o HUF PERSONAL INFORMATION Road/Street/Post Office Area/locality Date of Birth/Formation (DD/MM/YYYY) Country o Male o Female

Transcription

1 FORM ITR-4 INDIAN INCOME TAX RETURN (For ndvduals and HUFs havng ncome from a propretary busness or professon) (Please see rule 12 of the Income-tax Rules,1962) (Also see attached nstructons) Assessment Year Part A-GEN GENERAL Frst name Mddle name Last name PAN Flat/Door/Block No Name Of Premses/Buldng/Vllage Status (Tck) þ o Indvdual o HUF PERSONAL INFORMATION Road/Street/Post Offce Area/localty Date of Brth/Formaton (DD/MM/YYYY) Do you have Aadhaar Number? (n case of ndvdual) oyes ono. If Yes, please provde Town/Cty/Dstrct State Pn code Sex (n case of ndvdual) (Tck) þ Resdental/Offce Phone Number wth STD code / Moble No. 1 Country o Male o Female Moble No. 2 Employer Category (f n employment) (Tck) þ o Govt. o PSU o Others Emal Address-1 (self) Emal Address-2 Income Tax Ward/Crcle Passport No. (Indvdual) (If avalable) FILING STATUS (a) (b) (c) Return fled (Tck)[Please see nstructon number-7] o On or Before due date -139(1) o After due date -139(4) o Revsed Return- 139(5), o Modfed return- 92CD o under secton 119(2)(b), or In response to notce o 139(9)-Defectve o 142(1) o 148 o 153A/153C If revsed/defectve/modfed, then enter Recept No. and Date of flng orgnal return (DD/MM/YYYY) If fled, n response to a notce u/s 139(9)/142(1)/148/153A/153C enter date of such notce, or u/s 92CD enter date of advance prcng agreement / / / / (d) Resdental Status (Tck) þ oresdent o Non-Resdent o Resdent but Not Ordnarly Resdent (e) Whether any transacton has been made wth a person located n a jursdcton notfed u/s 94A of the Act? o Yes o No (f) Are you governed by Portuguese Cvl Code as per secton 5A? Tck) þ o Yes o No (If YES please fll Schedule 5A) (g) Whether ths return s beng fled by a representatve assessee? (Tck) þ o Yes o No If yes, furnsh followng nformaton - (1) Name of the representatve (2) Address of the representatve (3) Permanent Account Number (PAN) of the representatve (h) In case of non-resdent, s there a permanent establshment (PE) n Inda? (Tck) þ o Yes o No (a) Are you lable to mantan accounts as per secton 44AA? (Tck) þ o Yes o No AUDIT INFORMATION (b) Are you lable for audt under secton 44AB? (Tck) þ o Yes o No (c) For Offce Use Only If (b) s Yes, whether the accounts have been audted by an accountant? (Tck) þ o Yes o No If Yes, furnsh the followng nformaton below (1) Date of furnshng of the audt report (DD/MM/YYYY) / / (2) Name of the audtor sgnng the tax audt report (3) Membershp no. of the audtor (4) Name of the audtor (propretorshp/ frm) (5) Permanent Account Number (PAN) of the propretorshp/ frm (6) Date of report of the audt For Offce Use Only Recept No Date Seal and Sgnature of recevng offcal Page 1

2 (d) If lable to furnsh other audt report, menton the date of furnshng the audt report? (DD/MM/YY) (Please see Instructon 6)) 92E 115JC NATURE OF BUSINESS S.No. NATURE OF BUSINESS OR PROFESSION, IF MORE THAN ONE BUSINESS OR PROFESSION INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS Code Trade name of the Descrpton [Please see nstructon No.7()] propretorshp, f any () () () Part A-BS SOURCES OF FUNDS APPLICATION OF FUNDS 1 Propretor s fund BALANCE SHEET AS ON 31 ST DAY OF MARCH, 2015 OF THE PROPRIETORY BUSINESS OR PROFESSION (fll tems below n a case where regular books of accounts are mantaned, otherwse fll tem 6) a Propretor s captal b Reserves and Surplus Revaluaton Reserve b Captal Reserve b Statutory Reserve b v Any other Reserve bv v Total (b + b + b + bv) bv c Total propretor s fund (a + bv) 2 Loan funds a Secured loans Foregn Currency Loans a Rupee Loans A From Banks B From others C Total ( A + B) Total (a + C) a b Unsecured loans (ncludng deposts) From Banks b From others b Total (b + b) b c Total Loan Funds (a + b) 3 Deferred tax lablty 3 4 Sources of funds (1c + 2c +3) 4 1 Fxed assets a Gross: Block b Deprecaton c Net Block (a b) d Captal work-n-progress e Total (1c + 1d) 2 Investments a Long-term nvestments Government and other Securtes - Quoted a Government and other Securtes Unquoted a Total (a + a) a b Short-term nvestments Equty Shares, ncludng share applcaton money b A B C 1a 1b 1c 1d a 1c 2c 1e Page 2

3 NO ACCOUNT CASE Preference Shares b Debentures b v Total (b + b + b) bv c Total nvestments (a + bv) 3 Current assets, loans and advances a Current assets Inventores Stores/consumables ncludng packng A materal B Raw materals C Stock-n-process D Fnshed Goods/Traded Goods E Total (A + B + C + D) Sundry Debtors a Cash and Bank Balances A Cash-n-hand B Balance wth banks C Total (A + B) v Other Current Assets av v Total current assets (E + a + C + av) av b Loans and advances Advances recoverable n cash or n knd or for value to be receved b Deposts, loans and advances to corporates and others b Balance wth Revenue Authortes b v Total (b + b + b ) bv c Total of current assets, loans and advances (av + bv) d Current labltes and provsons Current labltes A Sundry Credtors B Lablty for Leased Assets C Interest Accrued on above D Interest accrued but not due on loans E Total (A + B + C + D) Provsons A Provson for Income Tax B Provson for Wealth Tax Provson for Leave C encashment/superannuaton/gratuty D Other Provsons E Total (A + B + C + D ) Total (E + E) d e Net current assets (3c d) 4 a Mscellaneous expendture not wrtten off or adjusted 4a b Deferred tax asset c Proft and loss account/ Accumulated balance d Total (4a + 4b + 4c) 5 Total, applcaton of funds (1e + 2c + 3e +4d) 5 6 In a case where regular books of account of busness or professon are not mantaned - (furnsh the followng nformaton as on 31 st day of March, 2015, n respect of busness or professon) a Amount of total sundry debtors b Amount of total sundry credtors c Amount of total stock-n-trade d Amount of the cash balance A B C D A B C D A B C D 4b 4c A B 2c E C 3c E E 3e 4d 6a 6b 6c 6d Page 3

