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(A15) Aadhaar Number (12 digit) / Aadhaar Enrolment Id (28 digit) (if eligible for
(A9) Area/locality
Aadhaar)
MUZAFFARPUR 9xxx xxxx 2210
(A11) State
(A10) Town/City/District 05-Bihar (A13) Pin code/Zip code
Muzaffarpur H.O (A12) Country 842001
91-India
(A16) Residential/Office Phone Number with STD Mobile No. 1
(A17) Mobile No. 2
/ISD code 919835481250
(A18) Email Address-1 (self)
(A19) Email Address-2
akhileshkumarsahu1953@gmail.com
139(1)-On or before due date, 139(4)-After due date, ✔ 139(5)-Revised
(a1i) Filed u/s (Tick)[Please see instruction ]
(A20) Return, 92CD-Modified return, 119(2)(b)-after condonation of delay.
Are you opting for new tax regime u/s 115BAC ? Yes ✔ No
Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? –
(Tick) Yes ✔ No
(b) If yes, please furnish following information
[Note: To be filled only if a person is not required to furnish a return of income under section 139(1) but filing return of income due
to fulfilling one or more conditions mentioned in the seventh proviso to section 139(1)]
Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more
(bi) current account during the previous year? (Yes/No) 0
Yes ✔ No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for
(bii) travel to a foreign country for yourself or for any other person? (Yes/No) 0
Yes ✔ No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on
(biii) consumption of electricity during the previous year? (Yes/No) 0
Yes ✔ No
Are you required to file a return as per other conditions prescribed under clause (iv) of seventh proviso to section 139(1) (If yes,
(biv)
please select the relevant condition from the drop down menu) Yes ✔ No
If filed, in response to a notice u/s 139(9)/142(1)/148 or order u/s 119(2)(b) enter unique number/ Document
(Unique
(d) Identification Number (DIN) and date of such notice/order, or if filed u/s 92CD, enter date of advance pricing
Number)
agreement
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Acknowledgement Number: Date of filing:
✔ You were in India for 182 days or more during the previous year
[section 6(1)(a)]
You were in India for 60 days or more during the previous year, and
have been in India for 365 days or more within the 4 preceding years
[section (6)(1)(c)] [where Explanation 1 is not applicable]
You are a citizen of India, who left India, for the purpose of employment,
as a member of the crew of an Indian ship and were in India for 182 days
A. Resident or more during the previous year and 365 days or more within the
preceding 4 years [Explanation 1(a) of section (6)(1)(c)]
You are a citizen of India or a person of Indian origin and have come on
a visit to India during the previous year and were in India for 182 days or
more during the previous year and 365 days or more within the preceding
4 years; or 120 days or more during the previous year and 365 days or
more within the preceding 4 years if the total income, other than income
from foreign sources, exceeds Rs. 15 lakh. [Explanation 1(b) of section (6)
(1)(c)]
You have been in India for 729 days or less during the 7 preceding
Residential Status in
years [section 6(6)(a)]
India (for individuals)
(Tick applicable option) You are a citizen of India or person of Indian origin, who comes on a
(e) visit to India, having total income, other than the income from foreign
B. Resident but not
Ordinarily Resident sources, exceeding Rs. 15 lakh and have been in India for 120 days or
more but less than 182 days during the previous year [section 6(6)(c)]
You are a citizen of India having total income, other than the income
from foreign sources, exceeding Rs. 15 lakh during the previous year and
not liable to tax in any other country or territory by reason of your domicile
or residence or any other criteria of similar nature [section 6(6)(d) rws 6
(1A)]
(ii) In case you are a Citizen of India or a Person of Indian Origin (POI),
please specify -
Total period of stay in India during Total period of stay in India during
the previous year (in days) the 4 preceding years (in days)
Residential Status in
India (for HUF) (Tick D. Resident Resident but not Ordinarily Resident Non-resident
applicable option)
(f) Do you want to claim the benefit under section 115H? (applicable in case of resident) Yes ✔ No
(g) Are you governed by Portuguese Civil Code as per section 5A? Tick) Yes ✔ No (If "YES" please fill Schedule 5A)
Whether you were Director in a company at any time during the previous year? (Tick) Yes ✔ No
(i)
If yes, please furnish following information -
Sl. Name of Type of PAN Whether its shares are listed or Director Identification Number
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Acknowledgement Number: Date of filing:
No. Company company unlisted (DIN)
Whether you have held unlisted equity shares at any time during the previous year? Yes ✔ No
(j)
If yes, please furnish following information in respect of equity shares
Sl. No. Name of Type of PAN Opening balance Shares acquired during the year Shares transferred during the Closing balance
Company company year
No. of Cost of No. of Date of Face value Issue price per Purchase price per share No. of Sale No. of Cost of
shares acquisition shares subscription / per share share (in case (in case of purchase shares consideration shares acquisition
purchase of fresh issue) from existing
shareholder)
1a 1b 2 3 4 5 6 7 8 9 10 11 12 13
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Acknowledgement Number: Date of filing:
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Acknowledgement Number: Date of filing:
A Standard deduction u/s 16(ia) 5a 50,000
B Entertainment allowance u/s 16(ii) 5b 0
C Professional tax u/s 16(iii) 5c 0
6 Income chargeable under the Head 'Salaries' (4 - 5) 6 3,11,006
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Acknowledgement Number: Date of filing:
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Acknowledgement Number: Date of filing:
