INDIVIDUAL INCOME TAX RETURN

FORM

SAHAJ

ITR-1

(For Individuals having Income from Salaries, One House Property, Other Sources (Interest etc.) Refer to
Instructions for eligibililty.)

First Name

PERSONAL INFORMATION

Assessment
Year
2 0 16 - 1 7

Middle Name

Flat / Door / Building

Last Name

PAN

Name of Premises / Building / Village

Road / Street

Status

Area / Locality

Sex

Date of birth

(Select)
Town/ City/ District

State

Country

(Select)
Email Address

Pincode

(Select)

Mobile No. 1

(STD Code)

Mobile No. 2

Phone No

Employer Category
(Select)

Return filed under section

Income Tax Ward / Circle

(Select)
Whether Person governed by Portuguese Civil Code under section 5A ?

Enter PAN of Spouse if

applicable

FILING STATUS

(Select)
Whether Original or Revised
return?

(Select)

Tax Status

Nil Tax Payable

If Revised/Defective, then Enter Receipt Number of

Original Return

Date of Filing Original

Return

Notice No (Where the Original Return filed was defective

and a notice is issued to the assessee to file a fresh return
Sec 139(9)

If filed in response to a
notice u/s
139(9)/142(1)/148/153A/15
3C enter date of such
notice

Residential Status

Whether you have Aadhaar Number?

(Select)
(Select)

If Yes, Please provide Aadhaar Number

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

Income from One House Property

Income from Other Sources (Ensure to fill Sch TDS2)

4
5

Gross Total Income (1+2+3)

Deductions under Chapter VI A (Section)

INCOME & DEDUCTIONS

1
(Select)

0
System Calculated

80 C

5a

80 CCC

5b

80 CCD (1)

5c

5d

80 CCD(1B)
80 CCD (2)

5e

80 CCG

5f

80 D

5g

80 DD

5h

i
j

80 DDB
80 E

5i
5j

0
0

80 G

5l

80 GG

5m

80 GGA

5n

80 GGC

5o

80 QQB

5p

80 RRB

5q

80 TTA

5r

80 U

5s

Total Deductions (Total of 5a to 5r)

##
0

Taxable Total Income (4 - 6)

##
0

Tax Payable on Total Income

Rebate u/s 87A

##
0

10 Tax Payable After Rebate (8-9)

10

##
0

11 Surcharge if Taxable Total Income (7) exceeds 1 crore

11

12 Education Cess, including secondary and higher education cess on 10+11

12

###
0

13 Total Tax,Surcharge and Education Cess (Payable) (10+11+12)

13

##
0

15

##
0

14 Relief under Section 89

14

15 Balance Tax after Relief (13-14)

a

Interest payable u/s 234 A

16a

##
0

Interest payable u/s 234 B

16b

##
0

Interest payable u/s 234 C

16c

###
0

17 Total Interest u/s 234A 234B 234C

17

###
0

18 Total Tax and Interest Payable (15 + 17)

18

##
0

16

Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)]
19 TDS1

SI.No

Tax Deduction
Account Number
(TAN) of the Employer

Name of the Employer

Income under salary

Tax Deducted

(1)

(2)

(3)

(4)

1
2
3
4
Total

(Do Not Delete Blank Rows)

20
TDS2

Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)]
SI.No
Tax Deduction
Account Number
(TAN) of the Deductor

Name of the Deductor

Unique TDS Certificate

No.

Deducted Year

Tax Deducted

Amount out of (5)

claimed this year

(1)

(2)

(3)

(4)

(5)

(6)

(Select)
(Select)
(Select)
(Select)

2
3
4
Total

(Do Not Delete Blank Rows)

21 IT

Details of Advance Tax and Self Assessment Tax Payments

Sl.No

BSR Code

Date of Deposit
(DD/MM/YYYY)

Challan No

Tax Paid

(1)

(2)

(3)

(4)

1
2
3
4
Total

(Do Not Delete Blank Rows)

ctor(s)]
If covered by
Portuguese Civil
Code, Amount
claimed in the hands
of spouse
(7)