4 Proft and Loss Account for the fnancal year (fll tems 1 to 52 n a case where regular books of accounts are Part A-P& L mantaned, otherwse fll tem 53) 1 Revenue from operatons CREDITS TO PROFIT AND LOSS ACCOUNT DEBITS TO PROFIT AND LOSS ACCOUNT A Sales/ Gross recepts of busness (net of returns and refunds and duty or tax, f any) Sale of goods Sale of servces Other operatng revenues (specfy nature and amount) a a b c Total (a + b) c v Total ( + + c) Av Dutes, taxes and cess receved or recevable n respect of goods and servces sold or B suppled Unon Excse dutes Servce tax VAT/ Sales tax v Any other duty, tax and cess v Total ( v) C Total Revenue from operatons (Av + Bv) 2 Other ncome Rent Commsson Dvdend ncome v Interest ncome b v Proft on sale of fxed assets v Proft on sale of nvestment beng securtes chargeable v v to Securtes Transacton Tax (STT) v Proft on sale of other nvestment v v Proft on account of currency fluctuaton x Agrcultural ncome x Any other ncome (specfy nature and amount) a b c Total (xa + xb) x Total of other ncome ( v + v + v + v + v + x + xc) 3 Closng Stock Raw materal Work-n-progress Fnshed goods Total ( ) 4 Total of credts to proft and loss account (1C + 2x + 3v) 4 5 Openng Stock Raw materal Work-n-progress Fnshed goods v Total ( ) 6 Purchases (net of refunds and duty or tax, f any) 6 7 Dutes and taxes, pad or payable, n respect of goods and servces purchased Custom duty Counter velng duty Specal addtonal duty v Unon excse duty v v v x xa xb xc v Bv 1C 2x 3v 5v Page 4

5 v Servce tax v VAT/ Sales tax v Any other tax, pad or payable v Total ( v + 7v + 7v + 7v) 8 Freght 8 9 Consumpton of stores and spare parts 9 10 Power and fuel Rents Repars to buldng Repars to machnery Compensaton to employees Salares and wages Bonus Rembursement of medcal expenses v Leave encashment v Leave travel benefts v Contrbuton to approved superannuaton fund v Contrbuton to recognsed provdent fund v Contrbuton to recognsed gratuty fund 7v 7v 7v v 14v 14v 14v 14v x Contrbuton to any other fund 14x x Any other beneft to employees n respect of whch an 14x expendture has been ncurred Total compensaton to employees ( v + 14v + 14v + 14v + 14v + x 14x + 14x) Whether any compensaton, ncluded n 14x, pad to x non-resdents xa Yes / No If Yes, amount pad to non-resdents xb 15 Insurance Medcal Insurance 15 Lfe Insurance 15 Keyman s Insurance 15 Other Insurance ncludng factory, offce, car, goods, v etc. 15v v Total expendture on nsurance ( v) 16 Workmen and staff welfare expenses Entertanment Hosptalty Conference Sales promoton ncludng publcty (other than advertsement) Advertsement Commsson Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 23 Royalty Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 24 Professonal / Consultancy fees / Fee for techncal servces Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 25 Hotel, boardng and Lodgng 25 7v 14x 15v Page 5

6 PROVISIONS FOR TAX AND APPROPRIATIONS NO ACCOUNT CASE 26 Travelng expenses other than on foregn travelng Foregn travellng expenses Conveyance expenses Telephone expenses Guest House expenses Club expenses Festval celebraton expenses Scholarshp Gft Donaton Rates and taxes, pad or payable to Government or any local body (excludng taxes on ncome) Unon excse duty Servce tax VAT/ Sales tax v Cess v Any other rate, tax, duty or cess ncl STT and CTT v v Total rates and taxes pad or payable ( v + 36v) 37 Audt fee Other expenses (specfy nature and amount) Total ( + ) Bad debts (specfy PAN of the person, f avalable, for whom Bad Debt for amount of Rs. 1 lakh or more s 39 clamed and amount) 39 Others (more than Rs. 1 lakh) where v PAN s not avalable v Others (amounts less than Rs. 1 lakh) v 39v v Total Bad Debt ( v + 39v) 40 Provson for bad and doubtful debts Other provsons 41 Proft before nterest, deprecaton and taxes [4 (5v v + 8 to x + 15v + 16 to to v v )] 43 Interest Pad outsde Inda, or pad n Inda to a non-resdent other than a company or a foregn company To others Total ( + ) 44 Deprecaton and amortsaton Proft before taxes ( ) Provson for current tax Provson for Deferred Tax and deferred lablty Proft after tax ( ) Balance brought forward from prevous year Amount avalable for appropraton ( ) Transferred to reserves and surplus Balance carred to balance sheet n propretor s account (50 51) In a case where regular books of account of busness or professon are not mantaned, furnsh the followng nformaton for prevous year n respect of busness or professon a Gross recepts 53a b Gross proft 53b c Expenses 53c d Net proft 53d 36v 36v 38 39v 43 Page 6

