SAHAJ

FORM

ITR-1

INDIAN INCOME TAX RETURN

Assessment
Year

[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)]

2012-13
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

PERSONAL INFORMATION

First Name

Middle Name

Last Name

PAN

Flat / Door / Building

Status
I - Individual

Road / Street

Area / Locallity

Town/City/District

State

Email Address

Mobile no

Pin Code

FILING STATUS

Employer Category (if in

employment) OTH
Return filed under section
[Pl see Form Instruction] 11-BeforeDueDt

O-Original

If revised, enter Original Ack no / Date

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

Date

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

No
Residential Status

Sex (Select)
M-Male

(Std code) Phone No

Income Tax Ward / Circle

Whether original or revised return?

Date of birth (DD/MM/YYYY)

00/00/0000

RES - Resident

If u/s 139(9)defective return ,

enter Notice Date
Nil Tax Balance
Tax Status

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

Income from one House Property
2

TAX COMPUTATION

INCOME & DEDUCTIONS

1
2

Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2+3)

5 Deductions under Chapter VI A (Section)
5a
a 80 C
5b
b 80 CCC
5c(i)
c(i) 80 CCD (Employers Contribution)
80 CCD (Employees / Self Employed
5c(ii)
c(ii)
Contribution)
5d
d 80 CCF
5e
e 80 D
5f
f 80 DD
5g
g 80 DDB
5h
h 80 E
5i
i 80 G
5j
j 80 GG
5k
k 80 GGA
5l
l 80 GGC
5m
m 80 U
6
6 Deductions (Total of 5a to 5m)
7 Total Income (4 - 6)
8 Tax payable on Total Income
9 Education Cess, including secondary and higher secondary cess on 8
10 Total Tax, Surcharge and Education Cess (Payable) (8 + 9)
11
11 Relief under Section 89
12
12 Relief under Section 90/91
Balance
Tax
Payable
(10
11
12)
13
14 Total Interest u/s 234A 234B 234C
15 Total Tax and Interest Payable (13 + 14)

4
System Calculated
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0 6
7
8
9
10
0
0
13
14
15

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0

0
0
0

23

Details of Tax Deducted at Source from SALARY

[As per FORM 16 issued by Employer(s)]
Tax Deduction
Name of the
Account Number
SI.No
Employer
(TAN) of the
Employer
(3)
(1)
(2)
1
2
3

Income charg
eable under the
head Salaries

Total tax
Deducted

(4)

(5)

(Click + to add more rows to 23) TDS on Salary above. Do not delete blank rows. )
24

Details of Tax Deducted at Source on Income OTHER THAN SALARY

[As per FORM 16 A issued by Deductor(s)]

SI.No

(1)
1
2
3
4

Tax Deduction
Account Number
(TAN) of the
Deductor

Name of the
Deductor

Unique TDS
Certificate No.

Deducted
Year

Total tax
Deducted

(2)

(3)

(4)

(5)

(6)

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

25
Sl No

Details of Advance Tax and Self Assessment Tax Payments

BSR Code

Date of Credit into

Govt Account
(DD/MM/YYYY)

Serial
Number of
Challan

Amount (Rs)

1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )

Amount
out of
(6)
claimed
for
this year
(7)

TAXES PAID
REFUND

16 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.
16a
16b

c Self Assessment Tax (item 25)

16c
Total Taxes Paid (16a+16b+16c)
Tax Payable (15-17) (if 15 is greater than 17)
Refund (17-15) if 17 is greater than 15
Enter your Bank Account number

a Advance Tax (from item 25)

b TDS (Total from item 23 + item 24)

17
18
19
20

0
17
18
19

No
21 Select Yes if you want your refund by direct deposit into your bank account,
Select No if you want refund by Cheque
22 In case of direct deposit to your bank account give additional details
MICR Code
Type of Account(As applicable)
26 Exempt income for reporting purposes only
VERIFICATION
son/daughter of
I,
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
Place
Date
Sign here ->
PAN
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

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

0
0
0

Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW)
Schedule 80G
Donations entitled for 100% deduction without qualifying limit
A
Name of
donee

Adress

City or Town or
District

State Code

PinCode

PAN of Donee Amount of Eligible

donation Amount of
Donation
0
0
0
0

1
2
3
4
Total 80GA

Donations entitled for 50% deduction without qualifying limit

Name of Address
City or Town or State Code
donee
District

PinCode

PAN of Donee Amount of Eligible

donation Amount of
Donation
0
0
0
0

1
2
3
4
Total 80GB :

Donations entitled for 100% deduction subject to qualifying limit

Name of Address
City Or Town Or State Code
donee
District

PinCode

PAN of Donee Amount of Eligible

donation Amount of
Donation
0
0
0
0

1
2
3
4
Total 80GC :

Donations entitled for 50% deduction subject to qualifying limit

Name of Address
City Or Town Or State Code
donee
District

PinCode

PAN of Donee Amount of Eligible

donation Amount of
Donation
0
0
0
0

1
2
3
4
Total 80GD

Donations (A + B + C + D)

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