INDIAN INCOME TAX RETURN

FILING STATUS PERSONAL INFORMATION FORM ITR3 Part AGEN Frst name Flat/Door/Block Desgnaton of Assessng Offcer ( Ward/Crcle) Return fled under Secton [Please see nstructon number9()] Whether orgnal or Revsed return? (Tck) Orgnal Revsed f revsed, then enter Recept and Date of flng orgnal return ( DD/MM/YYYY ) Resdental Status (Tck) Resdent n Resdent Resdent but not Ordnarly Resdent Whether ths return s beng fled by a representatve assessee? (Tck) f yes Please furnsh followng nfomaton (a) [For Indvdual/HUFs beng partners n frms and not carryng out busness or professon under any propretorshp] (Please see Rule 2 of the Incometax Rules,92) (Also see attached Instructons) GENERAL Mddle name Name of the representatve INDIAN INCOME TAX RETURN Last name Name Of Premses/Buldng/Vllage Yes PAN Status (Tck) Indvdual Road/Street/Post Offce Area/localty Date of Brth (DD/MM/YYYY) (n case of ndvdual) Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) Emal Address (STD code)phone Number Employer Category (f n employment) (Tck) () Govt PSU Others Male Assessmet Year HUF Female (b) (c) Address of the representatve Permanent Account Number (PAN) of the representatve PARTB Part BTI Computaton of total ncome ÿÿÿÿÿÿÿÿÿ Salares ( of Schedule î S) ÿÿÿÿÿÿÿÿ Šº 2 Income from house property ( c of Schedule HP) (enter nl f loss) 2 3 Profts and gans from busness or professon (v of Schedule BP) (enter nl f loss) 3 TOTAL INCOME 4 Captal gans ( a Short term ( Shortterm (u/s A) (A5 of Schedule CG) ½ ½ ñ ½ð Shortterm (others) (A of Schedule CG) ½ ½ ñ ½ð Total shortterm (4a + 4a) (enter nl f loss) (A4 of schedule CG) b Longterm (B5 of Schedule CG) (enter nl f loss) c Total ½ ð ½ captal gans (4a + 4b) (enter nl f 4c s a loss) n Do not wrte or stamp n ths area (Space for bar code) dule CG) (enter nl f lèeã 4a 4a 4a 4b 4c For Offce Use Only Recept Date Seal and Sgnature of recevng offcal Page of 8

5 7 8 9 0 2 3 4 5 Income from other sources a from sources other than from ownng race horses (3 of Schedule OS) (enter nl f loss) b c from ownng race horses (4c of Schedule OS) (enter nl f loss) Total (a + b) (enter nl f 5c s a loss) Total (+2+3+4c+5c) Losses of current year set off aganst (total of 2v,3v and 4v of Schedule CYLA) Balance after set off current year losses (7) (also total of column 5 of Schedule CYLA) Brought forward losses set off aganst 8 (2v of Schedule BFLA) Gross Total ncome (89) (also 3v of Schedule BFLA) Deductons under Chapter VIA (o of Schedule VIA) Total ncome (0) Net agrcultural ncome/ any other ncome for rate purpose (4 of Schedule EI) verúâ Aggregate ncome (2+3) Losses of current year to be carred forward (x of Schedule CFL) 5a 5b 5c 7 8 9 0 2 3 4 5 Part B TTI Computaton of tax lablty on total ncome Tax payable on total ncome a Tax at normal rates a b Tax at specal rates ( of Schedule SI) b c Tax Payable on Total Income (a + b) 2 Surcharge on c 3 Educaton Cess, ncludng secondary and hgher educaton cess on (c + 2) 4 Gross tax lablty (c+ 2 + 3) 5 Tax relef a Secton 89 5a b Secton 90 5b c Secton 9 5c d Total (5a + 5b+5c) Net tax lablty (4 5d) 7 Interest payable a For default n furnshng the return (secton 234A) 7a b For default n payment of advance tax (secton 234B) 7b c For deferment of advance tax (secton 234C) 7c d Total Interest Payable (7a+7b+7c) 8 Aggregate lablty ( + 7d) 9 Taxes Pad REFUND TAXES PAID COMPUTATION OF TAX LIABILITY a Advance Tax (from ScheduleIT) 9a b TDS (total of column 7 of ScheduleTDS and column 7 of ScheduleTDS2) 9b c Self Assessment Tax (from ScheduleIT) 9c d Total Taxes Pad (9a+9b+9c) 0 Amount payable (Enter f 8 s greater than 9d, else enter 0) Refund (If 9d s greater than 8, also gve Bank Account detals below) 2 Enter your bank account number (mandatory n case of refund) 3 Do you want your refund by cheque, or deposted drectly nto your bank account? 4 Gve addtonal detals of your bank account MICR Code Type of Account (tck as applcable) c 2 3 4 5d 7d 8 9d 0 (tck as applcable) Savngs Current Page 2 of 8