From sale of equity share or unit of equity oriented Mutual Fund (MF) or unit of a business trust on which STT is paid under section 111A or
2
115AD(1)(ii) proviso (for FII)
Loss to be disallowed u/s 94(7) or 94(8)- for example if asset bought/acquired within 3
d months prior to record date and dividend/income/bonus units are received, then loss arising 2d 0
out of sale of such asset to be ignored (Enter positive value only)
e Short-term capital gain on equity share or equity oriented MF (STT paid) (2c +2d) A2e -5,770
For NON-RESIDENT, not being an FII- from sale of shares or debentures of an Indian company (to be computed with foreign exchange
3
adjustment under first proviso to section 48)
b STCG on transactions on which securities transaction tax (STT) is not paid A3b 0
4 For NON-RESIDENT- from sale of securities (other than those at A2) by an FII as per section 115AD
In case securities sold include shares of a company other than quoted shares, enter the
a i
following details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
Loss to be disallowed u/s 94(7) or 94(8)- for example if security bought/acquired within 3
d months prior to record date and dividend/income/bonus units are received, then loss arising 4d 0
out of sale of such security to be ignored (Enter positive value only)
e Short-term capital gain on sale of securities by an FII (other than those at A2) (4c +4d) A4e 0
In case assets sold include shares of a company other than quoted shares, enter the following
a i
details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
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Acknowledgement Number: Date of filing:
i Cost of acquisition without indexation bi 0
In case of asset (security/unit) loss to be disallowed u/s 94(7) or 94(8)- for example if asset
d bought/acquired within 3 months prior to record date and dividend/income/bonus units are 5d 0
received, then loss arising out of sale of such asset to be ignored (Enter positive value only)
Whether any amount of unutilized capital gain on asset transferred during the previous years shown below was deposited in the Capital Gains
Accounts Scheme within due date for that year?
a
yes No Not applicable. If yes, then provide the details below
Sl. Previous year in which Section under which deduction New asset acquired/constructed Amount not used for new asset or remained
No. asset transferred claimed in that year unutilized in Capital gains account (X)
Year in which asset Amount utilised out of
acquired/constructed Capital Gains account
7 Pass Through Income/ Loss in the nature of Short Term Capital Gain, (Fill up schedule PTI) (A7a + A7b + A7c) A7 0
a Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 15% A7a 0
b Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 30% A7b 0
Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable at
c A7c 0
applicable rates
8 Amount of STCG included in A1 – A7 but not chargeable to tax in India as per DTAA
Sl. Amount of Item No. A1 to A7 above in Country name Article of Rate as per Treaty Whether TRC Section of I. Rate as per I. Applicable rate [lower
No. income which included & Code DTAA (enter NIL, if not obtained T. Act T. Act of (6) or (9)]
chargeable (Y/N)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
a Total amount of STCG not chargeable to tax in India as per DTAA A8a 0
b Total amount of STCG chargeable to tax at special rates in India as per DTAA A8b 0
9 Total Short-term Capital Gain (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6 + A7 - A8a) A9 -5,770
B Long-term capital gain (LTCG) (Sub-items, 5 , 6, 7 & 8 are not applicable for residents)
2 From sale of bonds or debenture (other than capital indexed bonds issued by Government)
From sale of, (i) listed securities (other than a unit) or zero coupon bonds where proviso under section 112(1) is
3
applicable (ii) GDR of an Indian company referred in sec. 115ACA
Cost of
acquisition
i bi 0
without
indexation
Cost of
Improvement
ii bii 0
without
indexation
Expenditure
wholly and
exclusively
iii biii 0
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Acknowledgement Number: Date of filing:
in
connection
with transfer
From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which STT is
4
paid under section 112A
c Long-term Capital Gains on sale of capital assets at B4 above (4a – 4b) B4c 0
For NON-RESIDENTS- from sale of shares or debenture of Indian company (to be computed with foreign
5
exchange adjustment under first proviso to section 48)
For NON-RESIDENTS- from sale of, (i) unlisted securities as per sec. 112(1)(c), (ii) bonds or GDR as referred in sec. 115AC, (iii) securities by
6
FII as referred to in sec. 115AD (other than securities referred to in section 112A for which column B7 is to be filled up)
In case securities sold include shares of a company other than quoted shares, enter the
a i
following details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
e Long-term Capital Gains on assets at 6 above in case of NON-REESIDENT (6c - 6d) B6e 0
For NON-RESIDENTS - From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which STT is paid
7
under section 112A
c Long-term Capital Gains on sale of capital assets at B7 above (7a – 7b) B7c 0
8 From sale of foreign exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A)
d LTCG on sale of asset, other than specified asset (computed without indexation) 8d 0
f Balance LTCG on sale of asset, other than specified asset (8d- 8e) B8f 0
In case securities sold include shares of a company other than quoted shares, enter the
A i
following details
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Acknowledgement Number: Date of filing:
c section 50CA for the purpose of Capital Gains (higher of a or b) ic 0
ii Full value of consideration in respect of securities other than unquoted shares aii 0
Whether any amount of unutilized capital gain on asset transferred during the previous year shown below was deposited in the Capital Gains
a Accounts Scheme within due date for that year?
