FORM TR-2A NDAN NCOME TAX RETURN [For ndvduals and HUFs not havng ncome from Busness or Professon and Captal Gans and who do not hold foregn assets] (Please see Rule 12 of the ncome-tax Rules,1962) (Also see attached nstructons) Assessment Year 2 0 1 6-1 7 Part A-GEN GENERAL Frst name Mddle name Last name PAN Flat/Door/Block Name of Premses/Buldng/Vllage Status (Tck) PERSONAL NFORMATON ndvdual HUF Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Do you have Aadhaar Number? (For ndvdual) Yes. f Yes, please provde Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) Country Male Female Resdental/Offce Phone Number wth STD code/ Moble. 1 Emal Address-1 (self) Moble. 2 Employer Category (f n employment) (Tck) Govt. PSU Others ncome Tax Ward/Crcle Emal Address-2 Passport. (ndvdual)(f avalable) FLNG STATUS Return fled (Tck)[Please see nstructon number-7] On or before due date-139(1), After due date-139(4), Revsed Return-139(5), under secton 119(2)(b), or n response to notce 139(9)-Defectve, 142(1), 148, 153A/153C f revsed/defectve, then enter Recept and Date of flng orgnal return (DD/MM/YYYY) / / f fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce / / Resdental Status (Tck) Resdent n-resdent Resdent but t Ordnarly Resdent Are you governed by Portuguese Cvl Code as per secton 5A? Tck) Yes (f YES please fll Schedule 5A) Whether return s beng fled by a representatve assessee? (Tck) Yes f yes, please furnsh followng nformaton - (a) (b) Name of the representatve Address of the representatve ( c) Permanent Account Number (PAN) of the representatve Part B - T TOTAL NCOME Computaton of total ncome PART-B 1 Salares (7 of Schedule S) 1 2 ncome from house property (3c of Schedule HP) (enter nl f loss) 2 3 ncome from other sources from sources other than from ownng race horses and ncome chargeable to tax at specal a rate (1 of Schedule OS) (enter nl f loss) b ncome chargeable to tax at specal rate (1fv of Schedule OS) c from the actvty of ownng and mantanng race horses (3c of Schedule OS)(enter nl f loss) d Total (3a + 3b + 3c) (enter nl f loss) 4 Total (1+2+3d) 4 5 Losses of current year set off aganst 4 (total of 2v and 3v of Schedule CYLA) 5 6 Balance after set off current year losses (4-5) (total of col. 4 of Schedule CYLA +3b) 6 7 Brought forward losses set off aganst 6 (2v of Schedule BFLA) 7 8 Gross Total ncome (6-7)(3v of Schedule BFLA +3b ) 8 Do not wrte or stamp n ths area (Space for bar code) For Offce Use Only Recept. 3a 3b 3c 3d Date Seal and Sgnature of recevng offcal http://www.smpletaxnda.net/ Page 1 of 3
9 ncome chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n 8 9 10 Deductons under Chapter V-A [q of Schedule VA and lmted to (8-9)] 10 11 Total ncome (8-10) 11 12 ncome whch s ncluded n 11 and chargeable to tax at specal rates (total of () of schedule S) 12 13 Net agrcultural ncome/ any other ncome for rate purpose (4 of Schedule E) 13 14 Aggregate ncome (11-12+13) [applcable f (11-12) exceeds maxmum amount not chargeable to tax] 14 15 Losses of current year to be carred forward (total of row x of Schedule CFL) 15 Part B - TT Computaton of tax lablty on total ncome 1 Tax payable on total ncome a Tax at normal rates on 14 of Part B-T b Tax at specal rates (total of () of Schedule S) COMPUTATON OF TAX LABLTY TAXES PAD BANK ACCOUNT c Rebate on agrcultural ncome [applcable f (11-12) of Part B-T exceeds maxmum amount not chargeable to tax] d Tax Payable on Total ncome (1a + 1b 1c) 2 Rebate under secton 87A (applcable for resdent and f 11 of Part B-T does not exceed 5 lakh) 2 3 Tax payable (1d - 2) 3 4 Surcharge on 3 (applcable f 11 of Part B-T exceeds 1 crore) 4 5 Educaton cess, ncludng secondary and hgher educaton cess, on (3 + 4) 5 6 Gross tax lablty (3 + 4 + 5) 6 7 Tax relef under secton 89 7 8 Net tax lablty (6 7) (enter zero f negatve) 8 9 nterest 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 nterest Payable (9a+9b+9c) 10 Aggregate lablty (8 + 9d) 10 11 Taxes Pad a Advance Tax (from column 5 of 17A) 11a b TDS (total of column 5 of 17B and column 8 of 17C) 11b c TCS (total of column 5 of 17D) 11c d Self-Assessment Tax (from column 5 of 17A) 11d e Total Taxes Pad (11a + 11b + 11c+11d) 12 Amount payable (Enter f 10 s greater than 11e, else enter 0) 12 13 Refund (f 11e s greater than 10) (Refund, f any, wll be drectly credted nto the bank account) 13 14 Detals of all Bank Accounts held n nda at any tme durng the prevous year (excludng dormant accounts) 9a 9b 9c 1a 1b 1c Total number of savngs and current bank accounts held by you at any tme durng the prevous year (excludng dormant accounts). Provde the detals below.. FS Code of Name of Account Number (the number should be 9 Savngs/ ndcate the account n whch you prefer to get the Bank the Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account ) 1 2 VERFCATON, 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 ncome-tax Act, 1961, n respect of ncome chargeable to ncome-tax for the prevous year relevant to the Assessment Year 2016-17. Place Date Sgn here 15 f the return has been prepared by a Tax Return Preparer (TRP) gve further detals as below: dentfcaton. of TRP Name of TRP Counter Sgnature of TRP 1d 9d 11e http://www.smpletaxnda.net/ Page 2 of 3
f TRP s enttled for any rembursement from the Government, amount thereof 16 17 TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B TDS ON SALARY C TDS ON OTHER NCOME D TCS Detals of payments of Advance Tax and Self-Assessment Tax BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) (1) (2) (3) (4) (5) v v NOTE Enter the totals of Advance tax and Self-Assessment tax n. 11a & 11c of Part B-TT Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Tax Deducton Account Number (TAN) of the Employer Name of the Employer ncome chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 11b of Part B-TT Detals of Tax Deducted at Source (TDS) on ncome [As per Form 16 A ssued by Deductor(s)] 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 clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (6) or (7) beng carred forward Fn. Year n whch deducted Amount b/f n own hands n the hands of spouse, f secton 5A s applcable (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-TT Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Tax Collecton Account Number of the Collector Name of the Collector Tax Collected Amount out of (4) beng clamed Amount out of (4) beng clamed n the hands of spouse, f secton 5A s applcable (1) (2) (3) (4) (5) (6) NOTE Please enter total of column (5) of Schedule-TCS n 11c NOTE: PLEASE FLL SCHEDULE TO THE RETURN FORM (PAGES S1-S5) AS APPLCABLE http://www.smpletaxnda.net/ Page 3 of 3
SCHEDULES TO THE RETURN FORM (FLL AS APPLCABLE) Schedule S Detals of ncome from Salary Name of Employer PAN of Employer (optonal) Address of employer Town/Cty State Pn code 1 Salary (Excludng all exempt/ non-exempt allowances, perqustes & proft n leu of salary as they are shown separately below) 2 Allowances exempt under secton 10 (t to be ncluded n 7 below) 1 SALARES Travel concesson/assstance receved [(sec. 10(5)] 2 Tax pad by employer on non-monetary perquste [(sec. 10(10CC)] 2 Allowance to meet expendture ncurred on house rent [(sec. 10(13A)] 2 v Other allowances 2v 3 Allowances not exempt (refer Form 16 from employer) 3 4 Value of perqustes (refer Form 16 from employer) 4 5 Profts n leu of salary (refer Form 16 from employer) 5 6 Deducton u/s 16 (Entertanment allowance by Government and tax on employment) 6 7 ncome chargeable under the Head Salares (1 + 3 + 4 + 5-6) 7 Schedule HP Detals of ncome from House Property (Please refer to nstructons) Address of property 1 Town/ Cty State PN Code 1 s the property co-owned? Yes (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property HOUSE PROPERTY 2 (Tck) f let out deemed let out Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) 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 nterest payable on borrowed captal 1h Total (1g + 1h) 1 j ncome from house property 1 (1f 1) 1j Address of property 2 Town/ Cty State PN Code s the property co-owned? Yes (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 (Tck) f let out deemed let out Name(s) of Tenant PAN of Tenant (optonal) http://www.smpletaxnda.net/ Page S1
a Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of the year, lower of the two, f let out for part of the year) 2a b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) 2e f Annual value of the property owned (own percentage share x 2e) 2f g 30% of 2f 2g h nterest payable on borrowed captal 2h Total (2g+ 2h) 2 j ncome from house property 2 (2f 2) 2j 3 ncome under the head ncome 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 SP whle computng the ncome under ths head Schedule OS OTHER SOURCES NOTE ncome from other sources 1 ncome a Dvdends, Gross b nterest, Gross c Rental ncome from machnery, plants, buldngs, etc., Gross d Others, Gross (excludng ncome from ownng race horses)menton the source Wnnngs from lotteres, crossword puzzles etc. 1d v Total (1d + 1d+ 1d) 1dv e Total (1a + 1b + 1c + 1dv) 1e f ncome ncluded n 1e chargeable to tax at specal rate (to be taken to schedule S) Wnnngs from lotteres, crossword puzzles, races, games, gamblng, bettng etc (u/s 115BB) 1f Any other ncome chargeable to tax at the rate specfed under Chapter X/X-A 1f FOR NON-RESDENTS- ncome chargeable to be taxed under DTAA. Country Artcle Rate of tax Whether TRC Correspondng secton of the Amount of name, code of DTAA under DTAA obtaned? Act whch prescrbes rate ncome Total amount of ncome chargeable to tax under DTAA 1f v ncome 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 ncome from other sources (other than from ownng race horses and amount chargeable to tax at specal rate) (1g h) (f negatve take the fgure to 3 of schedule CYLA) 2 ncome from other sources (other than from ownng race horses) (1fv + 1) (enter 1 as nl, f negatve) 2 3 ncome from the actvty of ownng and mantanng race horses a Recepts 3a b Deductons under secton 57 n relaton to (4) 3b c Balance (3a 3b) (f negatve take the fgure to 4x of Schedule CFL) 4 ncome under the head ncome from other sources (2 + 3c) (take 3c as nl f negatve) 4 Please nclude the ncome of the specfed persons referred to n Schedule SP whle computng the ncome under ths head. h 1a 1b 1c 1d 1d 1 3c Schedule CYLA CURRENT YEAR LOSS Detals of ncome after Set off of current year losses Head/ Source of ncome ncome of current House property loss of Other sources loss (other year the current year set than loss from race horses) (Fll ths column only off of the current year set off f ncome s postve) ADJUSTMENT. Loss to be set off (3c of Schedule HP) (1 of Schedule-OS) Current year s ncome remanng after set off 1 2 3 4=1-2-3 http://www.smpletaxnda.net/ Page S2
Salares (7 of Schedule S) House property (3c of Schedule HP) v v Other sources (excludng proft from ownng race horses and amount chargeable to specal rate of tax) Proft from ownng and mantanng race horses v Total loss set off ( + + v + v) v Schedule BFLA BROUGHT FORWARD LOSS ADJUSTMENT.. Loss remanng after set-off ( - v) (1 of schedule OS) (3c of schedule OS) Detals of ncome after Set off of Brought Forward Losses of earler years Head/ Source of ncome ncome after set off, f any, of current year s losses as per col. 4 of Schedule CYLA Salares (4 of schedule CYLA) Brought forward loss set off Current year s ncome remanng after set off 1 2 3 House property (4 of schedule CYLA) (B/f house property loss) Other sources (excludng proft from ownng race horses and wnnngs from lottery, game etc.) (4v of Schedule CYLA) v Proft from ownng and mantanng race horses (4v of Schedule CYLA) (B/f loss from horse races) v Total of brought forward loss set off (2 + 2 + v2) v