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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 of the Income-tax Rules,96) (Also see attached nstructons) Assessment Year 0 - Part A-GEN GENERAL Frst name Mddle name Last name PAN PERSONAL INFORMATION Flat/Door/Block No Road/Street/Post Offce Town/Cty/Dstrct Name Of Premses/Buldng/Vllage Area/localty State Pn code Status (Tck) Indvdual Date of Brth (DD/MM/YYYY) ( n case of ndvdual) / / HUF Sex (n case of ndvdual) (Tck) Male Female Resdental/Offce Phone Number wth STD code Moble Employer Category(f n employment) (Tck) Govt PSU Others Emal Address Income Tax Ward/Crcle Return fled (Tck)[Please see nstructon number-7] Before due date -39() After due date -39(4) Revsed Return- 39() FILING STATUS OR In response to notce 4() 48 3A/3C If revsed, then enter Recept No and Date of flng orgnal return (DD/MM/YYYY) / / Resdental Status (Tck) Resdent Non-Resdent Resdent but Not Ordnarly Resdent Whether ths return s beng fled by a representatve assessee? (Tck) Yes No If yes, please furnsh followng nformaton - (a) (b) (c) Name of the representatve Address of the representatve Permanent Account Number (PAN) of the representatve PART-B Part B - TI Computaton of total ncome Salares (6 of Schedule S) TOTAL INCOME Income from house property (3c of Schedule HP) (enter nl f loss) 3 Profts and gans from busness or professon (6v of Schedule BP) (enter nl f loss) 3 4 Captal gans a Short term Short-term (u/s A) (enter nl, f loss) (A of Schedule CG) 4a Short-term (others) (A6 of Schedule CG) Total short-term (4a + 4a) (enter nl f loss) (A4 of Schedule CG) b Long-term (B of Schedule CG) (enter nl f loss) c Total captal gans (4a + 4b) (enter nl f 4c s a loss) Do not wrte or stamp n ths area (Space for bar code) 4a 4a 4b 4c For Offce Use Only Recept No Date Seal and Sgnature of recevng offcal

Income from other sources a from sources other than from ownng race horses (3 of Schedule OS) (enter nl f loss) b from ownng race horses (4c of Schedule OS) (enter nl f loss) c Total (a + b) (enter nl f c s a loss) a b c 6 Total (++3+4c+c) 6 7 Losses of current year set off aganst 6 (total of v,3v and 4v of Schedule CYLA) 7 8 Balance after set off current year losses (6-7) (also total of column of Schedule CYLA) 8 9 Brought forward losses set off aganst 8 (v of Schedule BFLA) 9 0 Gross Total ncome (8-9)(also 3v of Schedule BFLA) 0 Deductons under Chapter VI-A (o of Schedule VIA) Total ncome (0 ) 3 Net agrcultural ncome/ any other ncome for rate purpose (4 of Schedule EI) 3 4 Aggregate ncome (+ 3) 4 Losses of current year to be carred forward (x of Schedule CFL) Part B - TTI Computaton of tax lablty on total ncome Tax payable on total ncome COMPUTATION OF TAX LIABILITY TAXES PAID a Tax at normal rates b Tax at specal rates ( of Schedule SI) c Tax Payable on Total Income (a + b) Educaton cess, ncludng secondary and hgher educaton cess on c 3 Gross tax lablty (c+ ) 3 4 Tax relef a Secton 89 b Secton 90 c Secton 9 d Total (4a + 4b+4c) Net tax lablty (3 4d) 6 Interest payable a For default n furnshng the return (secton 34A) b For default n payment of advance tax (secton 34B) c For deferment of advance tax (secton 34C) d Total Interest Payable (6a+6b+6c) 7 Aggregate lablty ( + 6d) 7 8 Taxes Pad a Advance Tax (from Schedule-IT) b TDS (total of column 7 of Schedule-TDS and column 7 of Schedule-TDS) c Self Assessment Tax(from Schedule-IT) d Total Taxes Pad (8a+8b+8c) 9 Amount payable (Enter f 7 s greater than 8d, else enter 0) 9 0 Refund (If 8d s greater than 7) 0 a b 4a 4b 4c 6a 6b 6c 8a 8b 8c c 4d 6d 8d REFUND Enter your bank account number (mandatory n all cases) Do you want your refund by cheque, or deposted drectly nto your bank account? (tck as applcable ) 3 Gve addtonal detals of your bank account MICR Code Type of Account (tck as applcable ) Savngs Current 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, 96, n respect of ncome chargeable to Income-tax for the prevous year relevant to the Assessment Year 0-0. Place Date Sgn here