Yes No Not applicable. If yes, then provide the details below
Sl. Previous year in which Section under which deduction New asset acquired/constructed Amount not used for new asset or remained
No. asset transferred claimed in that year unutilized in Capital gains account (X)
Year in which asset Amount utilised out of
acquired/constructed Capital Gains account
11 Pass Through Income/ Loss in the nature of Long Term Capital Gain,(Fill up schedule PTI) (B11a1+ B11a2 + B11b) B11 0
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @
a1 B11a1 0
10% u/s 112A
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @
a2 B11a2 0
10% under sections other than u/s 112A
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @
b B11b 0
20%
12 Amount of LTCG included in B1 - B11 but not chargeable to tax or chargeable at special rates in India as per DTAA
Sl. Amount of Item No. B1 to B11 above in which Country name & Article of Rate as per Treaty Whether TRC Section of I.T. Rate as per I.T. Applicable rate [lower of (6) or
No. income included Code DTAA (enter NIL, if not obtained Act Act (9)]
chargeable) (Y/N)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
b Total amount of LTCG chargeable to tax at special rates as per DTAA B12b 0
13 Total long term capital gain chargeable under I.T. Act (B1e+B2e+B3e+B4c+B5c+B6e+B7c+B8c+B8f+B9e+B10 + B11 - B12a) B13 0
C Income chargeable under the head "CAPITAL GAINS" (A9 + B13) (take B13 as nil, if loss) C -5,770
Date of Transfer of Date of purchase/ Cost of new asset Amount deposited in Amount of deduction
Original Asset construction of new Capital Gains Accounts claimed
asset Scheme before due date
Date of Transfer of Original Date of purchase of new agricultural Cost of new agricultural Amount deposited in Capital Gains Accounts Scheme before Amount of
Asset land land due date deduction
claimed
Date of Transfer of Amount invested in specified/notified bonds (not exceeding fifty lakh rupees) Date of investment Amount of deduction claimed
Original Asset
Date of Transfer Date of purchase/construction of new residential Cost of new residential Amount of Amount deposited in Capital Gains Accounts Scheme before
of house house deduction due date
Original Asset claimed
Date of transfer of PAN of the Amount utilised for Date of Cost of new plant and Date of Amount deposited in Capital Amount of
original residential eligible subscription of equity shares subscription machinery purchased by the purchase of Gains Accounts Scheme deduction
property company of eligible company of shares eligible company plant and before due date claimed
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Acknowledgement Number: Date of filing:
machinery
Date of Transfer of Amount invested in new specified asset or savings certificate Date of investment Amount of deduction claimed
foreign exchange asset
E Set-off of current year capital losses with current year capital gains (excluding amounts included in A8a & B12a which is not chargeable under DTAA)
Sl.No Type of Capital Gain Capital Gain of Short term capital loss Long term capital loss Current year’s capital gains
off
figure is negative)
ii Short 15% 0 0 0 0 0
Term
iii 30% 0 0 0 0 0
Capital
Gain
iv Applicable 0 0 0 0 0
Rate
v Covered 0 0 0 0 0
By DTAA
vi Long 10% 0 0 0 0 0 0 0 0
Term
vii 20% 0 0 0 0 0 0 0 0
Capital
Gain
viii Covered 0 0 0 0 0 0 0 0
By DTAA
(i-ix)
The figures of STCG in this table (A1e* etc.) are the amounts of STCG computed in respective column (A1-A6) as reduced by theamount of STCG not chargeable to tax or chargeable at special
rates as per DTAA, which is included therein, if any.
The figures of LTCG in this table (B1e* etc.) are the amounts of LTCG computed in respective column (B1-B10) as reduced by theamount of LTCG not chargeable to tax or chargeable at special
rates as per DTAA, which is included therein, if any.
Type of Capital gain / Date Upto 15/6 16/6 to 15/9 16/9 to 15/12 16/12 to 15/3 16/3 to 31/3
(i) (ii) (iii) (iv) (v)
1 Short-term capital gains taxable at the rate of 15% 0 0 0 0 0
Enter value from item 3iii of schedule BFLA, if any.
