(1)() 26 27 Deducton allowable under secton 32AD 27 28 Amount allowable as deducton under secton 32AC 28 29 30 31 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) 31 32 Deducton under secton 35AC c 7a 7b 7c 8 19 24 12 Page S2
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 33 34 Total (26 + 27+28 +29 +30 + 31 + 32c+33) 34 35 Income (13 + 25 34) 35 36 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 (34 37 37 + 35x) 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 39 40 Addtons n accordance wth secton 28 to 44DA 40 41 Deductons n accordance wth secton 28 to 44DA 41 42 Income from speculatve busness (39 + 40-41) (f loss, take the fgure to 6x of schedule CFL) B42 36 36 36v 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 43 44 Addtons n accordance wth secton 28 to 44DA 44 45 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 (43 + 44-45) 46 47 Deductons n accordance wth secton 35AD(1) or 35AD(1A) 47 48 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 (%) 15 30 40 50 60 80 100 3 Wrtten down value on the frst day of prevous year 32a () () () (v) (v) (v) (v) 45 Page S3
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 (3 + 4-5) (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 (10+11+12+13) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 (5 + 8-3-4-7 -15) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* (6+ 9-14) (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 (%) 5 10 100 10 25 20 3 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 (3 + 4-5) (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 (10+11+12+13) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50* (5 + 8-3-4-7 -15) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year* (6+ 9-14) (enter 0 f result s negatve) () () () (v) (v) (v) Page S4
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 deprecaton @ 15 per cent a ( Schedule DPM - 14 ) Block enttled for deprecaton @ 30 per cent b ( Schedule DPM - 14 ) Block enttled for deprecaton @ 40 per cent c ( Schedule DPM - 14 ) Block enttled for deprecaton @ 50 per cent d ( Schedule DPM - 14 v) Block enttled for deprecaton @ 60 per cent e ( Schedule DPM - 14 v) Block enttled for deprecaton @ 80 per cent f ( Schedule DPM 14 v) Block enttled for deprecaton @ 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 deprecaton @ 5 per cent (Schedule DOA- 14) b Block enttled for deprecaton @ 10 per cent (Schedule DOA- 14) c Block enttled for deprecaton @ 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 deprecaton @ 15 per cent 1a (Schedule DPM - 16) b Block enttled for deprecaton @ 30 per cent (Schedule 1b DPM 16) c Block enttled for deprecaton @ 40 per cent(schedule 1c DPM - 16) d Block enttled for deprecaton @ 50 per cent 1d (Schedule DPM - 16v) e Block enttled for deprecaton @ 60 per cent 1e (Schedule DPM 16v) f Block enttled for deprecaton @ 80 per cent (Schedule 1f DPM 16v) g Block enttled for deprecaton @ 100 per cent 1g (Schedule DPM 16v) h Total ( 1a +1b + 1c + 1d + 1e + 1f + 1g) 2 Buldng a Block enttled for deprecaton @ 5 per cent 2a (Schedule DOA- 16) b Block enttled for deprecaton @ 10 per cent (Schedule 2b DOA- 16) c Block enttled for deprecaton @ 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
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
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 2012-13 54D/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