FORM INDIAN INCOME TAX RETURN Assessment YearITR-5 Including Fringe Benefit Tax Return

[For firms, AOPs and BOIs](Please see Rule 12 of the Income-tax Rules,1962)

(Also see attached instruction)

2013-14

Part A-GEN GENERALName PAN

Is there any change in the name? If Yes, Please furnish the old name

Flat/Door/Block No Name Of Premises/Building/Village Date Of formation (DD/MM/YYYY)

Road/Street/Post Office Area/Locality Status (firm-1, local authority-2,cooperative bank-3, othercooperative society-4,LLP-5, any otherAOP/BOP artificial juridicalperson-6)

Town/City/District State Pin code Income Tax Ward / Circle

Country

Office Phone Number with STD code/Mobile no. 1

Mobile No.2

Email Address-1

Email Address-2

Return Filed (Tick)[Please see instruction number-6]

Before duedate139(1)

After due date- 139(4)

RevisedReturn139(5)

OR In response to notice 139(9)- Defective 142(1) 148 153A 153C Or 92CDIf revised/in response to notice for Defective, then enter ReceiptNo. and Date of filing original return(DD/MM/YYYY)Residential Status (Tick) Resident Non -ResidentWhether any income included in total income for which claim u/s 90/90A/91 has been made [applicable only in caseof resident] [If yes, ensure to fill Schedule FSI and Schedule TR]

Yes No

In the case of non-resident, is there a permanent establishment (PE) in India (Tick) Yes NoWhether this return is being filed by a representative assesse? (Tick) Yes No

If yes, please furnish the following information :-(a) Name of the representative(b) Address of the representative(c) Permanent Account Number (PAN) of the representative

For Office Use Only Receipt No.

Date

Seal and Signature of receiving official

a Are you liable to maintain accounts as per section 44AA? (Tick) Yes Nob Are you liable for audit under section 44AB? (Tick) Yes Noc if (b) is yes whether the accounts have been audited by an accountant? (Tick)

If Yes, furnish the following informationYes No

(i) Date of funishing to the audit report (DD/MM/YYYY)(ii) Name of the auditor signing the tax audit report(iii) Membership no. of the auditor(iv) Name of the auditor (proprietorship/ firm)(v) Permanent Account Number (PAN) of the proprietorship/ firm(vi) Date of audit report.If Liable to furnish other audit report, mention the date of furnishing of the audit report? (dd/mm/yy) (Please see Instruction 6(ii))

92E 115JC

A. Whether there was any change during the previous year in the partners/members of the firm/AOP/BOI (Tick) (In case of societies and cooperative banks give details of Managing Committee)

Yes No

B. Is any member of the AOP/BOI a foreign company? Yes NoC. If Yes, mention the percentage of share of the foreign company in the AOP/BOI.D. Where total income of any member of the AOP/BOI (excluding his share from such association of body ) exceeds the

maximum amount which is not chargeable to tax in the case of that member ? (Tick)Yes No

E. Particulars of persons who were partners/ members in the firm/AOP/BOI on 31st day of March, 2013S. No. Name and Address Percentage of share (if determinate) PAN Status

(see instruction no. 6)

Nature of business or profession, if more than one business or profession indicate the three main activities/ productsS.No. Code

[Please see instruction No. 7(i)]Description

Part A-BS BALANCE SHEET AS ON 31ST DAY OF MARCH, 2013. (fill items A and B in a case where regular books ofaccounts are maintained, otherwise fill item C)

A Sou rces of Funds1. Partners'/Members' Fund

a. Partners'/Members' capital ab. Reserves and surplus

(i) Revaluation Reserve bi(ii) Capital Reserve bii(iii) Statutory Reserve biii(iv) Any Other Reserve biv(v) Credit balance of Profit and loss account bv(vi) Total ( bi+bii+biii+biv+bv) bvi

c. Total Partners'/Members' fund (a+bvi) 1c2. Loan Funds

a. Secured loans(i) Foreign Currency Loans ai(ii) Rupee Loans A. From Banks iiA B. From others iiB C. Total (iiA+iiB) iiC(iii) Total secured loans (ai+iiC) aiii

b. Unsecured loans (Including deposits)(i) Foreign Currency Loans bi(ii) Rupee Loans A. From Banks iiA B. From persons specified in section 40A(2)(b) of the I.T. Act

iiB

C. From others iiC D. Total Rupee Loans(iiA+iiB+iiC) iiD

(iii) Total Unsecured loans (bi+iiD) biiic. Total Loan Funds (aiii+biii) 2c

3. Deferred tax liability 34. Advances

i From persons specified in section 40A(2)(b) of the I.T. Act i ii From other ii iii Total Advances (i+ii) 4iii

5. Sources of funds (1c+2c+3+4iii) 5B App lication of funds

1. Fixed Assetsa. Gross : Block 1ab. Depreciation 1bc. Net Block (a-b) 1cd. Capital work-in progress 1de. Total (1c+1d) 1e

