Income Tax

FO

RM

SAHAJ INDIAN INCOME TAX RETURN

ITR-1

(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

PE

RS

ON

AL

IN

FO

RM

AT

ION

First Name Middle Name Last Name PAN Kuldeep Singh Hooda AATPH4531L

Flat / Door / Building StatusHOUSE NO. 70 I - Individual

Road / Street Area / Locallity Date of birth (DD/MM/YYYY)Type-IV Thermal Colony 08/04/1973

Town/City/District State Pin Code Sex (Select)Panipat 12-HARYANA 132105 M-Male

Email Address Mobile no (Std code) Phone No Employer Category (if in [email protected] 9355084855 employment) GOV

FIL

ING

ST

AT

US

Income Tax Ward / Circle Return filed under section1 [Pl see Form Instruction]Whether original or revised return? O-Original

If revised, enter Original Ack no / Date Date

Residential Status RES - Resident Tax Status Tax Refundable

INC

OM

E &

DE

DU

CT

ION

S

1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1 1,004,390

2Income from one House Property

2

3 Income from Other Sources (Ensure to fill Sch TDS2) 3 525

4 Gross Total Income (1+2+3) 4 1,004,9155 Deductions under Chapter VI A (Section) System Calculated

a 80 C 5a 100,000 100,000b 80 CCC 5b 0 0

c(i) 80 CCD (Employers Contribution) 5c(i) 0 0

c(ii) 5c(ii)0

0

d 80 CCF 5d 20,000 20,000e 80 D 5e 0 0f 80 DD 5f 0 0g 80 DDB 5g 0 0h 80 E 5h 0 0i 80 G 5i 0 0j 80 GG 5j 0 0k 80 GGA 5k 0 0l 80 GGC 5l 0 0

m 80 U 5m 0 06 Deductions (Total of 5a to 5m) 6 120,000 6 120,0007 Total Income (4 - 6) 7 884,915

TA

X C

OM

PU

TA

TIO

N 8 Tax payable on Total Income 8 117,4749 Education Cess, including secondary and higher secondary cess on 8 9 3,52410 Total Tax, Surcharge and Education Cess (Payable) (8 + 9) 10 120,99811 Relief under Section 89 11 012 Relief under Section 90/91 12 013 Balance Tax Payable (10 - 11 - 12) 13 120,99814 Total Interest u/s 234A 234B 234C 14 015 Total Tax and Interest Payable (13 + 14) 15 120,998

Assessment Year

2 0 1 2 - 1 3

[For Individuals having Income from Salary / Pension / Income from One House Property (excluding loss brought forward from previous years) /

Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)]

11-BeforeDueDt 139(1)

If u/s 139(9)-defective return , enter Original Ack No

If u/s 139(9)-defective return , enter Notice No

If u/s 139(9)-defective return , enter Notice Date

80 CCD (Employees / Self Employed Contribution)

C6

Enter first name

M6

Enter middle name, if any

U6

Last name / Surname should not be blank

AL6

PAN: First five alphabets, next four digits, then alphabet (exactly 10 chars)

AL14

Should be in DD/MM/YYYY format only. DoB should be before 01/04/2012

AD18

Enter six digit pin code (NRI can enter 999999)

C22

Enter valid Email Address to receive copy of ITR-V via email

U22

Mobile number : Must be 10 digits.

Y22

Do not prefix '0' before STD code.

AD22

Enter your Phone Number

AP22

Select from list provided. If not employed or for HUF use 'OTH'

C24

Enter the ward or circle where the return is filed

AN24

Select from list provided. Usually would be 11

V26

Select from list provided. If this is the only Return then select 'Original' if you have already filed your return for this year and would like to make changes then select 'Revised'

AM28

On or after 01/04/2010 Enter the Acknowledgement number and date of filing of Original return

C30

S.139(9) If filed u/s 139(9), then mention Original Receiptno

C31

S.139(9) If filed u/s 139(9), then mention Notice No or Communication Reference No and Notice Date

U31

Notice No : 30 characters . (Communication Reference No)

AM31

Enter the Notice Date in dd/mm/yyyy format

U32

Select from list provided. Usually would be 'RES'

AM32

Tax Status :

Z70

Calculate relief u/s 89 as per IT Act in case of receipt of arrears of salary.or advances of salary recieved during the year.

Z71

Calculate relief u/s 90 or 91 as per IT Act in case of tax paid outside India

23

SI.No

(1) (2) (3) (4) (5) ###

1 RTKH01496F HPGCL 1,004,915 120,999 ###2 ###3 ###4 ###

(Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. ) ###

24 ###

SI.No

###(1) (2) (3) (4) (5) (6) (7) ###1 ###2 ###3 ###4 ###

(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. ) #########

25 Details of Advance Tax and Self Assessment Tax Payments ###

Sl No

###

BSR Code Amount (Rs)

1 ###2 ###3 ###4 ###5 ###6 ###7 ###8 ###9 ###

10 ###11 ###

Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)]

Tax DeductionAccount Number

(TAN) of the Employer

Name of the Employer

Income chargeable under thehead Salaries

Total taxDeducted

Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)]

Tax DeductionAccount Number

(TAN) of the Deductor

Name of the Deductor

Unique TDS Certificate No.

