Professional Documents
Culture Documents
[For Individuals having Income from Salary / Pension / Income from One House Property Year
FORM ITR-1 (excluding loss brought forward from previous years) /
Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)]
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions) 2011-12
First Name Middle Name Last Name PAN
PERSONAL INFORMATION
Sl No Serial
Date of Deposit
BSR Code Number of Amount (Rs)
(DD/MM/YYYY)
Challan
1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )
16 Taxes Paid
0
TAXES PAID
a Advance Tax (from item 25) 16a
b TDS (column 7 of item 23 +column 7 16b
0
of item 24)
c Self Assessment Tax (item 25) 16c 0
17 Total Taxes Paid (16a+16b+16c) 17 0
18 Tax Payable (15-17) (if 15 is greater than 17) 18 0
19 Refund (17-15) if 17 is greater than 15 19 0
20 Enter your Bank Account number (Mandatory )
REFUND
21 Select Yes if you want your refund by direct deposit into your bank account, No
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 (from Dividends, Agri. income < 5000)
VERIFICATION
I, (full name in block letters), son/daughter of
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 2011-12
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 Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be
28
filled by TRP)