2. Investmentsa. Long-term investments

(i) Investment in property i(ii) Equity Instruments (A) Listed equities iiA (B) Unlisted equities iiB (C) Total iiC(iii) Preference Shares iii(iv) Government or trust securities iv(v) Debenture of bonds v(vi) Mutual funds vi(vii) Others vii(viii) Total Long-term investments (i+iiC+iii+iv+v+vi+vii) aviii

b. Short-Term investments(i) Equity instruments (A)Listed equities iA (B)Unlisted equities iB (C)Total iC(ii) Preference shares ii(iii) Government or trust securities iii(iv) Debenture or bonds iv(v) Mutual funds v(vi) Others vi(vii) Total Short-term investments (iC + ii + iii + iv + v + vi) bvii

c. Total investments (aviii + bvii) 2c3. Currents assets, loans and advances

a Current assetsi Inventories

A Raw materials iAB Work-in-progress iBC Finished goods iCD Stock-in-trade (in respect of goods acquired for trading) iDE Stores/consumables including packing material iEF Loose tools iFG Others iGH Total (iA + iB + iC + iD + iE + iF + iG) iH

ii Sundry DebtorsA Outstanding for more than one year iiAB Others iiBC Total Sundry Debtors iiC

iii Cash and Bank BalancesA Balance with banks iiiAB Cash-in-hand iiiBC Others iiiCD Total Cash and cash equivalents (iiiA + iiiB + iiiC) iiiD

iv Other Current Assets aivv Total current assets (iH +iiC + iiiD + aiv) av

b Loans and advances

i Advances recoverable in cash or in kind or forvalue to be received

bi

ii Deposits, loans and advances to corporate and others biiiii Balance with Revenue Authorities biiiiv Total (bi + bii + biii) bivv Loans and advances included in biv which is

a for the purpose of business or profession vab not for the purpose of business or profession vb

c Total (av + biv) 3cd Current liabilities and provisions

i Current liabilitiesA Sundry Creditors

1 Outstanding for more than one year 12 Others 23 Total (1 + 2) A3

B Liability for Leased Assets iBC Interest Accrued and due on borrowings iCD Interest accrued but not due on borrowings iDE Income received in advance iEF Other payables iFG Total (A3 + iB + iC + iD + iE + iF) iG

ii ProvisionsA Provision for Income Tax iiAB Provision for Wealth Tax iiBC Provision for Leave

encashment/Superannuation/GratuityiiC

D Other Provisions iiDE Total (iiA + iiB + iiC + iiD) iiE

iii Total (iE + iiE) diiie Net current assets (3c – diii) 3e

4 a Miscellaneous expenditure not written off or adjusted 4ab Deferred Tax Asset 4bc Debit balance in Profit and loss account/ accumulated

balance4c

d Total (4a + 4b +4c) 4d5 Total, application of funds (1e + 2c + 3e +4d) 5

C In a case where regular books of account of business or profession are not maintained, furnish thefollowing information as on 31st day of March, 2013, in respect of business or profession

1 Amount of total sundry debtors C12 Amount of total sundry creditors C23 Amount of total stock-in-trade C34 Amount of the cash balance C4

Part A-P & L Profit and Loss Account for the financial year 2012-13 (fill items 1 to 52 in a case where regular books of accountsare maintained otherwise fill item 53)

1 Revenue from operationsA Sales/ Gross receipts of business (Net of returns and refunds and duty or tax, if any)

i Sal e of goods iii Sal e of Services iiiii Ot her operation revenues (specify nature and amount)

iv Total (i+ii+iiic) AivB Duties, taxes and cess, received or receivable, in respect of goods and services sold or supplied

i Union Excise duties iii Service tax iiiii VAT/Sales tax iiiiv Any other duty, tax and cess ivv Total (i + ii + iii + iv) Bv

C Tot al Revenue from operations (Aiv + Bv) 1C2 Other income

i Rent iii Commission ii

iii Dividend income iiiiv Interest income ivv Profit on sale of fixed assets vvi Profit on sale of investment being securities chargeable to

Securities Transaction Tax (STT)vi

vii Profit on sale of other investment viiviii Profit on account of currency fluctuation viiiix Agriculture income ixx Any other income (specify nature and amount)

xi Total of other income (i+ii+iii+iv+v+vi+vii+viii+ix+xc)3 Closing Stock

i Raw material 3i ii Work-in-progress 3ii iii Finished goods 3iiiTotal (3i+3ii+3iii) 3iv

4 Total of credits to profit and loss account (1 + 2xi + 3iv) 45 Opening Stock

i Raw material 5i ii Work-in-progress 5ii iii Finished goods 5iiiTotal (5i+5ii+5iii) 5iv

6 Purchases (net of refunds and duty or tax, if any) 67 Duties and taxes, paid or payable, in respect of goods and

services purchasedi Custom duty 7iii Counter veiling duty 7iiiii Special additional duty 7iiiiv Union excise duty 7ivv Service tax 7vvi VAT/sales tax 7vivii Any other tax, paid or payable 7viiviii Total (7i + 7ii + 7iii + 7iv + 7v + 7vi + 7vii) 7viii