7 Part A- OI OTHER INFORMATION Other Informaton (optonal n a case not lable for audt under secton 44AB) 1 Method of accountng employed n the prevous year (Tck) þ o mercantle o cash 2 Is there any change n method of accountng (Tck) þ o Yes o No Effect on the proft because of devaton, f any, n the method of accountng employed n the 3 3 prevous year from accountng standards prescrbed under secton 145A 4 Method of valuaton of closng stock employed n the prevous year a Raw Materal (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) b Fnshed goods (f at cost or market rates whchever s less wrte 1, f at cost wrte 2, f at market rate wrte 3) c Is there any change n stock valuaton method (Tck) þ o Yes o No d Effect on the proft or loss because of devaton, f any, from the method of valuaton prescrbed under secton 145A 5 Amounts not credted to the proft and loss account, beng - a the tems fallng wthn the scope of secton 28 5a b the proforma credts, drawbacks, refund of duty of customs or excse or servce tax, or refund of sales tax or value 5b added tax, where such credts, drawbacks or refunds are admtted as due by the authortes concerned c escalaton clams accepted durng the prevous year 5c d any other tem of ncome 5d e captal recept, f any 5e f Total of amounts not credted to proft and loss account (5a+5b+5c+5d+5e) 6 Amounts debted to the proft and loss account, to the extent dsallowable under secton 36 due to non-fulflment of condtons specfed n relevant clauses Premum pad for nsurance aganst rsk of damage or a destructon of stocks or store [36(1)()] 6a Premum pad for nsurance on the health of employees b [36(1)(b)] 6b Any sum pad to an employee as bonus or commsson for c servces rendered, where such sum was otherwse payable 6c to hm as profts or dvdend [36(1)()] Any amount of nterest pad n respect of borrowed d captal [36(1)()] 6d e Amount of dscount on a zero-coupon bond [36(1)(a)] 6e f Amount of contrbutons to a recognsed provdent fund [36(1)(v)] 6f Amount of contrbutons to an approved superannuaton g fund [36(1)(v)] 6g Amount of contrbuton to a penson scheme referred to n h secton 80CCD [36(1)(va)] 6h Amount of contrbutons to an approved gratuty fund [36(1)(v)] 6 j Amount of contrbutons to any other fund 6j Any sum receved from employees as contrbuton to any provdent fund or superannuaton fund or any fund set up k under ESI Act or any other fund for the welfare of 6k employees to the extent not credted to the employees account on or before the due date [36(1)(va)] l Amount of bad and doubtful debts [36(1)(v)] 6l m Provson for bad and doubtful debts [36(1)(va)] n Amount transferred to any specal reserve [36(1)(v)] Expendture for the purposes of promotng famly o plannng amongst employees [36(1)(x)] Amount of securtes transacton pad n respect of p transacton n securtes f such ncome s not ncluded n busness ncome [36(1)(xv)] q Any other dsallowance r Total amount dsallowable under secton 36 (total of 6a to 6q) 7 Amounts debted to the proft and loss account, to the extent dsallowable under secton 37 a Expendture of captal nature [37(1)] 7a b Expendture of personal nature [37(1)] 7b c Expendture lad out or expended wholly and exclusvely NOT for the purpose of busness or professon [37(1)] 7c 6m 6n 6o 6p 6q 4d 6r 5f Page 7

8 Expendture on advertsement n any souvenr, brochure, d tract, pamphlet or the lke, publshed by a poltcal party 7d [37(2B)] e Expendture by way of penalty or fne for volaton of any law 7e for the tme beng n force f Any other penalty or fne 7f Expendture ncurred for any purpose whch s an offence or g whch s prohbted by law 7g h Amount of any lablty of a contngent nature 7h Any other amount not allowable under secton 37 7 j Total amount dsallowable under secton 37 (total of 7a to 7) 8 A Amounts debted to the proft and loss account, to the extent dsallowable under secton 40 a Amount dsallowable under secton 40 (a)(), on account of Aa non-complance wth the provsons of Chapter XVII-B b Amount dsallowable under secton 40(a)(a) on account of Ab non-complance wth the provsons of Chapter XVII-B c Amount dsallowable under secton 40(a)() on account of Ac non-complance wth the provsons of Chapter XVII-B d Amount of tax or rate leved or assessed on the bass of profts [40(a)()] Ad e Amount pad as wealth tax [40(a)(a)] Ae f Amount pad by way of royalty, lcense fee, servce fee etc. Af g as per secton 40(a)(b) Amount of nterest, salary, bonus, commsson or remuneraton pad to any partner or member [40(b)] h Any other dsallowance Total amount dsallowable under secton 40(total of Aa to Ah) Any amount dsallowed under secton 40 n any precedng prevous year but allowable B durng the prevous year 9 Amounts debted to the proft and loss account, to the extent dsallowable under secton 40A a Amounts pad to persons specfed n secton 40A(2)(b) Amount pad n excess of twenty thousand rupees otherwse b than by account payee cheque or account payee bank draft under secton 40A(3) 100% dsallowable c Provson for payment of gratuty [40A(7)] any sum pad by the assessee as an employer for settng up or d as contrbuton to any fund, trust, company, AOP, or BOI or socety or any other nsttuton [40A(9)] e Any other dsallowance f Total amount dsallowable under secton 40A Any amount dsallowed under secton 43B n any precedng prevous year but allowable durng 10 the prevous year a Any sum n the nature of tax, duty, cess or fee under any law 10a Any sum payable by way of contrbuton to any provdent fund b or superannuaton fund or gratuty fund or any other fund for 10b the welfare of employees c Any sum payable to an employee as bonus or commsson for servces rendered 10c Any sum payable as nterest on any loan or borrowng from d any publc fnancal nsttuton or a State fnancal corporaton 10d or a State Industral nvestment corporaton e Any sum payable as nterest on any loan or borrowng from any scheduled bank 10e f Any sum payable towards leave encashment 10f g Total amount allowable under secton 43B (total of 10a to 10f) Any amount debted to proft and loss account of the prevous year but dsallowable under 11 secton 43B a Any sum n the nature of tax, duty, cess or fee under any law 11a Any sum payable by way of contrbuton to any provdent fund b or superannuaton fund or gratuty fund or any other fund for 11b the welfare of employees Any sum payable to an employee as bonus or commsson for c 11c servces rendered Any sum payable as nterest on any loan or borrowng from d any publc fnancal nsttuton or a State fnancal corporaton 11d or a State Industral nvestment corporaton Ag Ah 9a 9b 9c 9d 9e 7j 8A 8B 9f 10g Page 8

9 Any sum payable as nterest on any loan or borrowng from e any scheduled bank f Any sum payable towards leave encashment g Total amount dsallowable under Secton 43B (total of 11a to 11f) 12 Amount of credt outstandng n the accounts n respect of a Unon Excse Duty b Servce tax c VAT/sales tax d Any other tax e Total amount outstandng (total of 12a to 12d) 13 Amounts deemed to be profts and gans under secton 33AB or 33ABA Any amount of proft chargeable to tax under secton Amount of ncome or expendture of pror perod credted or debted to the proft and loss 15 account (net) 15 11e 11f 12a 12b 12c 12d 11g 12e Part A QD QUANTITATIVE DETAILS Quanttatve detals (optonal n a case not lable for audt under secton 44AB) (a) In the case of a tradng concern 1 Openng stock 1 2 Purchase durng the prevous year 2 3 Sales durng the prevous year 3 4 Closng stock 4 5 Shortage/ excess, f any 5 (b) In the case of a manufacturng concern Part B - TI TOTAL INCOME 6 Raw materals a Openng stock b Purchases durng the prevous year c Consumpton durng the prevous year d Sales durng the prevous year e Closng stock f Yeld fnshed products g Percentage of yeld h Shortage/ excess, f any 7 Fnshed products/ By-products a openng stock b purchase durng the prevous year c quantty manufactured durng the prevous year d sales durng the prevous year e closng stock f shortage/ excess, f any Computaton of total ncome 1 Salares (7 of Schedule S) 1 2 Income from house property (3c of Schedule-HP) (enter nl f loss) 2 3 Profts and gans from busness or professon Proft and gans from busness other than speculatve busness and specfed busness (A36 of Schedule-BP) (enter nl f loss) Proft and gans from speculatve busness (B40 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) Proft and gans from specfed busness (C46 of Schedule BP) (enter nl f loss and take the fgure to schedule CFL) v Total ( ) (enter nl f 3v s a loss) 4 Captal gans a Short term Short-term 15% (7 of tem E of schedule CG) Short-term 30% (7 of tem E of schedule CG) a a 6a 6b 6c 6d 6e 6f 6g 6h 7a 7b 7c 7d 7e 7f 3v Page 9