Current year s ncome remanng after set off Total (3 + 3 + 3 + v3) Schedule CFL CARRY FORWARD OF LOSS 2008-09 2009-10 2010-11 v 2011-12 v 2012-13 v 2013-14 v 2014-15 v 2015-16 x Total of earler year losses x Assessment Year Date of Flng House property loss Loss from ownng and mantanng race (DD/MM/YYYY) horses 1 2 3 4 Adjustment of above losses n Schedule BFLA x 2016-17 (Current year losses) x Total loss carred forward to future years (2 of schedule BFLA) (2v of schedule CYLA) (2v of schedule BFLA) Schedule VA Deductons under Chapter V-A (Secton) a 80C f 80DD m 80QQB b 80CCC g 80DDB n 80RRB c() 80CCD(1) h 80E o 80TTA TOTAL DEDUCTONS c() 80CCD(1B) 80G p 80U c() 80CCD(2) j 80GG d 80CCG k 80GGA e 80D l 80GGC q Total deductons (total of a to p) q Schedule 80G OF DONAT Detals of donatons enttled for deducton under secton 80G A Donatons enttled for 100% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton http://www.smpletaxnda.net/ Page S3
Total B Donatons enttled for 50% deducton wthout qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total C Donatons enttled for 100% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total D Donatons enttled for 50% deducton subject to qualfyng lmt Name and address of donee PAN of Donee Amount of donaton Elgble Amount of donaton Total E Total donatons (A + B + C + D) ncome of specfed persons (spouse, mnor chld etc) ncludable n ncome of the assessee (ncome of the mnor Schedule SP chld, n excess of Rs. 1,500 per chld, to be ncluded) Name of person PAN of person (optonal) Relatonshp Nature of ncome Amount (Rs) 1 2 3 Schedule S ncome chargeable to tax at specal rates (please see nstructons. 9 for rate of tax) Secton/Descrpton Specal rate ncome (%) () 1 115BB (Wnnngs from lotteres, puzzles, races, games etc.) 30 (1f of schedule OS) 2 115AC (ncome of a non-resdent from bonds or GDR purchased n foregn currency) 10 (part of 1f of schedule OS) SPECAL RATE 3 Chargeable under DTAA rate (part of 1f of schedule OS) 4 Total Tax thereon () Schedule E EXEMPT NCOME Detals of Exempt ncome (ncome not to be ncluded n Total ncome) 1 nterest ncome 1 2 Dvdend ncome 2 3 Long-term captal gans from transactons on whch Securtes Transacton Tax s pad 3 Gross Agrcultural recepts (other than ncome to be excluded under 4 rule 7A, 7B or 8 of.t. Rules) Expendture ncurred on agrculture Unabsorbed agrcultural loss of prevous eght assessment years v Net Agrcultural ncome for the year ( ) (enter nl f loss) 4 5 Others, ncludng exempt ncome of mnor chld 5 6 Total (1+2+3+4+5) 6 Schedule PT Pass Through ncome detals from busness trust or nvestment fund as per secton 115UA, 115UB. Name of busness trust/ PAN of the busness. Head of ncome Amount of nvestment fund trust/ nvestment fund ncome 1. House property Captal Gans a Short term b Long term Other Sources v ncome clamed to be exempt PASS THROUGH TDS on such amount, f any a u/s 10(23FBB) http://www.smpletaxnda.net/ Page S4
b u/s.. c u/s 2. House property Captal Gans a Short term b Long term Other Sources v ncome clamed to be exempt a u/s 10(23FBB) b u/s.. c u/s NOTE Please refer to the nstructons for fllng out ths schedule. Schedule 5A Name of the spouse nformaton regardng apportonment of ncome between spouses governed by Portuguese Cvl Code PAN of the spouse Heads of ncome ncome receved Amount apportoned n the Amount of TDS deducted TDS apportoned n the under the head hands of the spouse on ncome at () hands of spouse () () () (v) (v) 1 House Property 2 Busness or professon 3 Captal gans 4 Other sources 5 Total Schedule AL Asset and Lablty at the end of the year (Applcable n a case where total ncome exceeds Rs. 50 lakh) A Partculars of Asset Amount (Cost) (Rs.) DETALS OF ASSET AND LABLTY B 1 mmovable Asset a Land b Buldng 2 Movable Asset a Cash n hand b Jewellery, bullon etc. c Vehcles, yachts, boats and arcraft 3 Total Lablty n relaton to Assets at A http://www.smpletaxnda.net/ Page S5