22
TCS

DETAILS OF TAX COLLECTED AT SOURCE [AS PER FORM 27D ISSUED BY THE COLLECTOR(S)]

SI.No

Tax Collection Account Number of

the Collector

Name of the Collector

(1)

(2)

1
2
3
4
5
TOTAL

ISSUED BY THE COLLECTOR(S)]

Tax Collected

Amount out of (3) being claimed

Amount out of (3) being claimed

in the hands of spouse, if section
5A is applicable

(3)

(4)

(5)

TAXES PAID

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

Total Advance Tax Paid (from item 21)

Total TDS Claimed (Total from item 19 + item 20)

Total TCS Claimed (Total from item 22)

Total Self Assessment Tax Paid (from item 21)

24
25
26

Total Taxes Paid (23a+23b+23c+23d)

Tax Payable (18-24) (if 18 is greater than 24)
Refund (24-18) (if 24 is greater than 18)

27

Exempt Income only for Reporting Purpose (If agricultural income is more than Rs. 5000/-, use ITR-2 or 2A)

28

Details of all Bank Accounts (excluding dormant accounts) held in India at any time during the previous year (Mandatory irrespective of refund due or not)
Total number of savings and current bank accounts held by you at any time during the previous year (excluding dormant accounts).
Bank Account in which refund, if any, shall be credited
Sl.No

IFS Code of the Bank

Account Number

Name of the Bank

(the number should be 9 digits or more as per

CBS system of the bank)

Name of the Bank

(the number should be 9 digits or more as per

CBS system of the bank)

1
Other Bank account details
Sl.No
2
3
4

IFS Code of the Bank

Account Number

(Do Not Delete Blank Rows)

VERIFICATION
I,

son/daughter of

solemnly declare that to the best of my knowledge and belief, the information given in the return is correct and complete and that the amount of total income and other particulars sho
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
Place

Date

PAN
29

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:

Identification No of TRP

Name of TRP

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

M OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below

0
0
0

ng the previous year (Mandatory irrespective of refund due or not)

Type of Account

Type of Account
(Select)
(Select)
(Select)

ATION

rect and complete and that the amount of total income and other particulars shown therein are
e chargeable to Income-tax for the previous year relevant to the Assessment Year 2016-17

Schedule AL
DETAILS OF ASSET AND
LIABILTY

Asset and Liability at the end of the year (Applicable in a case where total income exceeds Rs. 50 lakh)
Particulars of Asset
1

Immovable Asset
Land
a
Building
b

Amount (Cost) (Rs.)

1a
1b

Movable Asset
a
Cash in hand
b
Jewellery, bullion etc.
c
Vehicles, yachts, boats and aircrafts
Total
3
Liability in relation to Assets at A

2a
2b
2c
3
B

e exceeds Rs. 50 lakh)

mount (Cost) (Rs.)

Schedule 80G
A

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

Donations entitled for 100% deduction without qualifying limit

If no entry is made in Name of Donee, then for such rows, any value entered in other columns will be ignored from 80GA to 80GD
Name of donee

Address

City or Town or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)

0
0
0
0

Total 80GA

(Do Not Delete Blank Rows)

Donations entitled for 50% deduction without qualifying limit

Name of donee

Address

City or Town or
District

1
2
3
4

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)
Total 80GB :

(Do Not Delete Blank Rows)

C

State Code

Donations entitled for 100% deduction subject to qualifying limit

0
0
0
0
0

Name of donee

Address

City Or Town Or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)

0
0

(Select)
(Select)

0
0

Total 80GC :

(Do Not Delete Blank Rows)

D

Donations entitled for 50% deduction subject to qualifying limit

Name of donee

Address

City Or Town Or
District

1
2
3
4

State Code

Pincode

PAN of Donee

Eligible Amount of
Donation

Amount of donation

(Select)
(Select)
(Select)
(Select)
Total 80GD

0
0
0
0
0

(Do Not Delete Blank Rows)

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".