Form PDF 395323140241221
Form PDF 395323140241221
Form PDF 395323140241221
Assessment
ITR-4 profession which is computed under sections 44AD, 44ADA or 44AE]
[Not for an individual who is either Director in a company or has Year
SUGAM invested in unlisted equity shares or if income-tax is deferred 2021-22
on ESOP or has agricultural income more than Rs.5000]
(Please refer instructions for eligibility)
01-Apr-1993 No.53,
(A7) Name of Premises/ Building/ Village (A8) Road/Street/Post Office (A9) Area/Locality
(A10) Town/City/District (A11) State (A12) Country (A13) PIN Code/ZIP Code
CHITRADURGA 15 - Karnataka 91 - India 577520
(A14) Aadhaar Number (12 digits)/ Aadhaar Enrolment Id (28 digits) (if eligible for Aadhaar (A15) Status
No.)
Individual
3xxx xxxx 7272
HUF
Firm (other than LLP)
(A16) Residential/Office Phone Number with STD code/ (A17) Mobile No.2 (A18) Email Address-1 (Self)
Mobile No.1 sunilsnaik16@gmail. com
91 9164867774 Email Address-2
(A19) Nature of Employment - Central Govt. State Govt. Public Sector Undertaking CG - Pensioners SG -
Pensioners PSU - Pensioners Other Pensioners Others Not Applicable (e.g. Family Pension etc.)
(A20) (a) Filed u/s [Please 139(1)-On or before due date 139(4)-After due date 142(1) 148 139(5)-Revised
see instruction]-
Return 139(9) 119(2)(b)- After Condonation of delay 139(8A)
Other selected)
v Income chargeable under the head ‘Salaries’ (iii – iv) ( NOTE- Ensure to Fill B2 0
“Sch TDS1”)
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Note:-Maximum loss from house property that can be set-off is INR
2,00,000. To avail the benefit of carry forward and set off of loss, please use
ITR-3/5.
B4 Income from Other Sources B4 0
NOTE- Fill "Sch TDS2" if applicable.
S.No. Nature of Income Description ( If Any Other selected) Total Amount
etc.
Government
by employer
house property
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B6 Total deductions (Add items C1 to C18) 72,000 60,000
D6 Relief u/s 89(Please ensure to submit Form 10E to claim this relief) D6 0
D12 Total Tax, Fee and Interest (D7 + D8 + D9 + D10 + D11) D12 0
D15 Total TDS Claimed (total of column 4 of Schedule-TDS1 and column 6 of D15 0
Schedule-TDS2)
D20 Exempt income only for reporting purposes (If agricultural income is more than Rs.5,000/-, use ITR 3/5)
Sl. No. Nature of Income Description (If 'Any Other' is selected) Amount
Total 0
D21 Details of all Bank Accounts held in India at any time during the previous year
(excluding dormant accounts) (In case of non-residents, details of any one
foreign Bank Account may be furnished for the purpose of credit of refund)
SL.No. IFS Code of the bank Name of the Bank Account Number Select Account
for Refund Credit
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S.No. Name of the Business Business Code Description
a Through a/c payee cheque or a/c payee bank draft or bank E1a 0
electronic clearing system or prescribed electronic modes
c Total (a + b) E2c 0
NOTE : If Income is less than the above percentage of Gross Receipts,
it is mandatory to have a tax audit under 44AB & other ITR as applicable
has to be filed.
COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA
E4 Presumptive Income under section 44ADA (50% of E3)or the amount E4 4,53,250
claimed to have been earned, whichever is higher
Note : If income is less than 50% of Gross Receipts, it is mandatory to
have a tax audit under 44AB & other ITR as applicable has to be filed.
COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44AE
Sl no Registration No. of goods carriage Whether owned/leased/hired Tonnage Capacity Number of months Presumptive income u/s 44AE for
of goods for which goods the goods carriage (Computed @
carriage(in MT) carriage was Rs.1000 per ton per month in case
owned/ leased / tonnage exceeds 12MT, or else @
hired by assessee Rs.7500 per month) or the amount
claimed to have been actually
earned, whichever is higher
(i) (1) (2) (3) (4) (5)
Add row options as necessary (At any time during the year the number of vehicles should not exceed 10 vehicles)
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Note – Please furnish the information below for each GSTIN No. separately
Annual Value of Outward Supplies as per the GST Return Filed
S.No. GSTIN No.