8 Freight 89 Consumption of stores and spare parts 910 Power and fuel 1011 Rents 1112 Repairs to building 1213 Repairs to machinery 1314 Compensation to employees

i Salaries and wages 14iii Bonus 14iiiii Reimbursement of medical expenses 14iiiiv Leave encashment 14ivv Leave travel benefits 14vvi Contribution to approved superannuation fund 14vivii Contribution to recognised provident fund 14viiviii Contribution to recognised gratuity fund 14viiiix Contribution to any other fund 14ixx Any other benefit to employees in respect of which an

expenditure has been incurred14x

xi Total compensation to employees (14i+14ii+14iii+14iv+14v+14vi+14vii+14viii+14ix+14x)

14xi

xii Whether any compensation ,included in 14xi, paid tonon-residents

xiia

If Yes, amount paid to non-residents xiib15 Insurance

i Medical Insurance 15iii Life Insurance 15iiiii Keyman’s Insurance 15iiiiv Other Insurance including factory, office, car, goods, etc. 15ivv Total expenditure on insurance (15i+15ii+15iii+15iv) 15v

16 Workmen and staff welfare expenses 16

17 Entertainment 1718 Hospitality 1819 Conference 1920 Sales promotion including publicity (other than advertisement) 2021 Advertisement 21

22 Commissioni To non-resident other than a company or a foreign

companyi

ii To others iiii Total (i+ii) 22iii

23 Royaltyi To non-resident other than a company or a foreign

companyi

ii To others iiiii Total(i+ii) 23iii

24 Professional/Consultancy fees/ Fee for technical servicesi To non-resident other than a company or a foreign

companyi

ii To others iiiii Total (i+ii) 24iii

25 Hotel, Boarding and Lodging 2526 Traveling expenses other than on foreign traveling 2627 Foreign travelling expenses 2728 Conveyance expenses 2829 Telephone expense 2930 Guest House expenses 3031 Club expenses 3132 Festival celebration expenses 3233 Scholarship 3334 Gift 3435 Donation 3536 Rates and taxes, paid or payable to Government or any local body( excluding taxes on income)

i Union excise duty 36iii Service Tax 36iiiii VAT/Sales Tax 36iiiiv Cess 36ivv Any other rate, tax, duty or cess incl STT 36vvi Total rates and taxes paid or payable (36i+36ii+36iii+

36iv+36v)36vi

37 Audit Fee 3738 Other expenses (Specify nature and amount)

i39 Bad debts (specify PAN of the person, if available, for whom Bad Debt for amount of Rs. 1 lakhs of

more is claimed and amount)i 39iii 39iiiii 39iiiiv Other (More than Rs. 1 lakh) where PAN is not available 39ivv Others (amounts less than Rs. 1 lakh) 39vvi Total Bad Debt (39i+39ii+39iii+39iv+39v) 39vi

40 Provision for bad and doubtful debts 4041 Other provisions 4142 Profit before interest, depreciation and taxes [4-(5iv+6+7viii+8 to 13+14xi+15v+16 to 21+22iii+

23iii+24iii+25 to 35+36vi+37+38iii+39vi+40+41)]42

43 Interesti To non resident other than a company or a foreign

companyi

ii To others iiiii Total (i+ii) 43iii

44 Depreciation 4445 Profit before taxes (42-43iii-44) 45

46 Provision for current tax 4647 Provision for Deferred Tax and deferred liability 4748 Profit after tax (45-46-47) 4849 Balance brought forward from previous year 4950 Amount available for appropriation (48+49) 5051 Transfered to reserves and surplus 5152 Balance carried to balance sheet in partner's account (50-51) 5253 In a case where regular books of account of business or profession are not maintained, furnish the

following information for previous year 2012-13 in respect of business or profession.a Gross receipts 53ab Gross profit 53bc Expenses 53cd Net profit 53d

Part A-OI Other Information (optional in a case not liable for audit under section 44AB)

1 Method of accounting employed in the previous year (Tick) Mercantile Cash2 Is there any change in method of accounting (Tick) Yes No3 Effect on the profit because of deviation, if any, in the method of accounting employed in

the previous year from accounting standards prescribed under section 145A3

4 Method of valuation of closing stock employed in the previous yeara Raw Material (if at cost or market rates whichever is less write 1, if at cost write 2, if

at market rate write 3)b Finished goods (if at cost or market rates whichever is less write 1, if at cost write 2,

if at market rate write 3)c Is there any change in stock valuation method (if yes

write 1 and if no write 2)d Effect on the profit or loss because of deviation , if any, from the method of valuation

prescribed under section 145A4d

5 Amounts not credited to the profit and loss account, being-a the items falling within the scope of section 28 5ab the proforma credits, drawbacks, refund of duty of

customs or excise or service tax, or refund of sales taxor value added tax, where such credits, drawbacks orrefunds are admitted as due by the authorities concerned

5b

c escalation claims accepted during the previous year 5cd any other item of income 5de capital receipt, if any 5ef Total of amounts not credited to profit and loss account

(5a+5b+5c+5d+5e)5f

6 Amounts debited to the profit and loss account, to the extent disallowable under section36:-

a Premium paid for insurance against risk of damage ordestruction of stocks or store

6a

b Premium paid for insurance on the health of employees 6bc Any sum paid to an employee as bonus or commission

for services rendered, where such sum was otherwisepayable to him as profits or dividend.

