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FORM
ITR-1 [For Individuals having Income from Salary/ Pension/ family pension & Interest]
(Please see Rule 12 of the Income Tax-Rules,1962) (Also see attached Instructions) 2 0 0 9 - 10
First Name Middle Name Last Name PAN
GANESH CHINNAPPAN AESPG9215K
PERSONAL INFORMATION
Flat / Door / Block No Name of Premises / Building / Village Status
2/391 9th Cross Street I - Individual
Road / Street / Post Office Area / Locality Date of birth (DD/MM/YYYY)
Singaravelan Street Chinna Neelangarai 24/05/1977
STATUS
FILING
Whether original or revised return? O-Original
If revised, enter Receipt no / Date Revised Date
Residential Status RES - Resident
1 Income chargeable under the Head ‘Salaries’(Salary/ Pension) 1 312,000
2 Income chargeable under the Head ‘Other Sources’
a Family Pension 2a
b Interest 2b
c Total (2a + 2b) 2c 0
3 Gross Total Income (1+2c) 3 312,000
4 Deductions under Chapter VI A (Section)
TAX COMPUTATION
9 a Tax payable on Total Income (8a-8b) 9a 0
b Surcharge on 9a 9b
Education Cess, including secondary and
c higher secondary cess on (9a+9b) 9c
19 Select Yes if you want your refund by direct deposit into your bank account, No
Select No if you want refund by Cheque
20 In case of direct deposit to your bank account give additional details
MICR Code Type of Account(As applicable)
24 Other Information (transactions reported through Annual Information Return) (Please see instruction
number-9(ii) for code)
Sl Code Amount (Rs) Sl Code Amount (Rs)
a 001 b 002
c 003 d 004
e 005 f 006
g 007 h 008
25 Tax-exempt interest income (for reporting purposes only)
VERIFICATION
I, (full name in block letters), GANESH son/daughter of CHINNAPPAN
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 2009-10
Place CHENNAI Date Sign here ->
PAN AESPG9215K
26 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No of TRP Name of TRP Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be
27
filled by TRP)
21 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Income Tax
Tax Deduction
charg Deduction payable
Account Tax
UTN (Unique Name of the eable under (incl. Total tax
SI.No Number Address City State PinCode payable/
Transaction Number) Employer under the Chapter surch. Deducted
(TAN) of the refundable
head VI-A and
Employer
Salaries edn.cess)
(1) (2) (9) (3) (4) (5) (6) (7) (8)
1
2
3
(Click + to add more rows to 22) TDS on Interest above. Do not delete blank rows. Blank rows will not be included In the ITR)
22 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]
Tax Deduction Amount
Account Amount Date of out of
UTN (Unique Name of the Total tax
SI.No Number Address City State PinCode paid/ Payment (6) claimed
Transaction Number) Deductor Deducted
(TAN) of the credited / Credit for
Deductor this year
(1) (2) (8) (3) (4) (5) (6) (7)
1
2
3
4
(Click + to add more rows to 22) TDS on Interest above. Do not delete blank rows. Blank rows will not be included In the ITR)
1
2
3
4
5
6
(Click '+' to add more rows to 23) Tax Payments. Do not delete blank rows. Blank rows will not be included In the ITR)