Deducted Year

Total taxDeducted

Amount out of

(6) claimed

forthis year

Date of Credit into Govt Account(DD/MM/YYYY)

Serial Number ofChallan

C4

First four alphabets, next five digits, then alphabet(exactly 10 chars). Quote valid TAN to ensure credit for TDS

D4

Enter name of employer

E4

Enter details from Form 16

F4

Enter details from Form 16. Round off to nearest Rupee. This is the value TDS to be included in item 15b

C5


D5

Enter name of employer

E5

Enter details from Form 16

F5

Enter details from Form 16. Round off to nearest Rupee. This is the value TDS to be included in item 15b

C12


D12

Enter name of deductor

E12

Enter 6 character TDS Certificate No. (where available)

F12

Enter Deducted Year , for ex: enter 2011 for 2011-12

N12

Enter details from Form 16A. Usually this will be the same as tax deducted. This value cannot exceed tax deducted. Round off to nearest Rupee. This is the value TDS to be included in item 15b

C13


D13


E13


F13


N13

Enter details from Form 16A. Usually this will be the same as tax deducted. This value cannot exceed tax deducted. Round off to nearest Rupee. This is the value TDS to be included in item 15b

D14


E14


F14


D15


E15


F15


B22

Enter seven digit code as per bank seal on counterfoil

C22

Enter date of Credit of tax payment into Govt Account in DD/MM/YYYY format. Date will be used to distinguish between Advance Tax Payments and Self Assessment Tax Payments. Date must not be prior to 01/04/2011

D22

Enter challan serial number as per bank seal

E22

Enter tax payment. Round off nearest Rupee

B23


C23


D23


E23


B24


C24


D24


E24


B25


C25


D25


E25


B26


C26


D26


E26


B27


C27


D27


E27


12 ###

(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )

TA

XE

S P

AID

16

a 16a 0

b TDS (Total from item 23 + item 24) 16b 120,999

c Self Assessment Tax (item 25) 16c 0

17 Total Taxes Paid (16a+16b+16c) 17 120,999

18 Tax Payable (15-17) (if 15 is greater than 17) 18 0

RE

FU

ND

19 Refund (17-15) if 17 is greater than 15 19 1

20 Enter your Bank Account number 55001529149

21 No

22 In case of direct deposit to your bank account give additional detailsMICR Code 132007250 Type of Account(As applicable) Savings

26 Exempt income for reporting purposes only VERIFICATION

I,

son/daughter of

Place PANIPAT Date 27/07/2012 Sign here ->

PAN AATPH4531L

27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:Identification No of TRP Name of TRP

28

Taxes Paid PLEASE NOTE THAT CALCULATED FIELDS (IN WHITE) ARE PICKED UP FROM OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below will get filled up when the Schedules linked to them are filled.

Advance Tax (from item 25)

Select Yes if you want your refund by direct deposit into your bank account, Select No if you want refund by Cheque

KULDEEP SINGH HOODA

RAM TIRATH HOODA

solemnly declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of income chargeable to Income-tax for the previous year relevant to the Assessment Year 2012-13

If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled by TRP)

J9

Select if Y in case direct deposit is required. This facility avilable only in select cities.

E11

MICR Code is printed on the middle of the bottom portion of your cheque.

J11

Select appropriate nature of the account

J28

Enter fathers name

C31

Enter city

H31

Enter date in DD/MM/YYYY. Date should be on after 01/04/2012. Do not enter future date.

A35

Enter ID of TRP

F35

Enter name of TRP

J37

Enter TRP reimbursement amount

Schedule 80G ###

ADonations entitled for 100% deduction without qualifying limit

###

Adress State Code PinCode PAN of Donee

1 0 ###2 0 ###3 0 ###4 0 ###

Total 80GA 0 0

B Donations entitled for 50% deduction without qualifying limit

Address State Code PinCode PAN of Donee

1 0 ###2 0 ###3 0 ###4 0 ###

Total 80GB : 0 0

C Donations entitled for 100% deduction subject to qualifying limit


1 0 ###2 0 ###3 0 ###4 0 ###

Total 80GC : 0 0

Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW)

Name of donee

City or Town or District

Amount of donation

Eligible Amount of Donation

Name of donee

City or Town or District

Amount of donation


Name of donee

City Or Town Or District

Amount of donation


D Donations entitled for 50% deduction subject to qualifying limit


1 0 ###2 0 ###3 0 ###4 0 ###

Total 80GD 0 0

E Donations (A + B + C + D) 0 0

NOTE : (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2), PLEASE USE PAN AS "GGGGG0000G".

Name of donee

City Or Town Or District

Amount of donation


Documents

Income Tax