6c

d Any amount of interest paid in respect or borrowedcapital

6d

e Amount of discount on a zero-coupon bond 6ef Amount of contributions to a recognised provident fund 6fg Amount of contributions to an approved superannuation

fund6g

h Amount of contributions to an approved gratuity fund 6hi Amount of contributions to any other fund 6ij Amount of bad and doubtful debts 6jk Provision for bad and doubtful debts 6kl Amount transferred to any special reserve 6lm Expenditure for the purposes of promoting family

planning amongst employees6m

n Any sum received from employees as contribution to anyprovident fund or superannuation fund or any fund set

6n

up under ESI Act or any other fund for the welfare ofemployees to the extent credited to the employeesaccount on or before the due date

o Any other disallowance 6op Total amount disallowable under section 36 (total of 6a

to 6o)6p

q Total number of employees employed (mandatory incase the assessee has recognized Provident Fund)

i deployed in India iii deployed outside India iiiii Total iii

7 Amounts debited to the profit and loss account, to the extent disallowable under section 37a Expenditure of personal nature; 7ab Expenditure on advertisement in any souvenir, brochure,

tract, pamphlet or the like, published by a political party;7b

c Expenditure by way of penalty or fine for violation ofany law for the time being in force;

7c

d Any other penalty or fine; 7de Expenditure incurred for any purpose which is an

offence or which is prohibited by law; 7e

f Amount of any liability of a contingent nature 7fg Any other amount not allowable under section 37 7gh Total amount disallowable under section 37 (total of 7a to 7g ) 7h

8 A Amounts debited to the profit and loss account, to the extent disallowable undersection 40

a Amount disallowable under section 40 (a) (i),40(a)(ia) and 40 (a)(iii) on account ofnon-compliance with theprovisions of Chapter XVII-B

Aa

b Amount of tax or rate levied or assessed on thebasis of profits

Ab

c Amount paid as wealth tax Acd Amount of interest, salary, bonus, commission or

remuneration paid to any partner or memberAd

e Any other disallowance Aef Total amount disallowable under section 40

(total of Aa to Ae)8Af

B Any amount disallowed under section 40 in any preceding previous year but allowableduring the previous year

8B

9 Amounts debited to the profit and loss account, to the extent disallowable under section40A

a Amounts paid to persons specified in section40A(2)(b)

9a

b Amount paid otherwise than by account payee cheque oraccount payee bank draft disallowable under section40A(3) – 100% disallowance

9b

c Provision for payment of gratuity 9c

d any sum paid by the assesse as an employer forsetting up or as contribution to any fund, trust,company, AOP, or BOI or society or any otherinstitution;

9d

e Any other disallowance 9ef Total amount disallowable under section 40A (total of

9a to 9e)9f

10 Any amount disallowed under section 43B in any preceding previous year but allowableduring the previous year

a Any sum in the nature of tax, duty, cess or fee under anylaw

10a

b Any sum payable by way of contribution to anyprovident fund or superannuation fund or gratuityfund or any other fund for the welfare of employees

10b

c Any sum payable to an employee as bonus or 10c

commission for services renderedd Any sum payable as interest on any loan or

borrowing from any public financial institution or a Statefinancial corporation or a state industrial investmentcorporation.

10d

e Any sum payable as interest on any loan orborrowing from any scheduled bank

10e

f Any sum payable towards leave encashment 10fg Total amount allowable under section 43B (total of 10a

to 10f)10g

11 Any amount debited to profit and loss account of the previous year but disallowable undersection 43B:-

a Any sum in the nature of tax, duty, cess or fee underany law

11a

b Any sum payable by way of contribution to anyprovident fund or superannuation fund or gratuityfund or any other fund for the welfare of employees

11b

c Any sum payable to an employee as bonus orcommission for services rendered

11c

d Any sum payable as interest on any loan orborrowing from any public financial institution or aState financial corporation or a state industrialinvestment corporation.