10 Short-term chargeable at applcable rate (7v of tem E of schedule CG) v Total Short-term (a + a + a) b Long-term Long-term 10% (7v of tem E of schedule CG) Long-term 20% (7v of tem E of schedule CG) Total Long-term (b + b + b) (enter nl f loss) c Total captal gans (4av + 4b) (enter nl f loss) 5 Income from other sources a from sources other than from ownng race horses and ncome chargeable to tax at specal rate (1 of Schedule OS) (enter nl f loss) b Income chargeable to tax at specal rate (1fv of Schedule OS) c from the actvty of ownng and mantanng race horses (3c of Schedule OS) (enter nl f loss) d Total (5a + 5b + 5c) (enter nl f loss) 6 Total ( v +4c +5d) 6 7 Losses of current year to be set off aganst 6 (total of 2x,3x and 4x of Schedule CYLA) 7 8 Balance after set off current year losses (6 7) (total of column 5 of Schedule CYLA+5b) 8 9 Brought forward losses to be set off aganst 8 (total of 2x, 3x and 4x of Schedule BFLA) 9 10 Gross Total ncome (8-9) (5xv of Schedule BFLA+ 5b) Income chargeable to tax at specal rate under secton 111A, 112 etc. ncluded n Deducton u/s 10A or 10AA (c of Sch. 10A + c of Sch. 10AA) Deductons under Chapter VI-A a Part-B, CA and D of Chapter VI-A [(1 + 3) of Schedule VI-A and lmted upto (10-11)] a 4av b b 4b b Part-C of Chapter VI-A [(2 of Schedule VI-A and lmted upto ( )] c Total (13a + 13b) [lmted upto (10-11)] 14 Total ncome ( c) Income whch s ncluded n 14 and chargeable to tax at specal rates (total of () of schedule SI) Net agrcultural ncome/ any other ncome for rate purpose (4 of Schedule EI) Aggregate ncome ( ) [applcable f (14-15) exceeds maxmum amount not chargeable to tax] Losses of current year to be carred forward (total of row x of Schedule CFL) 18 Part B - TTI COMPUTATION OF TAX LIABILITY Computaton of tax lablty on total ncome 1 a Tax payable on deemed total ncome under secton 115JC (4 of Schedule AMT) 1a b Surcharge on (a) (applcable f 3 of schedule AMT exceeds 1 crore) c Educaton Cess, ncludng secondary and hgher educaton cess on (1a+1b) above d Total Tax Payable on deemed total ncome (1a+1b+1c) 2 Tax payable on total ncome a Tax at normal rates on 17 of Part B-TI b Tax at specal rates (total of () of Schedule-SI) c Rebate on agrcultural ncome [applcable f (14-15) of Part B-TI exceeds maxmum amount not chargeable to tax] d Tax Payable on Total Income (2a + 2b 2c) e Rebate under secton 87A (applcable f 14 of Part B-TI does not exceed 5 lakh) f Tax payable after rebate (2d 2e) g Surcharge on 2f (applcable f 14 of Part B-TI exceeds 1 crore) h Educaton cess, ncludng secondary and hgher educaton cess on (2f + 2g) Gross tax lablty (2f + 2g + 2h) 3 Gross tax payable (hgher of 1d and 2) 3 Credt under secton 115JD of tax pad n earler years (applcable f 2 s more than 1d) (5 of 4 4 Schedule AMTC) 5 Tax payable after credt under secton 115JD (3-4) 5 6 Tax relef a Secton 89 b Secton 90/ 90A ( 2 of Schedule TR) c Secton 91 ( 3 of Schedule TR) 6a 6b 6c 2a 2b 2c 5a 5b 5c 4c 5d 13a 13b 13c 1b 1c 1d 2d 2e 2f 2g 2h 2 Page 10

11 TAXES PAID BANK ACCOUNT d Total (6a + 6b+ 6c) 7 Net tax lablty (5-6d) (enter zero f negatve) 7 8 Interest payable a For default n furnshng the return (secton 234A) 8a b For default n payment of advance tax (secton 234B) c For deferment of advance tax (secton 234C) d Total Interest Payable (8a+8b+8c) 9 Aggregate lablty (7 + 8d) 9 10 Taxes Pad a Advance Tax (from column 5 of 18A) b TDS (total of column 5 of 18B and column 8 of 18C) c TCS (column 7 of 18D) d Self-Assessment Tax (from column 5 of 18A) e Total Taxes Pad (10a+10b+10c+10d) 11 Amount payable (Enter f 9 s greater than 10e, else enter 0) Refund (If 10e s greater than 9) (Refund, f any, wll be drectly credted nto the bank account) Detals of all Bank Accounts held n Inda at any tme durng the prevous year (excludng dormant accounts) 8b 8c 10a 10b 10c 10d Total number of savngs and current bank accounts held by you at any tme durng the prevous year (excludng dormant accounts). Provde the detals below. Sl. IFS Code of Name of the Account Number (the number should be 9 Savngs/ Indcate the account n whch you prefer to get the Bank Bank dgts or more as per CBS system of the bank ) Current your refund credted, f any (tck one account þ ) 14 Do you at any tme durng the prevous year,- () hold, as benefcal owner, benefcary or otherwse, any asset (ncludng fnancal nterest n any entty) located outsde Inda; or () have sgnng authorty n any account located outsde Inda; or o Yes () have ncome from any source outsde Inda? [applcable only n case of a resdent] [Ensure Schedule FA s flled up f the answer s Yes ] 6d 8d 10e o No VERIFICATION I, son/ daughter of, holdng permanent account number solemnly declare that to the best of my knowledge and belef, the nformaton gven n the return and schedules thereto s correct and complete and that the amount of total ncome and other partculars shown theren are truly stated and are n accordance wth the provsons of the Income-tax Act, 1961, n respect of ncome chargeable to Income-tax for the prevous year relevant to the Assessment Year I further declare that the crtcal assumptons specfed n the agreement have been satsfed and all the terms and condtons of the agreement have been compled wth. (Applcable, n a case where return s furnshed under secton 92CD) Place Date Sgn here è 16 If the return has been prepared by a Tax Return Preparer (TRP) gve further detals below: Identfcaton No. of TRP Name of TRP Counter Sgnature of TRP If TRP s enttled for any rembursement from the Government, amount thereof TAX PAYMENTS A ADVANCE/ SELF ASSESSMENT TAX B Detals of payments of Advance Tax and Self-Assessment Tax Sl No BSR Code Date of Depost (DD/MM/YYYY) Seral Number of Challan Amount (Rs) (1) (2) (3) (4) (5) v NOTE Enter the totals of Advance tax and Self-Assessment tax n Sl No. 10a & 10d of Part B-TTI Detals of Tax Deducted at Source from Salary [As per Form 16 ssued by Employer(s)] Page 11