4 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals 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 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 separately below) Allowances exempt under secton 0 (Not to be ncluded n 6 below) 3 Allowances not exempt (refer Form 6 from employer) 3 4 Value of perqustes (refer Form 6 from employer) 4 Profts n leu of salary (refer Form 6 from employer) 6 Income chargeable under the Head Salares (+3+4+) 6 Schedule HP Detals of Income from House Property (Please refer to nstructons) Address of property Town/ Cty State PIN Code (Tck) f let out Name of Tenant PAN of Tenant (optonal) HOUSE PROPERTY a Annual letable value/ rent receved or recevable (hgher f let out for whole of the year, lower a 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) e f 30% of e f g Interest payable on borrowed captal g h Total (f + g) h Income from house property (e h) Address of property Town/ Cty State PIN Code (Tck) f let out Name of Tenant PAN of Tenant (optonal) a Annual letable value/ rent receved or recevable (hgher f let out for whole of the year, lower a 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) e f 30% of e f g Interest payable on borrowed captal g h Total (f + g) h Income from house property (e h) 3 Income under the head Income from house property a Rent of earler years realzed under secton A/AA 3a b Arrears of rent receved durng the year under secton B after deductng 30% 3b c Total (3a + 3b + + ) 3c 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

FIRMS IN WHICH PARTNER Number of frms n whch you are partner Sl. 3 4 6 Total 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 3 st March n the frm Schedule BP INCOME FROM FIRMS Sl. 3 4 Frm PAN (From Schedule-IF) 6 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 Iv v v 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 gan From assets n case of non-resdent to whch frst provso to secton 48 s applcable From assets n the case of others a Full value of consderaton a b Deducton under secton 48 Cost of acquston b Cost of Improvement b Expendture on transfer b v Total ( + + ) bv c Balance (a bv) c d Loss, f any, to be gnored under secton 94(7) or d 94(8) (enter postve values only) e Deducton under secton 4B/4D e f Short-term captal gan (c + d e) f 3 Amount deemed to be short term captal gans under sectons 4B/4D/4EC/ 4ED/4G/ A3 4GA 4 Total short term captal gan ( + f + A3) A4 Short term captal gan under secton A ncluded n 4 A 6 Short term captal gan other than referred to n secton A (A4 A) A6 B Long term captal gan Asset n case of non-resdent to whch frst provso to secton 48 s applcable Asset n the case of others where provso under secton () not exercsed a Full value of consderaton a b Deductons under secton 48 Cost of acquston after ndexaton b Cost of mprovement after ndexaton b Expendture on transfer b v Total (b + b +b) bv c Balance (a bv) c d Deducton under sectons 4/4B/4D/4EC/4F d 4G/4GA e Net balance (c d) 3 Asset n the case of others where provso under secton () s exercsed 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 v Total (b + b +b) bv e

c Balance (3a bv) 3c d Deducton under sectons 4/4B/4D/4EC/4F 3d e Net balance (3c 3d) 3e 4 Amount deemed to be long term captal gans under sectons 4/4B/4D/4EC/4ED/4F B4 Total long term captal gan ( + e [(enter e as nl f loss) + 3e (enter 3e as nl f loss) + 4)] B C Income chargeable under the head CAPITAL GAINS (A4 + B) (enter B as nl, f loss) C D Informaton about accrual/recept of captal gan Date Upto /9 () Long- term where provso under secton () s exercsed (Wthout Indexaton)- Code n SI Schedule s, Tax Rate s 0% ; Enter only postve value from Item B3e of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. Long- term where provso under secton () s NOT exercsed (Wth Indexaton)- Code n SI Schedule s, Tax Rate s 0%; Enter only postve value from Item (B-B3e) of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 3 Short-term under A- Code n SI Schedule s A, Tax Rate s % ; Enter only postve value from Item A7 of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 4 Short-term OTHERS- Taxed at normal rates; Enter only postve value from Item A8 of Schedule CG AFTER loss adjustment under ths category n Schedule CYLA and BFLA, f any. 6/9 to / () 6/ to /3 () Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head 6/3 to 3/3 (v) Schedule OS OTHER SOURCES Income from other sources Income a Dvdends, Gross a b Interest, Gross b 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 7:- Expenses / Deductons f Deprecaton f Total f g Balance (e f) g Wnnngs from lotteres, crossword puzzles, races, etc. 3 Income from other sources (other than from ownng race horses) (g + ) (enterg as nl, f loss) 3 4 Income from ownng and mantanng race horses a Recepts 4a b Deductons under secton 7 n relaton to (4) 4b c Balance (4a 4b) Income chargeable under the head Income from other sources (3 + 4c) (enter 4c as nl f loss and take 4c loss fgure to Schedule CYLA) 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 years losses Sl.No Head/ Source of Income Income of current year House property loss of the current year set off Busness Loss (Fll ths column only f ncome s zero or postve) Total loss CURRENT YEAR LOSS ADJUSTMENT v Loss to be adjusted -> Salares House property Busness or professon Short-term captal gan 4c 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 Total loss (3c of Schedule HP) (6v of Schedule-BP) 3 4 =--3-4