11d

e Any sum payable as interest on any loan orborrowing from any scheduled bank

11e

f Any sum payable towards leave encashment 11fg Total amount disallowable under Section 43B(total of

11a to 11f)11g

12 Amount of credit outstanding in the accounts in respect ofa Union Excise Duty 12ab Service tax 12bc VAT/sales tax 12cd Any other tax 12de Total amount outstanding (total of 12a to 12d) 12e

13 Amounts deemed to be profits and gains under section 33AB or 33ABA or 33AC 1314 Any amount of profit chargeable to tax under section 41 1415 Amount of income or expenditure of prior period credited or debited to the profit and loss

account (net)15

Part A -QD Quantitative details (optional in a case not liable for audit under section 44AB)(a) In the case of a trading concern

1 Opening stock 12 Purchase during the previous year 23 Sales during the previous year 34 Closing stock 45 Shortage/ excess, if any 5

(b) In the case of a manufacturing concern6 Raw materials

a Opening stock 6ab Purchases during the previous year 6bc Consumption during the previous year 6cd Sales during the previous year 6de Closing stock 6ef Yield finished products 6fg Percentage of yield 6gh Shortage/ excess, if any 6h

7 Finished products/ By-productsa opening stock 7ab purchase during the previous year 7bc quantity manufactured during the previous year 7cd sales during the previous year 7de closing stock 7e

f shortage/ excess, if any 7f

Part B -TI Computation of total income1 Income from house property (4c of Schedule-HP) (enter nil if loss) 12 Profits and gains from business or profession

i Profit and gains from business other than speculative business andspecified business (A37 of Schedule-BP)(enter nil if loss)

2i

ii Profit and gains from speculative business (B41 of Schedule-BP)(enter nil if loss and carry this figure to Schedule CFL)

2ii

iii Profit and gains from specified business (C47 of Schedule-BP)(enter nil if loss and carry this figure to Schedule CFL)

2iii

iv Total (2i + 2ii+2iii)(enter nil, if loss and carry this figure to loss to schedule CYLA) 2iv3 Capital gains

a Short termi Short-term (under section 111A) (A2a+A3e of Schedule-

CG)3ai

ii Short-term (others) (A7-A2a-A3e of Schedule-CG) 3aiiiii Total short-term (3ai + 3aii) 3aiii

b Long termi Long-term with indexation [(B7-B4e-B5) of Schedule-CG] 3biii Long-term without indexation (B4e+B5 of Schedule-CG) 3biiiii Total Long Term (3bi+3bii) (enter nil if loss and take the figure to

schedule CFL)3biii

c Total capital gains (3aiii + 3biii) (take the figure adjusted to Schedule CYLA)(In case of negativefigure enter nil and take the figure under respective head to schedule CFL)

3c

4 Income from other sourcesa from source other than from owning race horses and winning

from Lottery etc. (1g of Schedule OS)4a

b winning from lotteries, crossword puzzles, races, games gamblingbetting etc. (2 of Schedule OS)

4b

c from owning race horses (4c of Schedule OS) (enter nill if loss) 4cd Total (4a + 4b+4c) (enter nil if loss) 4d

5 Total (1 + 2iv +3c +4d) 56 Losses of current year to be set off against 5 (total of 2ix,3ix and 4ix of Schedule CYLA) 67 Balance after set off current year losses (5 – 6)(also total of column 5 of schedule CYLA+4b) 78 Brought forward losses to be set off losses against 7 (total of 2ix, 3ix and 4ix of Schedule

BFLA)8

9 Gross Total income (7-8) (also 5x of Schedule BFLA+4b) 910 Income chargeable to tax at special rate under section 111A, 112 etc. included in 9 1011 Deductions under Chapter VI-A (k of Schedule VIA and limited to 9-10) 1112 Total income (9 – 11) 1213 Income chargeable to tax at special rates (total of (i) of schedule SI) 1314 Net agricultural income/ any other income for rate purpose (4 of Schedule EI) 1415 ‘Aggregate income’ (12-13 + 14)[applicable if (12-13) exceeds maximum amount Not chargable

to tax]15

16 Losses of current year to be carried forward (total of xi of schedule CFL) 1617 Deemed total income under section 115JC (3 of Schedule AMT) 17

Part B - TTI Computation of tax liability on total income1 a Tax payable on deemed total income under section 115JC (4 of Schedule AMT) 1a

b Education Cess on (1a) above 1bc Total Tax Payable 1c

2 Tax payable on total incomea Tax at normal rates on 15 of Part B-TI 2ab Tax at special rates (total of (ii) of Schedule SI) 2bc Rebate on agricultural income [applicable if (12-13) of

Part B-TI exceeds maximum amount not chargeable totax]

2c

d Tax Payable on Total Income (2a+2b-2c) 2d

3 Education cess, including secondary and higher education cess on 2d 34 Gross tax liability (2d+3) 45 Gross tax payable (higher of 4 or 1c) 56 Credit under section 115JD of tax paid in earlier years (if 4 is more than 1c) (5 of Schedule

AMTC)6

7 Tax payable after credit under section 115JD (5-6) 78 Tax relief

a Section 90/90A (1B1 of Schedule TR) 8ab Section 91 (1B2 of Schedule TR) 8bc Total (8a + 8b ) 8c

9 Net tax liability (7 - 8c) 910 Interest payable

a For default in furnishing the return (section 234A) 10ab For default in payment of advance tax (section 234B) 10bc For deferment of advance tax (section 234C) 10cd Total Interest Payable (10a+10b+10c) 10d