12 D C TDS ON SALARY TDS ON OTHER INCOME TDS ON OTHER INCOME Sl No Tax Deducton Account Number (TAN) of the Employer Name of the Employer Income chargeable under Salares Total tax deducted (1) (2) (3) (4) (5) NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 10b of Part B-TTI Detals of Tax Deducted at Source (TDS) on Income [As per Form 16 A ssued by Deductor(s) or Form 26QB] Sl No Tax Deducton Account Number (TAN) of the Deductor Name of the Deductor Unque TDS Certfcate Number Unclamed TDS brought forward (b/f) Fn. Year n whch deducted Amount b/f TDS of the current fn. year Amount out of (6) or (7) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) n own hands n the hands of spouse, f secton 5A s applcable Amount out of (6) or (7) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) NOTE Please enter total of column 5 of Schedule-TDS1 and column 8 of Schedule-TDS2 n 10b of Part B-TTI Detals of Tax Collected at Source (TCS) [As per Form 27D ssued by the Collector(s)] Sl No Tax Deducton and Tax Collecton Account Number of the Collector Name of the Collector Unclamed TCS brought forward (b/f) Fn. Year n whch collected Amount b/f TCS of the current fn. year Amount out of (5) or (6) beng clamed ths Year (only f correspondng ncome s beng offered for tax ths year) Amount out of (5) or (6) beng carred forward (1) (2) (3) (4) (5) (6) (7) (8) NOTE Please enter total of column (7) of Schedule-TDS n 10c of Part B-TTI NOTE: PLEASE FILL SCHEDULES TO THE RETRUN FORM (PAGES S1-S19) AS APPLICABLE Page 12

13 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE) Schedule S Detals of Income from Salary Name of Employer PAN of Employer (optonal) Address of employer Town/Cty State Pn code SALARIES Salary (Excludng all exempt/ non-exempt allowances, perqustes & proft n leu of salary as they are shown 1 separately below) 2 Allowances exempt under secton 10 (Not to be ncluded n 7 below) Travel concesson/assstance receved (sec. 10(5) Tax pad by employer on non-monetary perquste (sec. 10(10CC) Allowance to meet expendture ncurred on house rent (sec. 10(13A) v Other allowances 3 Allowances not exempt (refer Form 16 from employer) 3 4 Value of perqustes (refer Form 16 from employer) 4 5 Profts n leu of salary (refer Form 16 from employer) 5 6 Deducton u/s 16 (Entertanment allowance by Government and tax on employment) 6 7 Income chargeable under the Head Salares ( ) v 1 Schedule HP Detals of Income from House Property (Please refer to nstructons) Address of property 1 Town/ Cty State PIN Code 1 Is the property co-owned? o Yes o No (f YES please enter followng detals) Your percentage of share n the property. Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property I II HOUSE PROPERTY 2 (Tck) þ f let out o deemed let out o Name(s) of Tenant (f let out) PAN of Tenant(s) (optonal) I II Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two f let out for part of the year) 1a b The amount of rent whch cannot be realzed 1b c Tax pad to local authortes 1c d Total (1b + 1c) 1d e Annual value (1a 1d) (nl, f self -occuped etc. as per secton 23(2)of the Act) 1e f Annual value of the property owned (own percentage share x 1e) 1f g 30% of 1f 1g h Interest payable on borrowed captal 1h Total (1g+ 1h) 1 j Income from house property 1 (1f 1) 1j Address of property 2 Town/ Cty State PIN Code Is the property co-owned? o Yes o No (f YES please enter followng detals) Your percentage of share n the property Name of Co-owner(s) PAN of Co-owner (s) Percentage Share n Property (optonal) I II (Tck) þ f let out o deemed let out o Name(s) of Tenant (f let out) PAN(s) of Tenant (optonal) I II Page S1

14 Annual letable value or rent receved or recevable (hgher of the two, f let out for whole of a the year, lower of the two, f let out for part of the year) 2a b The amount of rent whch cannot be realzed 2b c Tax pad to local authortes 2c d Total (2b + 2c) 2d e Annual value (2a 2d) 2e f Annual value of the property owned (own percentage share x 2e) 2f g 30% of 2f 2g h Interest payable on borrowed captal 2h Total (2g + 2h) 2 j Income from house property 2 (2f 2) 2j 3 Income under the head Income from house property a Rent of earler years realzed under secton 25A/AA 3a b Arrears of rent receved durng the year under secton 25B after deductng 30% 3b c Total (1j + 2j + 3a + 3b ) (f negatve take the fgure to 2 of schedule CYLA) 3c NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head Schedule BP Computaton of ncome from busness or professon A From busness or professon other than speculatve busness and specfed busness 1 Proft before tax as per proft and loss account (tem 45 and 53d of Part A-P&L ) 1 Net proft or loss from speculatve busness ncluded n 1 (enter ve 2a sgn n case of loss) 2a Net proft or Loss from Specfed Busness u/s 35AD ncluded n 1 2b (enter ve sgn n case of loss) 2b INCOME FROM BUSINESS OR PROFESSION a Salares Income/ recepts credted to proft and loss b House property 3 account consdered under other heads of ncome c Captal gans d Other sources Proft or loss ncluded n 1, whch s referred to n secton 4 44AD/44AE/44B/44BB/44BBA/44BBB/ 44D/44DA/ Chapter-XII-G/ Frst Schedule of Income-tax Act 5 Income credted to Proft and Loss account (ncluded n 1) whch s exempt a Share of ncome from frm(s) 5a b Share of ncome from AOP/ BOI 5b c Any other exempt ncome (specfy nature and amount) Total (c + c) 5c d Total exempt ncome (5a + 5b + 5c) 5d 6 Balance (1 2a 2b 3a - 3b 3c - 3d 4 5d) 6 7 Expenses debted to proft and loss account consdered under other heads of ncome c c a Salares 3a 3b 3c 3d 4 7a b House property 7b c Captal gans d Other sources 7d 8 Expenses debted to proft and loss account whch relate to exempt ncome 8 9 Total (7a + 7b + 7c + 7d + 8) 9 10 Adjusted proft or loss (6+9) Deprecaton and amortsaton debted to proft and loss account Deprecaton allowable under Income-tax Act Deprecaton allowable under secton 32(1)() and 32(1)(a) (tem 6 of Schedule-DEP) 12 Deprecaton allowable under secton 32(1)() (Make your own computaton refer Appendx-IA of IT Rules) 12 Total ( ) 13 Proft or loss after adjustment for deprecaton ( ) 13 Amounts debted to the proft and loss account, to the extent 14 dsallowable under secton 36 (6r of PartA-OI) 14 Amounts debted to the proft and loss account, to the extent 15 dsallowable under secton 37 (7j of PartA-OI) 15 Amounts debted to the proft and loss account, to the extent 16 dsallowable under secton 40 (8A of PartA-OI) 16 7c 12 Page S2