v Long term captal gan v Other sources (ncl. proft from ownng race horses but excludng wnnngs from lottery) v Total loss set off v Loss remanng after set-off Schedule BFLA Detals of Income after Set off of Brought Forward Losses of earler years Sl. Head/ Source of Income Income after set off, f any, of Brought forward loss set off Current year s ncome current year s losses as per 4 of Schedule CYLA) remanng after set off 3 BROUGHT FORWARD LOSS ADJUSTMENT Salares House property Busness or professon v Short-term captal gan v Long-term captal gan v Other sources (ncl. proft from ownng race horses but excludng wnnngs from lottery) v Total of brought forward loss set off v Current year s ncome remanng after set off Total (3 + 3 + 3 + v3 + v3+v3) Schedule CFL Detals of Losses to be carred forward to future years Sl. Assessment Year Date of Flng House Busness or (DD/MM/YYYY) property loss professon 003-04 Short-term captal loss Long-term Captal loss Other sources loss (from ownng race horses) 004-0 CARRY FORWARD OF LOSS 00-06 v 006-07 v 007-08 v 008-09 v 009-0 v 00- x Total of earler year losses x Adjustment of above losses n Schedule BFLA x 0- (Current year losses) x Total loss Carred Forward to future years Schedule VIA Deductons under Chapter VI-A (Secton) a 80C 80G TOTAL DEDUCTIONS b 80CCC j 80GG c 80CCD k 80GGA d 80CCF l 80GGC e 80D m 80QQB f 80DD n 80RRB g 80DDB o 80U h 80E p Total deductons (total of a to o) p Schedule SPI Income of specfed persons(spouse, mnor chld etc) ncludable n ncome of the assessee Sl No Name of person PAN of person (optonal) Relatonshp Nature of Income Amount (Rs) 3 Schedule SI Income chargeable to Income tax at specal rates IB [Please see nstructon Number-9() for secton code and rate of tax]

Sl No Secton code Specal rate (%) Income Tax thereon Sl No Secton code Specal rate (%) Income Tax thereon SPECIAL RATE A 6 0 7 3 0 8 4 BB 30 9 0 Total ( to 0 ) Schedule EI Detals of Exempt Income (Income not to be ncluded n Total Income) Interest ncome EXEMPT INCOME Dvdend ncome 3 Long-term captal gans on whch Securtes Transacton Tax s pad 3 4 Net Agrculture ncome /any other ncome for rate purpose 4 Share n the proft of frm/aop etc. 6 Others 6 7 Total (++3+4++6) 7 Schedule IT Sl No TAX PAYMENTS v v Detals of Advance Tax and Self Assessment Tax Payments of Income-tax BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) Enter the totals of Advance tax and Self Assessment tax n Sl 9a & 9c of PartB-TTI Schedule TDS Detals of Tax Deducted at Source from Salary [As per Form 6 ssued by Employer(s)] Sl Tax Deducton Account Name of the Employer Income chargeable under Salares Total tax deducted No Number (TAN) of the Employer () () (3) (4) () TDS ON SALARY Schedule TDS Detals of Tax Deducted at Source on Income [As per Form 6 A ssued by Deductor(s)] Sl Tax Deducton Account Name of the Deductor Total tax deducted Amount out of (4) clamed for ths year No Number (TAN) of the Deductor () () (3) (4) () TDS ON OTHER INCOME Please enter total of column 7 of Schedule-TDS and column 7 of Schedule-TDS n 9(b) of PartB-TTI