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while computing the income under this head
11 of 45
Acknowledgement Number: Date of filing:
From sale of equity share in a company or unit of equity oriented fund or unit of a business
Schedule 112A
trust on which STT is paid under section 112A
Sl. No. Share/Unit acquired ISIN Code Name of No. of Sale-price Full Value of Cost of Cost of If the long Fair Total Fair Expenditure Total Balance (6-
the Share Shares per Share Consideration acquisition acquisition term Market Market wholly and deductions 13) Item 4
/Unit /Units /Unit (Total Sale without capital Value per Value of exclusively (7+12) (a) of
-Lower of (2)(ac)-
6 & 11 (4*10)
(Col 1) (col 1a) (Col 2) (Col 3) (Col 4) (Col 5) (Col 6) (Col 7) (Col 8) (Col 9) (Col 10) (Col 11) (Col 12) (Col 13) (Col 14)
Total 0 0 0 0 0 0 0 0
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Acknowledgement Number: Date of filing:
115AD(1)(b)(iii) For NON-RESIDENTS - From sale of equity share in a company or unit of equity oriented
proviso fund or unit of a business trust on which STT is paid under section 112A
Sl. Share ISIN Name No. of Sale- Full Value of Cost of acquisition Cost of If the long term capital asset Fair Market Value Total Fair Market Value of Expenditure wholly Total Balance (6-13)
No. /Unit Code of the Shares price Consideration without indexation acquisition was acquired before per share/unit as on capital asset as per and exclusively in deductions Item 7 (a) of
acquired Share /Units per (Total Sale Value) (higher of 8 or 9) 01.02.2018, -Lower of 6 & 11 31st January,2018 section 55(2)(ac)- (4*10) connection with (7+12) LTCG
/Unit ITR2
(Col (col 1a) (Col (Col 3) (Col (Col 5) (Col 6) (Col 7) (Col 8) (Col 9) (Col 10) (Col 11) (Col 12) (Col 13) (Col 14)
1) 2) 4)
Total 0 0 0 0 0 0 0 0
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Acknowledgement Number: Date of filing:
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Acknowledgement Number: Date of filing:
received for inadequate
iii consideration stamp duty value of diii 0
property in excess of such
consideration as adjusted as per
section 56(2)(x)
In case any other property is
iv received without consideration, div 0
fair market value of property
In case any other property is
received for inadequate
v consideration, fair market value dv 0
of property in excess of such
consideration
e Any other income (please specify nature) 1e 0
Sl. Nature Amount
No.
1 Family Pension 0
2 Income from retirement benefit account maintained in a notified country u/s 0
89A
Country Amount
15 of 45
Acknowledgement Number: Date of filing:
Amount included in 1 and 2 above, which is chargeable at special rates in India as per 2f 0
DTAA (total of column (2) of table below)
Sl. Amount Item No.1ai, 1b to Country Article Rate as per Treaty Whether Section Rate as Applicable rate
f No. of 2 in which name & of (enter NIL, if not TRC of I.T. per I.T. [lower of (6) or
income included Code DTAA chargeable) obtained (Y Act Act (10)]
/N)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Deductions under section 57 (other than those relating to income chargeable at special rates
3
under 2a, 2b & 2d)
Expenses / Deductions other than "aii"
ai 3ai 0
(in case other than family pension)
Interest expenditure u/s 57(i) (available
aii only if income offered in 1a) - entered 3aii
amount
Interest expenditure claimed 0
a Eligible amount of interest expenditure u 3a
0
(iia) /s 57(i) – Computed Amount (iia)
Deduction u/s. 57(iia) (in case of family
aiii 3aiii 0
pension only)
b Depreciation 3b 0
c Total 3c 0
4 Amounts not deductible u/s 58 4 0
5 Profits chargeable to tax u/s 59 5 0
5a Income claimed for relief from taxation u/s 89A 5a 0
Net Income from other sources chargeable at normal applicable rates (1(after
6 reducing income related to DTAA portion) – 3 + 4 + 5 - 5a) (If negative take the 6 3,79,930
figure to 3i of schedule CYLA )
Income from other sources (other than from owning race horses) (2 + 6) (enter 6 as
7 7 3,79,930
nil, if negative)
8 Income from the activity of owning and maintaining race horses
a Receipts 8a 0
Deductions under section 57 in
b 8b 0
relation to receipts at 8a only
c Amounts not deductible u/s 58 8c 0
d Profits chargeable to tax u/s 59 8d 0
Balance (8a - 8b + 8c + 8d) (if negative take the figure to 6xi of Schedule
e 8e 0
CFL)
Income under the head"Income from other sources" (7 + 8e) (take 8e as nil if
9 9 3,79,930
negative)
10 Information about accrual/receipt of income from Other Sources
S.No. Other Source Income Upto 15/6 From 16/6 to 15/9 From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3
16 of 45
Acknowledgement Number: Date of filing:
gambling, betting etc.
(ix)
in Sl.no.1a(i)
PTI Income)
115AC @ 10%
Income)
DTAA rates
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while
computing the income under this head.