11 Aggregate liability (9+10d) 1112 Taxes Paid

a Advance Tax (from Schedule - IT) 12ab TDS (total of column 7 of Schedule-TDS) 12bc TCS (total of column 5 of Schedule-TCS) 12cd Self Assessment Tax (from Schedule-IT) 12de Total taxes Paid (12a+12b+12c+12d) 12e

13 Amount payable (Enter if 11 is greater than 12e, else enter 0) 1314 Refund (If 12e is greater than 11) (give Bank Account details in Sch. BA) 14

Schedule BA Please furnish the following information1 Enter your bank account number (mandatory in all cases and for direct deposit of refund

into bank, the number should be 11 digits or more)2 Do you want your refund by Cheque, or Deposited directly into your bank account? (tick as applicable )3 Give additional details of your bank account

IFSC Code Type of Account (tick as applicable ) Savings CurrentCash credit

Do you have,-(i) any asset (including financial interest in any entity) located outside India or(ii) signing authority in any account located outside India? Yes No[applicable only in case of a resident] [Ensure Schedule FA is filed up if the answer is Yes ]

VERIFICATIONI, ............................................. (Full Name In Block Letter) son/ daughter of .................................. holding permanent accountnumber holding permanent account number ................. solemnly declare that to the best of my knowledge and belief, theinformation given in the return and the schedules thereto is correct and complete and that the amount of total income and otherparticulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of incomechargeable to Income-tax for the previous year relevant to the Assessment Year 2013-2014. I further declare that I am making this returnin my capacity as .................................. and I am also competent to make this return and verify it.

Place Date Sign here

Schedule HP Details of Income from House Property (Please refer instruction)1 Address of property 1 Town/City State Pin Code

Is the property co-owned? Yes No (If "Yes" please enter following details)Assessee's percentage of share in the property.

Sn. Name of Co-owner(s) PAN of Co-owner (s) (optional) Percent Share in Property

(Tick) if let out Name of Tenant PAN of Tenant (Optional)

a Annual letable value/rent received or receivable (higher of the two, if let out for whole of the year, lowerof the two, if let out for part of the year)

1a

b The amount of rent which cannot be realized 1bc Tax paid to local authorities 1cd Total (1b + 1c) 1de Balance (1a - 1d) 1e

1 f 30% of 1e 1fg Interest payable on borrowed capital 1gh Total (1f + 1g) 1hi Income from house property 1 (1e - 1h) 1i

2 Address of property 2 Town / City State PIN Code

Is the property co-owned? Yes No (If "Yes" please enter following details)Assessee's percentage of share in the property.

Sn. Name of Co-owner(s) PAN of Co-owner (s) (optional) Percent Share in Property

(Tick) if let out Name of Tenant PAN of Tenant (Optional)

a Annual letable value/rent received or receivable (higher of the two, if let out for whole of the year,lower of the two, if let out for part of the year)

2a

b The amount of rent which cannot be realized 2bc Tax paid to local authorities 2cd Total (2b + 2c) 2de Balance (2a - 2d) 2ef 30% of 2e 2fg Interest payable on borrowed capital 2gh Total (2f + 2g) 2hi Income from house property 2 (2e - 2h) 2i

3 Address of property 3 Town / City State PIN Code

Is the property co-owned? Yes No (If "Yes" please enter following details)Assessee's percentage of share in the property.

Sn. Name of Co-owner(s) PAN of Co-owner (s) (optional) Percent Share in Property

(Tick) if let out Name of Tenant PAN of Tenant (Optional)

a Annual letable value/ rent received or receivable (higher of the two, if let out for whole of the year.lower of the two, if let out for part of the year)

3a

b The amount of rent which cannot be realized 3bc Tax paid to local authorities 3cd Total (3a + 3c) 3de Balance (3a - 3d) 3ef 30% of 3e 3fg Interest payable on borrowed capital 3gh Total (3f + 3g) 3hi Income from house property 3 (3e - 3h) 3i

4 Income under the head "Income from house property"a Rent of earlier years realized under section 25A/AA 4ab Arrears of rent received during the year under section 25B after deducting 30% 4bc Total (4a + 4b + 1i + 2i + 3i) 4c

Schedule BP Computation of income from business or professionA From business or profession other than speculative business and specified business

1 Profit before tax as per profit and loss account (item 45 or item 53d of Part A-P&L) 12a Net profit or loss from speculative business included in 1 2a2b Net profit or loss from Specified Business u/s 35AD included

in 1(enter –ve sign in case of loss)2b

3 Income/ receipts credited to profit and loss account consideredunder other heads of income

3

4 Profit or loss included in 1, which is referred to in section44AD/44AE/44AF/44B/44BB/44BBA/44BBB/44D/44DA

4

Chapter-XII-G/ First Schedule of Income- tax Act5 Income credited to Profit and Loss account (included in 1) which is exempt

a share of income from firm(s) 5ab Share of income from AOP/BOI 5bc Any other exempt income 5cd Total exempt income 5d