15 Amounts debted to the proft and loss account, to the extent 17 dsallowable under secton 40A (9f of PartA-OI) Any amount debted to proft and loss account of the prevous 18 year but dsallowable under secton 43B (11g of PartA-OI) Interest dsallowable under secton 23 of the Mcro, Small and 19 Medum Enterprses Development Act, Deemed ncome under secton Deemed ncome under secton 33AB/33ABA/35ABB/40A(3A)/ 21 72A/80HHD/80-IA Deemed ncome under secton 43CA Any other tem of addton under secton 28 to 44DA Any other ncome not ncluded n proft and loss account/any other expense not allowable (ncludng ncome from salary, commsson, bonus and nterest from frms n whch ndvdual/huf/prop. concern s a partner) 25 Total ( ) Deducton allowable under secton 32(1)() 26 Amount of deducton under secton 35 or 35CCC or 35CCD n excess of the amount debted to proft and loss account (tem x(4) 27 of Schedule ESR) (f amount deductble under secton 35 or 35CCC 27 or 35CCD s lower than amount debted to P&L account, t wll go to tem 24) Any amount dsallowed under secton 40 n any precedng 28 prevous year but allowable durng the prevous year(8b of 28 PartA-OI) Any amount dsallowed under secton 43B n any precedng 29 prevous year but allowable durng the prevous year(10g of 29 PartA-OI) 30 Deducton under secton 35AC a Amount, f any, debted to proft and loss account 30a b Amount allowable as deducton 30b c Excess amount allowable as deducton (30b 30a) 30c 31 Any other amount allowable as deducton Total ( c + 31) Income ( ) Profts and gans of busness or professon deemed to be under - Secton 44AD 34 Secton 44AE Secton 44B v Secton 44BB v Secton 44BBA v Secton 44BBB v Secton 44D v 34v 34v 34v v Secton 44DA 34v (tem 4 of Form 3CE) x Frst Schedule of Income-tax Act x Total (34 to 34x) 34x Net proft or loss from busness or professon other than speculatve and specfed busness ( x) Net Proft or loss from busness or professon other than speculatve busness and specfed 36 busness after applyng rule 7A, 7B or 8, f applcable (If rule 7A, 7B or 8 s not applcable, enter same A36 fgure as n 35) (If loss take the fgure to 2 of tem E) B Computaton of ncome from speculatve busness 37 Net proft or loss from speculatve busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA Income from speculatve busness ( ) (f loss, take the fgure to 6x of schedule CFL) B40 C Computaton of ncome from specfed busness under secton 35AD 41 Net proft or loss from specfed busness as per proft or loss account Addtons n accordance wth secton 28 to 44DA Deductons n accordance wth secton 28 to 44DA (other than deducton under secton,- () 35AD, () 32 or 35 on whch deducton u/s 35AD s clamed) 44 Proft or loss from specfed busness ( ) 44 34x Page S3

16 45 Deductons n accordance wth secton 35AD(1) or 35AD(1A) Income from Specfed Busness (44 45) (f loss, take the fgure to 7x of schedule CFL) C46 D D Income chargeable under the head Profts and gans from busness or professon (A36+B40+C46) me D E Intra head set off of busness loss of current year Sl. Type of Busness ncome Loss to be set off (Fll ths row only f fgure s negatve) Income from speculatve busness Income from specfed busness v Total loss set off ( + ) v Loss remanng after set off ( v) Income of current year (Fll ths column only f fgure s zero or postve) Busness loss set off Busness ncome remanng after set off (1) (2) (3) = (1) (2) NOTE Please nclude the ncome of the specfed persons referred to n Schedule SPI whle computng the ncome under ths head (B40) (C46) (A36) Deprecaton on Plant and Machnery (Other than assets on whch full captal expendture s allowable as deducton Schedule DPM under any other secton) 1 Block of assets Plant and machnery DEPRECIATION ON PLANT AND MACHINERY 2 Rate (%) Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) () () () (v) (v) (v) (v) Schedule DOA Deprecaton on other assets (Other than assets on whch full captal expendture s allowable as deducton) 1 Block of assets Buldng Furnture and Intangble Shps fttngs assets 2 Rate (%) DEPRECIATION ON OTHER ASSETS 3 Wrtten down value on the frst day of prevous year 4 Addtons for a perod of 180 days or more n the prevous year 5 Consderaton or other realzaton durng the prevous year out of 3 or 4 () () () (v) (v) (v) Page S4