17 of 45
Acknowledgement Number: Date of filing:
Schedule CYLA Details of Income after Set off of Current Year Losses
Sl. Head/ Source of Income Income of current year (Fill House property Net loss from Other sources chargeable at normal Current year’s
No. this column only if income loss of the applicable rates (other than loss from race Income
is zero or positive) current year set horses) of the current year set off remaining after
off set off
1 2 3 4=1-2-3
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Acknowledgement Number: Date of filing:
Schedule BFLA Details of Income after Set off of Brought Forward Losses of earlier years
Sl. Head/ Source of Income Income after set off, if any, of current year’s losses Brought forward Current year’s income
No. as per 4 of Schedule CYLA) loss set off remaining after set off
1 2 3
ii House property 0 0 0
xii Total of brought forward loss set off (2ii + 2iii + 2iv + 2v+ 2vi + 2vii +2viii+ 2ix + 2xi) 0
xiii Current year's income remaining after set off Total of (3i + 3ii + 3iii + 3iv + 3v+ 3vi + 3vii + 3viii+ 3ix + 3x + 3xi) 6,90,936
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Acknowledgement Number: Date of filing:
1 2 3 4 5 6
i 2014-15 0 0 0
ii 2015-16 0 0 0
iii 2016-17 0 0 0
iv 2017-18 0 0 0
v 2018-19 0 0 0 0
vi 2019-20 0 0 0 0
vii 2020-21 0 0 0 0
viii 2021-22 0 0 0 0
ix Total of 0 0 0 0
earlier year
losses
x Adjustment 0 0 0 0
of above
losses in
Schedule
BFLA
xi 2022-23 0 5,770 0 0
(Current year
losses)
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Acknowledgement Number: Date of filing:
21 of 45
Acknowledgement Number: Date of filing:
Schedule 80G Details of donations entitled for deduction under section 80G
Donations entitled for 100% deduction without
A
qualifying limit
Eligible
PAN of Amount
Name and address of Donee Amount of donation
Donee of
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 50% deduction without
B
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 100% deduction subject to
C
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 50% deduction subject to
D
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
E Total donations (A + B + C + D) 0
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Acknowledgement Number: Date of filing:
Schedule
Details of donations for scientific research or rural development
80GGA
Sl. Relevant clause under which deduction is Name and PAN Amount of donation Eligible
No. claimed (drop down to be provided) address of of Amount of
Donee Donee donation
Total donation 0 0 0 0
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Acknowledgement Number: Date of filing:
Schedule AMT Computation of Alternate Minimum Tax payable under section 115JC
1 Total Income as per item 12 of PART-B-TI 1 6,90,936
2 Adjustment as per section 115JC(2)
Deduction claimed under any section included in Chapter VI-A
a under the heading "C.—Deductions in respect of certain 2a 0
incomes"
3 Adjusted Total Income under section 115JC(1) (1+2a) 3 6,90,936
4 Tax payable under section 115JC [18.5% of (3)] (if 3 is greater than Rs. 20 lakhs) 4 0
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Acknowledgement Number: Date of filing:
x Current AY (enter 0 0
1-2, if 1>2 else
enter 0)
xi Total 0 0 0 0 0
Amount of tax credit under section 115JD utilised during the year [total of item No. 4
5 5 0
(C)]
Amount of AMT liability available for credit in subsequent assessment years [total of 4
6 6 0
(D)]
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Acknowledgement Number: Date of filing:
Income of specified persons (spouse, minor child etc.) includable in income of the assessee
Schedule SPI
as per section 64
Sl Name of person PAN/ Aadhaar of person Relationship Amount Head of Income in which
No (optional) (Rs) included
26 of 45
Acknowledgement Number: Date of filing:
Income chargeable to tax at special rates (please see instructions No. 9 for rate of tax)
Schedule SI
Income chargeable to tax at special rates
Sl. No. Section Special rate Income Taxable Tax thereon
Income
after
adjusting
for min
chargeable
to tax
27 of 45
Acknowledgement Number: Date of filing:
15 115A(1) (a)(iiab) -Interest as per 5% 0 0
Sec. 194LD
16 115A(1) (a)(iiac) -Interest as per 5% 0 0
Sec. 194LBA
17 115A(1) (a)(iii) - Income received in 20 % 0 0
respect of units of UTI purchased in
Foreign Currency
18 115A(1)(b)- Income from royalty or 10 % 0 0
fees for technical services received
from Government or Indian concern
- chargeable u/s 115A(1)(b)
19 115AC(1)(a) - Income by way of 10 % 0 0
interest on bonds purchased in
foreign currency
20 115AC(1)(b) - Income by way of 10 % 0 0
dividend on GDR purchased in
foreign currency
21 115AC(1)(c) -LTCG arising from 10 % 0 0
the transfer of bonds or GDR
purchased in foreign currency - non-
resident
22 115ACA(1)(a) - Income from GDR 10 % 0 0
purchased in foreign currency -
resident
23 115ACA(1)(b) - LTCG arising from 10 % 0 0
the transfer of GDR purchased in
foreign currency -resident
24 115AD(1)(i) -Income (other than 20 % 0 0
dividend) received by an FII in
respect of securities(other than
units as per Sec 115AB)
25 115AD(1)(i) -Income received by 5% 0 0
an FII in respect of bonds or
government securities as per Sec
194LD
26 115AD(1)(iii)-Long term capital 10 % 0 0
gains by an FII
27 Securities referred in section 112A 10 % 0 0
read with section 115AD
28 115BBA - Income received by non- 20 % 0 0
resident sportsmen or sports
associations or entertainer