6 Balance (1-2a-2b-3-4-5d) 67 Expenses debited to profit and loss account considered under

other heads of income7

8 Expenses debited to profit and loss account which relate toexempt income

8

9 Total (7 + 8) 910 Adjusted profit or loss (6+9) 1011 Depreciation debited to profit and loss account 1112 Depreciation allowable under Income-tax Act

i Depreciation allowable under section 32(1)(ii) (Column6 of Schedule-DEP)

12i

ii Depreciation allowable under section 32(1)(i)(Make your own computation refer Appendix-IA of ITRules)

12ii

iii Total (12i + 12ii) 12iii13 Profit or loss after adjustment for depreciation (10+11 - 12iii) 1314 Amounts debited to the profit and loss account, to the extent

disallowable under section 36 (6p of Part-OI)14

15 Amounts debited to the profit and loss account, to the extentdisallowable under section 37 (7h of Part-OI)

15

16 Amounts debited to the profit and loss account, to the extentdisallowable under section 40 (8Af of Part-OI)

16

17 Amounts debited to the profit and loss account, to the extentdisallowable under section 40 A (9f of Part-OI)

17

18 Any amount debited to profit and loss account of the previousyear but disallowable under section 43B(11g of part-OI )

18

19 Interest disallowable under section 23 of the Micro, Small andMedium Enterprises Development Act, 2006

19

20 Deemed income under section 41 2021 Deemed income under section

33AB/33ABA/35ABB/72A/80HHD/80-IA21

22 Any other item or items of addition under section 28 to 44DA 2223 Any other income not included in profit and loss account/any

other expense not allowable (including income from salary,commission, bonus and interest from firms in which assesseeis a partner)

23

24 Total (14 + 15 + 16 + 17 + 18 + 19 + 20 + 21 + 22+23) 2425 Deduction allowable under section 32(1)(iii) 2526 Amount of Deduction under section 35 in Excess of the

amount debited to profit and loss account(Item vii(4) ofschedule ESR)

26

27 Any amount disallowed under section 40 in any precedingprevious year but allowable during the previous year(8B ofpart-OI)

27

28 Any amount disallowed under section 43B in any precedingprevious year but allowable during the previous year (10g ofpart-OI)

28

29 Deduction under section35ACa Amount, if any, debited to profit and loss account 29ab Amount allowable as deduction 29bc Excess amount allowable as deduction (29b-29a) 29c

30 Any other amount allowable as deduction 3031 Total ( 25 + 26 + 27+28+29c+30) 3132 Income (13 + 24 - 31) 3233 Profits and gains of business or profession deemed to be

under -i Section 44AD 33iii Section 44AE 33iiiii Section 44AF 33iiiiv Section 44B 33ivv Section 44BB 33vvi Section 44BBA 33vivii Section 44BBB 33vii

viii Section 44D 33viiiix Section 44DA 33ixx Chapter-XII-G 33xxi First Schedule of Income-tax Act 33xixii Total (33i to 33xi) 33xii

34 Profit or loss before deduction under section 10A/10AA(32 +33x) 3435 Deductions under section-

i 10A (e of Schedule-10A) 35iii 10AA (e of Schedule-10AA) 35iiiii Total (35i+35ii) 35iii

36 Net profit or loss from business or profession other than speculative business and specified business(34-35iii)

36

37 Net Profit or loss from business or profession other than speculative business and specified businessafter applying rule 7A, 7B or 7C if applicable (if rule 7A,7B or 7C is not applicable, enter same figureas in 36)

A37

B Computation of income from speculative business38 Net profit or loss from speculative business as per profit or loss account 3839 Additions in accordance with section 28 to 44DA 3940 Deductions in accordance with section 28 to 44DA 4041 Profit or loss from speculative business (38+39-40) B41

C Computation of income from specified business42 Net profit or loss from specified business as per profit or loss account 4243 Additions in accordance with section 28 to 44DA 4344 Deductions in accordance with section 28 to 44DA (other than deduction u/s 35AD) 4445 Profit or loss from specified business (42+43-44) 4546 Deductions in accordance with section 35AD 4647 Profit or loss from specified business (45-46) C47

D Income chargeable under the head 'Profits and gains' (A37+B41+C47) D

Schedule DPM Depreciation on Plant and Machinery1 Block of assets Plant and machinery2 Rate (%) 15 30 40 50 60 80 100

(i) (ii) (iii) (iv) (v) (vi) (vii)3 Written down value on the first day of

previous year4 Additions for a period of 180 days or more in

the previous year5 Consideration or other realization during the

previous year out of 3 or 46 Amount on which depreciation at full rate to

be allowed (3 + 4 - 5)(enter 0, if result isnegative)