17 6 Amount on whch deprecaton at full rate to be allowed ( ) (enter 0, f result s negatve) 7 Addtons for a perod of less than 180 days n the prevous year 8 Consderaton or other realzatons durng the year out of 7 9 Amount on whch deprecaton at half rate to be allowed (7-8) (enter 0, f result s negatve) 10 Deprecaton on 6 at full rate 11 Deprecaton on 9 at half rate 12 Addtonal deprecaton, f any, on 4 13 Addtonal deprecaton, f any, on 7 14 Total deprecaton ( ) 15 Expendture ncurred n connecton wth transfer of asset/ assets 16 Captal gans/ loss under secton 50 ( ) (enter negatve only f block ceases to exst) 17 Wrtten down value on the last day of prevous year ( ) (enter 0 f result s negatve) Summary of deprecaton on assets (Other than assets on whch full captal expendture s allowable as deducton under Schedule DEP any other secton) 1 Plant and machnery SUMMARY OF DEPRECIATION ON ASSETS a Block enttled for 15 per cent 1a ( Schedule DPM - 14 ) b Block enttled for 30 per cent 1b ( Schedule DPM - 14 ) c Block enttled for 40 per cent 1c ( Schedule DPM - 14 ) d Block enttled for 50 per cent 1d ( Schedule DPM - 14 v) e Block enttled for 60 per cent 1e ( Schedule DPM - 14 v) f Block enttled for 80 per cent 1f ( Schedule DPM 14 v) g Block enttled for 100 per cent 1g ( Schedule DPM - 14 v) h Total deprecaton on plant and machnery ( 1a + 1b + 1c + 1d+ 1e + 1f + 1g ) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 14) b Block enttled for 10 per cent (Schedule 2b DOA- 14) c Block enttled for 100 per cent 2c (Schedule DOA- 14) d Total deprecaton on buldng (total of 2a + 2b + 2c) 3 Furnture and fttngs(schedule DOA- 14 v) 3 4 Intangble assets (Schedule DOA- 14 v) 4 5 Shps (Schedule DOA- 14 v) 5 6 Total deprecaton ( 1h+2d+3+4+5) 6 1h 2d Schedule DCG Deemed Captal Gans on sale of deprecable assets 1 Plant and machnery DEEMED CAPITAL GAINS a Block enttled for 15 per cent 1a (Schedule DPM - 16) b Block enttled for 30 per cent (Schedule 1b DPM 16) c Block enttled for 40 per cent(schedule 1c DPM - 16) d Block enttled for 50 per cent 1d (Schedule DPM - 16v) Page S5

18 e Block enttled for 60 per cent 1e (Schedule DPM 16v) f Block enttled for 80 per cent (Schedule 1f DPM 16v) g Block enttled for 100 per cent 1g (Schedule DPM 16v) h Total ( 1a +1b + 1c + 1d + 1e + 1f + 1g) 2 Buldng a Block enttled for 5 per cent 2a (Schedule DOA- 16) b Block enttled for 10 per cent (Schedule 2b DOA- 16) c Block enttled for 100 per cent 2c (Schedule DOA- 16) d Total ( 2a + 2b + 2c) 2d 3 Furnture and fttngs ( Schedule DOA- 16v) 3 4 Intangble assets (Schedule DOA- 16v) 4 5 Shps (Schedule DOA- 16v) 5 6 Total ( 1h+2d+3+4+5) 6 1h Schedule ESR Deducton under secton 35 or 35CCC or 35CCD Sl No Expendture of the nature referred to n secton (1) Amount, f any, debted to proft and loss account (2) Amount of deducton allowable (3) 35(1)() v v v v v x x 35(1)() 35(1)(a) 35(1)() 35(1)(v) 35(2AA) 35(2AB) 35CCC 35CCD Total Amount of deducton n excess of the amount debted to proft and loss account (4) = (3) - (2) Schedule CG Captal Gans A Short-term Captal Gans (STCG) (Items 4, 5 and 9 are not applcable for resdents) 1 From sale of land or buldng or both a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty a Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans (a or a) a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b + b) bv c Balance (a bv) 1c Short-term Captal Gans d Deducton under secton 54B/54D/ 54G/54GA (Specfy detals n tem D below) 1d e Short-term Captal Gans on Immovable property (1c - 1d) A1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) 3 b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Short term captal gans from slump sale (2a-2b) A2c From sale of equty share or unt of equty orented Mutual Fund (MF) or unt of a busness trust on whch STT s pad under secton 111A or 115AD(1)() provso (for FII) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv Page S6

19 c Balance (3a bv) 3c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of 3d such asset to be gnored (Enter postve value only) e Short-term captal gan on equty share or equty orented MF (STT pad) (3c +3d) A3e 4 For NON-RESIDENT, not beng an FII- from sale of shares or debentures of an Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a STCG on transactons on whch securtes transacton tax (STT) s pad A4a b STCG on transactons on whch securtes transacton tax (STT) s not pad A4b For NON-RESIDENTS- from sale of securtes (other than those at A3 above) by an FII as per secton 5 115AD a Full value of consderaton 5a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (5a bv) 5c d Loss to be dsallowed u/s 94(7) or 94(8)- for example f securty bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng out of sale of such securty to be gnored (Enter postve value only) 5d e Short-term captal gan on sale of securtes (other than those at A3 above) by an FII (5c +5d) A5e 6 From sale of assets other than at A1 or A2 or A3 or A4 or A5 above a Full value of consderaton 6a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of Improvement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total ( + + ) bv c Balance (6a bv) 6c d In case of asset (securty/unt) loss to be dsallowed u/s 94(7) or 94(8)- for example f asset bought/acqured wthn 3 months pror to record date and dvdend/ncome/bonus unts are receved, then loss arsng 6d out of sale of such asset to be gnored (Enter postve value only) e Deducton under secton 54D/54G/54GA 6e f STCG on assets other than at A1 or A2 or A3 or A4 or A5 above (6c + 6d) A6f 7 Amount deemed to be short term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous years shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? o Yes o No o Not applcable. If yes, then provde the detals below Sl. Prevous year Secton under whch n whch asset deducton clamed n transferred that year New asset acqured/constructed Year n whch asset acqured/constructed Amount utlsed out of Captal Gans account D/54G/54GA B b Amount deemed to be short term captal gans u/s 54B/54D/54G/54GA, other than at a Total amount deemed to be short term captal gans (X + X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) 8 Deemed short term captal gans on deprecable assets (6 of schedule- DCG) A8 9 FOR NON-RESIDENTS- STCG ncluded n A1-A8 but not chargeable to tax as per DTAA Sl. I II Country name, code Artcle of DTAA Whether Tax Resdency Certfcate obtaned? III Total amount of STCG not chargeable to tax as per DTAA Item No. A1 to A7 above n whch ncluded A1e/A2c/A3e/A4a/A4b/A5e/A6f/A7/A8 A1e/A2c/A3e/A4a/A4b/A5e/A6f/A7/A8 Amount of STCG 10 Total Short-term Captal Gan (A1e+ A2c+ A3e+ A4a+ A4b+ A5e+ A6f+A7+A8-A9) A10 B Long-term captal gan (LTCG) (Items 5, 6, 7 & 10 are not applcable for resdents) Long-term Captal Gans 1 From sale of land or buldng or both a Full value of consderaton receved/recevable a Value of property as per stamp valuaton authorty Full value of consderaton adopted as per secton 50C for the purpose of Captal Gans (a or a) a a A7 A9 Page S7