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 Incometax Act, 9, n respect of ncome chargeable to Incometax for the prevous year relevant to the Assessment Year. Place Date Sgn here 5 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: Identfcaton. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof Schedule S Name of Employer Detals of Income from Salary PAN of Employer (optonal) Address of employer Town/Cty State Pn code SALARIES Salary (Excludng all allowances, perqustes & proft n leu of salary).. 2 Allowances exempt under secton 0 2 3 Allowances not exempt 4 Value of perqustes 5 Profts n leu of salary Income chargeable under the Head Salares (+3+4+5) 3 4 5 Schedule HP Detals of Income from House Property Address of property Town/Cty State PIN Code (Tck) f let out Name of Tenant PAN of Tenant (optonal) HOUSE PROPERTY NOTE a Annual letable value/ rent receved or recevable (hgher f let out for whole of the year, lower f let out for part of the year) b The amount of rent whch cannot be realzed b c Tax pad to local authortes c d Total ( b + c ) d e Balance ( a d ) f g h 30% of e Interest payable on borrowed captal Total ( f + g ) Income from house property ( e h ) Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA a b Arrears of rent receved durng the year under secton 25B after deductng 30% b c Total (a + b ) c Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head f g e h a Schedule IF FIRMS IN WHICH PARTNER Informaton regardng partnershp frm n whch you are partner Number of frms n whch you are partner SI. Frm. Name of the Frm. PAN of the frm Percentage share n the proft of the frm Amount of share n the proft Captal balance on 3st March n the frm Total Page 3 of 8

Schedule BP INCOME FROM FIRMS Sl.. Frm PAN. (From ScheduleIF) 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 te : Total 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 Shortterm captal gan CAPITAL GAINS From assets n case of nonresdent to whch frst provso to secton 48 applcable 2 From other assets a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) c Balance (2a bv) 2c d Loss, f any, to be gnored under secton 94(7) or 2d 94(8) (enter postve values only) e Exempton under secton 54B/54D 2e f Shortterm captal gan (2c + 2d 2e) 2f 3 Amount deemed to be short term captal gans under sectons54b/54d/54ec/54ed/54g/54ga 4 Total short term captal gan ( + 2f + A3 ) A4 5 Short term captal gan under secton A ncluded n 4 A5 Short term captal gan other than referred to n secton A (A4 A5) A B Long term captal gan Asset n case of nonresdent to whch frst provso to secton 48 applcable 2 Other assets where provso to secton 2() not applcable a Full value of consderaton 2a b Deductons under secton 48 Cost of acquston after ndexaton b Cost of mprovement after ndexaton b Expendture on transfer v Total (b + b +b) bv c Balance (2a bv) 2c d Exempton under sectons 54/54B/54D/54EC/54F/54G 2d /54GA e Net balance (2c 2d) 2e 3 Other assets where provso to secton 2() s applcable bv b a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture on transfer b A3 v Total (b + b +b) bv c Balance (3a bv) 3c d Deducton under sectons 54/54B/54D/54EC/54F 3d e Net balance (3c3d) 3e 4 Amount deemed to be long term captal gans under sectons54/54b/54d/54ec/54ed/54f B4 5 Total long term captal gan ( + 2e[ (enter 2e as nl f loss)+ 3e(enter 3e as nl f loss) + 4)] B5 C Income chargeable under the head CAPITAL GAINS (A + B5) (enter B5 as nl, f loss) C D Informaton about accrual/recept of captal gan Page 4 of 8

NOTE Date Upto 5/9 () /9 to 5/2 () /2 to 5/3 () Long term 2 Shortterm Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head /3 to 3/3 (v) Schedule OS OTHER SOURCES c Balance (4a 4b) 4c 5 Income chargeable under the head Income from other sources ( 3 + 4c)(enter 4c as nl f loss 5 and take 4c loss fgure to schedule CYLA) NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head CURRENT YEAR LOSS ADJUSTMENT Income a Dvdends, Gross a b Interest, Gross c Rental ncome from machnery, plants, buldngs, c d Others, Gross (excludng ncome from ownng race horses)d e Total (a + b + c + d) e f Deductons under secton 57: Expenses f Deprecaton Total g Balance (e f) Income from other sources 2 Wnnngs from lotteres, crossword puzzles, races, etc. 2 3 Income from other sources (other than from ownng race horses) (g + 2)(enter g as nl, f loss) 3 4 Income from ownng and mantanng race horses a Recepts 4a b Deductons under secton 57 n relaton to (4) Schedule CYLA Detals of Income after Set off of current year losses Sl. Head/ Source ÿÿÿ of ÿÿÿÿÿÿÿÿÿÿÿü Income of House µ property loss of Busness Loss Income current the current year set off year (Fll ths column only f ncome s zero Total loss(c of Total loss(v of or postve) Schedule HP) Schedule BP v v v v v Loss to be adjusted Salares House property ÿ _B¼ Busness or professon Shortterm captal gan Long term captal gan Other sources (ncl proft from ownng race horses) Total loss set off Loss remanng after setoff b f f 4b g Other sources loss (other than loss from race horses) of the current year set off Total loss(3 of Schedule OS) Current year s Income remanng after set off 2 3 4 5=234 Page 5 of 8

Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years Sl. Head/ Source ÿÿÿ of Income ÿÿÿÿÿÿÿÿÿÿÿü Income after µ set off, f any, of Brought forward loss set off Current year s Income current year s losses as per 4 of remanng after set off Schedule CYLA BROUGHT FORWARD LOSS ADUSTMENT v v v Salares House property ÿ _B¼ Busness or professon Shortterm captal gan Long term captal gan Other sources (proft from ownng race horses) 2 3 v P v Schedule CFL SI.. Total of brought forward loss set off Current year s ncome remanng after set off Total (3 + 3 + 3 + v3 + v3+v3) Detals of Losses to be carred forward to future years ÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿü µ Assessment Year Date of Flng House (DD/MM/YYYY) property loss Busness or professon Shortterm captal loss Longterm Capta l loss Other sources loss (from ownng race horses) CARRY FORWARD OF LOSS v v v v v x x x x Total of earler year losses Adjustment of above losses n Schedule BFLA 2009200 (Current year losses) Total loss Carred Forward to future years Schedule VIA Deductons under Chapter VIA (Secton) a 80C ÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿü h µ 80G b 80CCC 80GG c 80CCD j 80GGA d 80D k 80GGC e 80DD l 80QQB f 80DDB m 80RRB g 80E n 80U o Total deductons (total of a to n) TOTAL DEDUCTIONS o P Schedule SPI Sl. Name of person Income of specfed persons(spouse, mnor chld etc) ncludable n ncome of the assessee ÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿü µ PAN of person(optonal) Relatonshp Nature of Income Amount (Rs) Page of 8

Schedule SI Income chargeable to Income tax at specal rates IB [Please see nstructon.9() for secton code and rate of tax] Sl Secton Specal rate Income Tax thereon Sl Secton Specal code (%) code rate(%) P 2 P 7 P 3 P 8 P 4 P 9 P 5 P 0 P P Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income) Interest ncome ÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿü µ P 2 Dvdend ncome P 2 P 3 Longterm captal gans on whch Securtes Transacton Tax s pad P 3 P 4 Net Agrculture ncome /any other ncome for rate purpose P 4 P 5 Share n the proft of frm/aop etc. P 5 P Others P P 7 Total (+2+3+4+5+) P 7 SPECIAL RATE EXEMPT INCOME TAX PAYMENTS Income Total ( to 0 ) Tax thereon P Schedule AIR Other Informaton (Informaton relatng to Annual Informaton Return) [Please see nstructon number9() for code SI Code of Transacton Amount (Rs) SI Code of Transacton 00 5 005 P 2 002 00 P 3 003 7 007 P 4 004 8 008 P Schedule IT Detals of Advance Tax and Self Assessment Tax Payments of Incometax Sl Name of Bank & Branch BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) Amount (Rs) () () () (v) (v) NOTE > Enter the totals of Advance tax and Self Assessment tax n Sl. 9a & 9c of PartBTTI Schedule TDS TDS ON SALARY Sl () Detals of Tax Deducted at Source from Salary [As per Form ssued by Employer(s)] Tax Deducton Account Number (TAN) of the Employer (2) Unque Transacton Number (UTN) (9) Name and address of the Employer (3) Income chargeable under the head Salares (4) Deducton under Chapter VIA (5) Tax payable (ncl. surch. and edn. cess) () Total tax deposted (7) Tax payable/ refundable (8) Page 7 of 8

Schedule TDS2 Detals of Tax Deducted at Source on Income [As per Form A ssued by Deductor(s)] TDS ON OTHER INCOME Sl () Tax Deducton Account Number (TAN) of the Deductor (2) Unque Transacton Number (UTN) (9) Name and address of the Deductor (3) Amount pad (4) Date of Payment /Credt (5) Total tax deposted () Amount out of () clamed for ths year (7) NOTE > Please enter total of column 7 of ScheduleTDS and column 7 of ScheduleTDS2 n 9(b) of Part BTTI Page 8 of 8