29 115BBC - Anonymous donations 30 % 0 0
30 115BBE - Tax on income referred 60 % 0 0
to in sections 68 or 69 or 69A or
69B or 69C or 69D
31 115BBF - Income under head other 10 % 0 0
sources
32 115BBG - Income under head 10 % 0 0
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Acknowledgement Number: Date of filing:
other sources
33 115E(a)-Investment income 20 % 0 0
34 115E(a)-LTCG on any asset other 20 % 0 0
than a specified asset-non resident
Indian
35 115E(b) - Income by way of long 10 % 0 0
term capital gains
36 STCGDTAARate - STCG 1% 0 0
Chargeable at special rates in India
as per DTAA
37 LTCGDTAARate - LTCG 1% 0 0
Chargeable at special rates in India
as per DTAA
38 Other source income chargeable 1% 0 0
under DTAA rates
39 Pass Through Income in the nature 15 % 0 0
of Short Term Capital Gain
chargeable @ 15%
40 Pass Through Income in the nature 30 % 0 0
of Short Term Capital Gain
chargeable @ 30%
41 Pass Through Income in the nature 10 % 0 0
of Long Term Capital Gain
chargeable @ 10% u/s other than u
/s 112A
42 Pass Through Income in the nature 10 % 0 0
of Long Term Capital Gain
chargeable @ 10% u/s 112A
43 Pass Through Income in the nature 20 % 0 0
of Long Term Capital Gain
chargeable @ 20%
44 PTI_115A(1)(a)(i)- Dividends in the 20 % 0 0
case of non-residents
45 PTI_115A(1)(a)(ii)- Interest 20 % 0 0
received in the case of non-
residents
46 PTI_115A(1)(a)(iia)- Interest 5% 0 0
received by non-resident from
infrastructure debt fund
47 PTI_115A(1)(a)(iiaa)- Income 5% 0 0
received by non-resident as
referred in section 194LC(1)
48 PTI_115A(1) (a)(iiaa) -Interest 4% 0 0
received by non-resident as
referred in proviso to section 194LC
(1)
49 PTI_115A(1)(a)(iiab)- Income 5% 0 0
received by non-resident as
referred in section 194LD
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Acknowledgement Number: Date of filing:
50 PTI_115A(1)(a)(iiac)- Income 5% 0 0
received by non-resident as
referred in section 194LBA
51 PTI_115A(1)(a)(iii)- Income from 20 % 0 0
units purchased in foreign currency
in the case of non-residents
52 PTI_115A(1)(b)-Income from 10 % 0 0
royalty or fees for technical
services received from Government
or Indian concern
53 PTI_115AC(1)(a)- Income by way 10 % 0 0
of interest on bonds purchased in
foreign currency
54 PTI_115AC(1)(b)- Income by way 10 % 0 0
of dividend on GDR purchased in
foreign currency
55 PTI_115ACA(1)(a )- Income from 10 % 0 0
GDR purchased in foreign currency
or long term capital gains arising
from their transfer in case of a
resident employee of an Indian
company, engaged in knowledge
based industry or service
56 PTI_115AD(1)(i)- PTI - Income 20 % 0 0
(other than dividend) received by
an FII in respect of securities (other
than units referred to in
section115AB)
57 115AD(1)(i) - Income being 20 % 0 0
dividend received by an FII in
respect of securities (other than
units referred to in section115AB)
58 PTI_115AD(1)(i)-PTI - Income 20 % 0 0
(being Dividend) received by an FII
in respect of securities(other than
units referred to in section115AB)
59 PTI_115AD(1)(i)- Income received 5% 0 0
by an FII in respect of bonds or
government securities referred to in
section 194LD
60 PTI_115BBA- Income received by 20 % 0 0
non-resident sportsmen or sports
associations or entertainer
61 PTI_115BBF- Income from patent 10 % 0 0
62 PTI_115BBG- Income from transfer 10 % 0 0
of carbon credits
63 PTI_115E(a)- Investment income of 20 % 0 0
a non-resident Indian
Total 0 0
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Acknowledgement Number: Date of filing:
Details of Exempt Income (Income not to be included in Total Income or not chargeable to
Schedule EI
tax)
1 Interest income 1 0
Gross Agricultural receipts (other than income to be excluded
i i 0
under rule 7A, 7B or 8 of I.T. Rules)
ii Expenditure incurred on agriculture ii 0
Unabsorbed agricultural loss of previous eight assessment
2 iii iii 0
years
iv Net Agricultural income for the year (i – ii – iii) (enter nil if loss) 2 0
In case the net agricultural income for the year exceeds Rs.5 lakh, please furnish the
v
following details (Fill up details separately for each agricultural land)
3 Other exempt income (including exempt income of minor child) 3 0
SL.No Other exempt income Amount
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Acknowledgement Number: Date of filing:
Pass Through Income details from business trust or investment fund as per section 115UA,
Schedule PTI
115UB
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number: Date of filing:
Schedule FSI Details of Income from outside India and tax relief (Available in case of resident)
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number: Date of filing:
Details Summary of tax relief claimed for taxes paid outside India (available only in case of
Schedule TR
resident)
1 Summary of Tax relief claimed
Country Taxpayer Total proportionate taxes paid outside Total tax relief available (total Tax Relief Claimed
Code Identification India (total of (c) of Schedule FSI in of (f) of Schedule FSI in under section
Number respect of each country) respect of each country) (specify 90, 90A or
91)
Total 0 0
Total Tax relief available in respect of country where DTAA is applicable (section
2 2 0
90/90A) (Part of total of 1(d))
Total Tax relief available in respect of country where DTAA is not applicable
3 3 0
(section 91) (Part of total of 1(d))
Whether any tax paid outside India, on which tax relief was allowed in India, has