E10 Total value of outward supplies as per the GST returns filed 0
FINANCIAL PARTICULARS OF THE BUSINESS
Note : For E11 to E25 furnish the information as on 31st day of March,2021
TOTAL 0
Note:Enter the totals of Advance tax and Self-Assessment tax in D13 and D14
Schedule TCS - Details of Tax Collected at Source [As per Form 27D issued by the Collector(s)]
SL.No. Tax Collection Account Number of Name of Collector Details of amount Tax Collected Amount out of (4)
the Collector paid as mentioned in being claimed
Form 26AS
Col (1) Col (2) Col (3) Col (4) Col (5)
TOTAL 0
TOTAL 0
Note: Enter the total of column 4 of Schedule-TDS1 and column 6 of Schedule-TDS2 in D15
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SCHEDULE TDS2 - DETAILS OF TAX DEDUCTED AT SOURCE ON INCOME OTHER THAN SALARY [As per Form 16 A
issued or Form 16C or Form 16D furnished by Deductor(s)]
Sl.No. TAN of the Unclaimed TDS brought forward (b/f) TDS of the TDS credit being Corresponding TDS credit
Deductor current Fin. Year claimed this receipt offered being carried
Year (only if forward
corresponding
receipt is being
offered for
tax this year)
Fin. Year in TDS b/f TDS Deducted TDS Claimed Gross Amount Head of
which deducted Income
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Total 0
Note: Enter the total of column 6 of Schedule TDS2 and column 4 of Schedule-TDS1 in D15
Details of Tax Deducted at Source [TDS 2(ii)] [as per form 16C furnished by the payer(s)]
Sl.No. PAN/Aadhaar no. of Tenant Unclaimed TDS TDS of the TDS credit Corresponding TDS credit
brought forward (b/f) current Fin. Year being claimed receipt offered being carried
this Year forward
(only if
corresponding
receipt
is being
offered for
tax this year)
Fin. Year in TDS b/f TDS Deducted TDS Claimed Gross Head of
which deducted Amount Income
1 2 3 4 5 6 7 8 9
Total 0
Note: Enter the total of column 6 of Schedule TDS2 and column 4 of Schedule-TDS1 in D15
Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior Not claiming for Self/ Family
citizen?
2 Whether any one of your parents is a senior citizen Not claiming for Parents
(a) Parents 0
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(ii) Preventive Health Checkup 0
SCHEDULE 80G - DETAILS OF DONATIONS ENTITLED FOR DEDUCTION UNDER SECTION 80G
A.Donations entitled for 100% deduction without qualifying limit
SL. No. Name of the Donee Address City or Town State code Pincode PAN of the Donee Amount of donation Eligible
or District Donation Donation in Total Amount of
in cash other mode Donation Donation
0 0 0 0
Total A
B. Donations entitled for 50% deduction without qualifying limit
SL. No. Name of the Donee Address City or Town State code Pincode PAN of the Donee Amount of donation Eligible
or District Donation Donation in Total Amount of
in cash other mode Donation Donation
0 0 0 0
Total B
C. Donations entitled for 100% deduction subject to qualifying limit
SL. No. Name of the Donee Address City or Town State code Pincode PAN of the Donee Amount of donation Eligible
or District Donation Donation in Total Amount of
in cash other mode Donation Donation
0 0 0 0
Total C
D. Donations entitled for 50% deduction subject to qualifying limit
SL. No. Name of the Donee Address City or Town State Pincode PAN of the Donee Amount of donation Eligible
or District Donation Donation in Total Amount of
in cash other mode Donation Donation
0 0 0 0
Total D
0 0 0 0
E. Total Amount of Donations (A + B + C+ D)
xyz
xyz
xyz
VERIFICATION
I, SUNIL KUMARA SAJYANAYAK son/ daughter of SAJYANAYAK solemnly declare that to the best of my knowledge
and belief, the information given in the return is correct and complete and is in accordance with the provisions of the
Income-tax Act, 1961. I further declare that I am making this return in my capacity as Self and I am also competent to
make this return and verify it. I am holding permanent account number ETNPS4256N
Place : 157.45.44.237
Date : 24-Dec-2021
If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
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