20 b Deductons under secton 48 Cost of acquston wth ndexaton Cost of Improvement wth ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b + b) c Balance (a bv) d Deducton under secton 54/54B/54D/54EC/54F/54G/54GA/54GB (Specfy detals n tem D below) e Long-term Captal Gans on Immovable property (1c - 1d) B1e 2 From slump sale a Full value of consderaton 2a (5 of Form 3CEA) b Net worth of the under takng or dvson 2b (6(e) of Form 3CEA) c Balance (2a 2b) d Deducton u/s 54EC/54F (Specfy detals n tem D below) e Long term captal gans from slump sale (2c-2d) 3 From sale of bonds or debenture (other than captal ndexed bonds ssued by Government) a Full value of consderaton 3a b Deductons under secton 48 Cost of acquston wthout ndexaton Cost of mprovement wthout ndexaton Expendture wholly and exclusvely n connecton wth transfer v Total (b + b +b) c Balance (3a bv) 3c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 3d e LTCG on bonds or debenture (3c 3d) B3e From sale of, () lsted securtes (other than a unt) or zero coupon bonds where provso under secton 112(1) s applcable or unt of a Mutual Fund transferred on or before % wthout ndexaton beneft), () GDR of an Indan company referred n sec. 115ACA a Full value of consderaton 4a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (4a bv) 4c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 4d e Long-term Captal Gans on assets at B4 above (4c 4d) B4e For NON-RESIDENTS- from sale of shares or debenture of Indan company (to be computed wth foregn exchange adjustment under frst provso to secton 48) a LTCG computed wthout ndexaton beneft 5a b Deducton under sectons 54EC/54F (Specfy detals n tem D below) 5b c LTCG on share or debenture (5a-5b) B5c For NON-RESIDENTS- from sale of, () unlsted securtes as per sec. 112(1)(c), () bonds or GDR as referred n sec. 115AC, () securtes by FII as referred to n sec. 115AD a Full value of consderaton 6a b Deductons under secton 48 Cost of acquston wthout ndexaton b Cost of mprovement wthout ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (6a bv) 6c d Deducton under sectons 54EC/54F (Specfy detals n tem D below) 6d e Long-term Captal Gans on assets at 6 above n case of NON-REESIDENT (6c 6d) B6e 7 From sale of foregn exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A) a LTCG on sale of specfed asset (computed wthout ndexaton) 7a b Less deducton under secton 115F (Specfy detals n tem D below) 7b c Balance LTCG on sale of specfed asset (7a 7b) B7c d LTCG on sale of asset, other than specfed asset (computed wthout ndexaton) 7d e Less deducton under secton 115F (Specfy detals n tem D below) 7e f Balance LTCG on sale of asset, other than specfed asset (7d 7e) B7f 8 From sale of assets where B1 to B7 above are not applcable 2c 2d b b b bv 1c 1d b b b bv B2e Page S8

21 a Full value of consderaton 8a b Deductons under secton 48 Cost of acquston wth ndexaton b Cost of mprovement wth ndexaton b Expendture wholly and exclusvely n connecton wth transfer b v Total (b + b +b) bv c Balance (8a bv) 8c d Deducton under secton 54D/54EC/54F/54G/54GA (Specfy detals n tem D 8d e below) Long-term Captal Gans on assets at B8 above (8c-8d) B8e 9 Amount deemed to be long-term captal gans a Whether any amount of unutlzed captal gan on asset transferred durng the prevous year shown below was deposted n the Captal Gans Accounts Scheme wthn due date for that year? o Yes o No o Not applcable. If yes, then provde the detals below Sl. New asset acqured/constructed Prevous year n whch asset transferred Secton under whch deducton clamed n that year /54D/54F/54G/54GA B Amount utlsed Year n whch asset out of Captal acqured/constructed Gans account b Amount deemed to be long-term captal gans, other than at a 10 Total amount deemed to be long-term captal gans (X + X + b) Amount not used for new asset or remaned unutlzed n Captal gans account (X) FOR NON-RESIDENTS- LTCG ncluded n tems B1 to B8 but not chargeable to tax n Inda as per DTAA Sl. I II Country name, code Whether Tax Resdency Artcle of DTAA Certfcate obtaned? Item B1 to B8 above n whch ncluded B1e/B2e/B3e/ B4e/ B5c/B6e/B7c/B7f/B8e/B9 B1e/B2e/B3e/ B4e/ B5c/B6e/B7c/B7f/B8e/B9 Amount of LTCG III Total amount of LTCG not chargeable to tax as per DTAA Total long term captal gan chargeable under I.T. Act [B1e +B2e+ B3e +B4e + B5c + B6e + B7c + B7f 11 + B8e+ B9-B10] (In case of loss take the fgure to 9x of schedule CFL) C Income chargeable under the head CAPITAL GAINS (A10 + B11) (take B11as nl, f loss) D Informaton about deducton clamed 1 In case of deducton u/s 54/54B/54D/54EC/54F/54G/54GA/115F gve followng detals a Secton under whch deducton clamed 1a amount of deducton Cost of new asset Date of ts acquston/constructon a dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date b Secton under whch deducton clamed 1b amount of deducton Cost of new asset Date of ts acquston/constructon b dd/mm/yyyy Amount deposted n Captal Gans Accounts Scheme before due date c Total deducton clamed (1a + 1b) 2 In case of deducton u/s 54GB, furnsh PAN of the company E Set-off of current year captal losses wth current year captal gans (excludng amounts ncluded n A9 & B10 whch s chargeable under DTAA) a a b b 1c B9 B10 B11 C Sl. Type of Captal Gan Gan of current year (Fll ths column only f computed fgure s postve) Short term captal loss set off 15% 30% applcable rate Long term captal loss set off 10% 20% Current year s captal gans remanng after set off (7= ) Loss to be set off (Fll ths row f fgure computed s negatve) 15% (A3e+A4a) Short term 30% A5e captal gan v (A1e+A2c+A4b+ A6f applcable rate +A7+A8) v Long term 10% (B4e+ + B6e+B7c) v captal gan (B1e+B2e+B3e+ B5c+ 20% B7f+B8e+B9) (A3e+A4a) A5e (A1e+A2c+A4 b+a6f +A7+A8) (B4e+ B6e+B7c) (B1e+B2e+B3e + B5c+ B7f+B8e+B9) Page S9