4 been refunded/credited by the foreign tax authority during the year? If yes, 4
provide the details below
Amount of tax Assessment year in which tax
a 0 b
refunded relief allowed in India
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number: Date of filing:
Schedule FA Details of Foreign Assets and Income from any source outside India
A1 Details of Foreign Depository Accounts held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of financial Address of financial ZIP Account Status Account Peak balance during Closing Gross interest paid/credited to the account
No name code institution institution code number opening date the period balance during the period
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A2 Details of Foreign Custodial Accounts held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of Address of ZIP Account Status Account Peak balance Closing Gross interest paid/credited to the account during the period
No name code financial financial code number opening during the balance (drop down to be provided specifying nature of amount viz. interest/dividend
institution institution date period /proceeds from sale or redemption of financial assets/ other income)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A3 Details of Foreign Equity and Debt Interest held (including any beneficial interest) in any entity at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name Address ZIP Nature Date of Initial value Peak value of Closing Total gross amount paid/credited with Total gross proceeds from sale or
No name code of of entity code of acquiring the of the investment during balance respect to the holding during the redemption of investment during the
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
A4 Details of Foreign Cash Value Insurance Contract or Annuity Contract held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of financial institution in which Address of financial ZIP Date of The cash value or surrender value Total gross amount paid/credited with respect to the
No name code insurance contract held institution code contract of the contract contract during the period
B Details of Financial Interest in any Entity held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Nature of Name and Address Nature of Date Total Investment (at Income accrued from Nature of Income taxable and offered in this return
No and code Code entity of the Entity Interest-Direct since cost) (in rupees) such Interest Income
Amount Schedule Item number
/Beneficialowner held
where offered of schedule
/Beneficiary
(1) (2) 2a (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
C Details of Immovable Property held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Address of the Ownership-Direct/ Beneficial Date of Total Investment (at Income derived from Nature of Income taxable and offered in this return
No and code Code Property owner/ Beneficiary acquisition cost) (in rupees) the property Income
Amount Schedule Item number
(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
D Details of any other Capital Asset held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Nature of Ownership-Direct/ Beneficial Date of Total Investment (at cost) Income derived from Nature of Income taxable and offered in this return
No and code Code Asset owner/ Beneficiary acquisition (in rupees) the asset Income
Amount Schedule Item number of
(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
E Details of account(s) in which you have signing authority held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021 and which has not been included in A to D above.
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Acknowledgement Number: Date of filing:
Sl Name of the Address Country Zip Name of Account Peak Balance/ Investment during the Whether income If (7) is yes, If (7) is yes, Income offered in
No Institution in which of the Name Code the Number year (in rupees) Peak Balance/ accrued is taxable in Income accrued this return
the account is held Institution and Code account Investment during the year your hands? in the account
Amount Schedule Item
holder
where number
offered of
schedule
(1) (2) (3) (3a) (3b) (4) (5) (6) (7) (8) (9) (10) (11)
F Details of trusts, created under the laws of a country outside India, in which you are a trustee, beneficiary or settlor
Sl Country ZIP Name and Name and Name and Name and Date since Whether income derived is If (8) is yes, Income If (8) is yes, Income offered in this
No Name and CODE address of the address of address of address of position taxable in your hands? derived from the trust return
where number
offered of
schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
G Details of any other income derived from any source outside India which is not included in,- (i) items A to F above and, (ii) income under the head business or profession
Sl Country Name and ZIP Name and address of the person from Income Nature of Whether taxable in your If (6) is yes, Income offered in this return
offered schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9)
Note: Please refer to instructions for filling out this schedule. In case of an individual, not being an Indian citizen, who is in India on a business, employment or student visa, an asset acquired during any previous year in which he was non-
resident is not mandatory to be reported in this schedule if no income is derived from that asset during the current previous year.
