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Itr-V: Indian Income Tax Return Verification Form - .

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INDIAN INCOME TAX RETURN VERIFICATION FORM Assessment Year

FORM ITR-V [Where the data of the Return of Income in Form ITR-1 (SAHAJ), ITR-2, ITR-2A, ITR-3,
ITR-4S (SUGAM), ITR-4, ITR-5, ITR-7 transmitted electronically without digital signature] . 2016.-17.
(Please see Rule 12 of the Income-tax Rules, 1962)

Name PAN
Chandiran Sampath
PERSONAL INFORMATION AND THE

CXCPS0139R

Form No. which


DATE OF ELECTRONIC

Flat/Door/Block No Name Of Premises/Building/Village


has been ITR-1
TRANSMISSION

221
electronically
transmitted
Road/Street/Post Office Area/Locality
guduvanchery mahalakshmi nagar,chenglepet Individual
Status

Town/City/District State Pin Aadhaar Number


Guduvanchery,Kancheepuram
TAMILNADU 603202

Designation of AO (Ward / Circle) WARD 2 VILLUPURAM Original or Revised ORIGINAL

E-filing Acknowledgement Number 312712250270716 Date(DD-MM-YYYY) 27-07-2016


1 Gross Total Income 1 272370
2 Deductions under Chapter-VI-A 2 220
3 Total Income 3 272150
COMPUTATION OF INCOME

a Current Year loss, if any 3a 0


4
AND TAX THEREON

4 Net Tax Payable 221


5 Interest Payable 5 0
6 Total Tax and Interest Payable 6 221
7 Taxes Paid
a Advance Tax 7a 0
b TDS 7b 0
c TCS 7c 0
d Self Assessment Tax 7d 220
e Total Taxes Paid (7a+7b+7c +7d) 7e 220
8 Tax Payable (6-7e) 8 0
9 Refund (7e-6) 9 0
10 Exempt Income Agriculture
10
Others
VERIFICATION

I, Chandiran Sampath son/ daughter of Chandrin , holding Permanent Account Number CXCPS0139R
solemnly declare to the best of my knowledge and belief, the information given in the return and the schedules thereto which have been transmitted
electronically by me vide acknowledgement number mentioned above 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 2016-17. I further declare that I am making this return in my capacity as
and I am also competent to make this return and verify it.
Sign here Date 27-07-2016 Place CHENNAI

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

For Office Use Only


Receipt No Filed from IP address 101.222.245.199

Date
Seal and signature of CXCPS0139R01312712250270716BCC36902EF8C454CEFE03AD514C20E632BCE9B2F
receiving official

Please send the duly signed Form ITR-V to “Centralized Processing Centre, Income Tax Department, Bengaluru 560500”, by ORDINARY
POST OR SPEED POST ONLY, within 120 days from date of transmitting the data electronically. Form ITR-V shall not be received in any other
office of the Income-tax Department or in any other manner. The confirmation of receipt of this Form ITR-V at ITD-CPC will be sent to the e-mail
address subbu_1973@yahoo.com

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