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Acknowledgement Number: Date of filing:
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Acknowledgement Number: Date of filing:
Assets and Liabilities at the end of the year (applicable in a case where total income exceeds Rs.50
Schedule AL
lakh)
A Details of immovable assets
Sl. No. Description Address Pin code Amount (cost) in Rs.
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Acknowledgement Number: Date of filing:
(3- 7)
1 2021-22 0 0 0 0
2 2022-23 0
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Acknowledgement Number: Date of filing:
Part B –
Computation of total income
TI
1 Salaries (6 of Schedule S) 1 3,11,006
2 Income from house property ( 4 of Schedule HP) (enter nil if loss) 2 0
3 Capital gains
Short term
i Short-term chargeable @ 15% (9ii of item E of schedule CG) ai 0
ii Short-term chargeable @ 30% (9iii of item E of schedule CG) aii 0
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Acknowledgement Number: Date of filing:
5 Surcharge 0
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Acknowledgement Number: Date of filing:
IAC
Credit u/s 115JD of tax paid in earlier years (applicable only if 7 is higher than 1d) (row 5 of
9 9 0
Schedule AMTC)
11 Tax relief
a Section 89(Please ensure to submit Form 10E to claim this relief) 11a 0
Refund (If 15e is greater than 14) (Refund, if any, will be directly credited into the bank
17 17 0
account)
Do you have a bank account in India (Non- Residents claiming refund with no bank account in India
18 Yes
may select No)
Sl. IFS Code of the Bank in case of Name of Indicate the account in which you prefer to get
Account Number
No Bank Accounts held in India the Bank your refund credited, if any (tick accounts
BANK OF ✔
1 BKID0004669 466911110000003
INDIA
BANK OF
2 BKID0004669 46691111000003
INDIA
Note:
1. Minimum one account should be selected for refund credit.
2. In case of Refund, multiple accounts are selected for refund credit, then refund will be credited to one of the account decided by
CPC after processing the return
b) Non- residents, who are claiming income-tax refund and not having bank account in India may, at their option, furnish the details
43 of 45
Acknowledgement Number: Date of filing:
ii of one foreign bank account:
Sl. No. SWIFT Code Name of the Bank Country of Location IBAN
20 TAX PAYMENTS
Sl No BSR Code Date of Deposit (DD/MMM/YYYY) Serial Number of Challan Amount (Rs)
Note: Enter the totals of Advance tax and Self-Assessment tax in Sl No. 15a & 15d of Part B-TTI
B Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Sl Tax Deduction Account Number (TAN) of the Name of the Income chargeable under Total tax
No Employer Employer Salaries deducted
C Details of Tax Deducted at Source (TDS) on Income [As per Form 16 A issued by Deductor(s)]
Sl TDS credit PAN/ TAN of the Unclaimed TDS TDS of the current Financial TDS credit being claimed this Year Corresponding TDS
No relating to self Aadhaar of Deductor/ brought forward Year (TDS deducted during FY (only if corresponding income is Receipt offered credit
/other person Other PAN/ (b/f) 2021-22) being offered for tax this year,not being
[spouse as per Person (if Aadhaar of applicable if TDS deducted u/s 194N) carried
37BA(2) (if
applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Aadhaar
D Details of Tax Deducted at Source (TDS) on Income [As per Form 16B/16C furnished by Deductor(s)]
Sl TDS credit PAN/ PAN Unclaimed TDS TDS of the current Financial TDS credit being claimed this Year Corresponding TDS
No relating to self Aadhaar of /Aadhaar brought forward Year (TDS deducted during FY (only if corresponding income is Receipt offered credit
/other person Other No. of (b/f) 2021-22) being offered for tax this year) being
(if applicable)
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Acknowledgement Number: Date of filing:
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Aadhaar
E Details of Tax Collected at Source (TCS) [As per Form 27D issued by the Collector(s)]
Sl Tax Deduction and Collection Name of Tax Amount out of Amount out of (4) being claimed in the
No Account Number of the the Collected (4) being hands of spouse, if section 5A is
Collector Collector claimed applicable
VERIFICATION
I, AKHILESH KUMAR SAHU son/ daughter of SITA RAM SAHU solemnly declare that to the best of my knowledge
and belief, the information given in the return and schedules thereto is correct and complete and is in accordance with
the provisions of the Income-tax Act, 1961.
I further declare that I am making return in my capacity as Self and I am also competent to make this return and verify
it. I am holding permanent account number (if allotted) AIAPS9280Q (Please see instruction) I further declare that the
critical assumptions specified in the agreement have been satisfied and all the terms and conditions of the agreement
have been complied with. (Applicable in a case where return is furnished under section 92CD)
Date: Sign Here:
If the return has been prepared by a Tax Return Preparer (TRP) give further details below:
Identification No. of TRP Name of TRP Counter Signature of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof 0
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