7 Additions for a period of less than 180 daysin the previous year

8 Consideration or other realizations during theyear out of 7

9 Amount on which depreciation at half rate tobe allowed (7 - 8 )(enter 0, if result is negative)

10 Depreciation on 6 at full rate11 Depreciation on 9 at half rate12 Additional depreciation, if any, on 413 Additional depreciation, if any, on 714 Total depreciation* (10 + 11 + 12 + 13)15 Expenditure incurred in connection with

transfer of asset/assets16 Capital gains/loss under section 50* (5 + 8 -

3 - 4 - 7 -15) (enter negative only if blockceases to exist)

17 Written down value on the last day ofprevious year* (6 + 9 - 14) (enter 0, if resultis negative)

Schedule DOA Depreciation on other assets1 Block of assets Building Furniture and

fittingsIntangible assets Ships

2 Rate (%) 5 10 100 10 25 20(i) (ii) (iii) (iv) (v) (vi)

3 Written down value on the first day ofprevious year

4 Additions for a period of 180 days or more inthe previous year

5 Consideration or other realization during theprevious year out of 3 or 4

6 Amount on which depreciation at full rate tobe allowed (3 + 4 - 5)(enter 0, if result isnegative)

7 Additions for a period of less than 180 daysin the previous year

8 Consideration or other realizations during theyear out of 7

9 Amount on which depreciation at half rate tobe allowed (7-8) (enter 0, if result isnegative)

10 Depreciation on 6 at full rate11 Depreciation on 9 at half rate12 Additional depreciation, if any, on 413 Additional depreciation, if any, on 714 Total depreciation * (10 + 11 + 12 + 13)15 Expenditure incurred in connection with

transfer of asset/ assets16 Capital gains/loss under section 50*

(5+8-3-4-7-15)(enter negative only if blockceases to exist)

17 Written down value on the last day ofprevious year* (6+ 9-14)(enter 0, if result isnegative)

Schedule DEP Summary of depreciation on assets1 Plant and machinery

a Block Entitled for depreciation @ 15 per cent (Schedule DPM - 14i) 1ab Block entitled for depreciation @ 30 per cent (Schedule DPM - 14 ii) 1bc Block entitled for depreciation @ 40 per cent (Schedule DPM - 14 iii) 1cd Block entitled for depreciation @ 50 per cent (Schedule DPM -14 iv) 1de Block entitled for depreciation @ 60 per cent (Schedule DPM - 14 v) 1ef Block entitled for depreciation @ 80 per cent (Schedule DPM-14vi) 1fg Block entitled for depreciation @ 100 per cent (Schedule DPM - 14 vii) 1gh Total depreciation on plant and machinery (1a + 1b + 1c + 1d + 1e + 1f + 1g) 1h

2 Buildinga Block entitled for depreciation @ 5 per cent (Schedule DOA-14i) 2ab Block entitled for depreciation @ 10 per cent (Schedule DOA-14ii) 2bc Block entitled for depreciation @ 100 per cent (Schedule DOA - 14iii) 2cd Total depreciation on building (2a + 2b + 2c) 2d

3 Furniture and fittings (Schedule DOA - 14iv) 34 Intangible assets (Schedule DOA - 14v) 45 Ships (Schedule DOA - 14 vi) 56 Total depreciation (1h+2d+3+4+5) 6

Schedule DCG Deemed Capital Gains on sale of depreciable assets1 Plant and machinery

a Block entitled for depreciation @ 15 per cent (Schedule DPM -16i) 1ab Block entitled for depreciation @ 30 per cent (Schedule DPM-16ii) 1bc Block entitled for depreciation @ 40 per cent (Schedule DPM - 16iii) 1cd Block entitled for depreciation @ 50 per cent (Schedule DPM - 16iv 1de Block entitled for depreciation @ 60 per cent (Schedule DPM - 16v) 1ef Block entitled for depreciation @ 80 per cent (Schedule DPM - 16vi) 1fg Block entitled for depreciation @ 100 per cent (Schedule DPM - 16vii) 1gh Total (1a + 1b + 1c + 1d + 1e + 1f + 1g) 1h

2 Buildinga Block entitled for depreciation @ 5 per cent (Schedule DOA - 16i) 2ab Block entitled for depreciation @ 10 per cent (Schedule DOA - 16ii) 2bc Block entitled for depreciation @ 100 per cent (Schedule DOA- 16iii) 2cd Total (2a+2b+2c) 2d

3 Furniture and fittings (Schedule DOA - 16iv) 34 Intangible assets (Schedule DOA-16v) 45 Ships (Schedule DOA - 16vi) 56 Total (1h+2d+3+4+5) 6

Schedule ESR Deduction under section 35Slno Expenditure of the nature

referred to in section

(1)

Amount, If any, Debited to profitan d loss account

(2)

Amount of deduction allowable

(3)

Amount of deduction in excess of theamount debited to profit and loss account

(4)=(3)-(2)i 35(1)(i)ii 35(1)(ii)iii 35(1)(iii)iv 35(1)(iv)v 35(2AA)vi 35(2AB)vii Total

Schedule CG Capital GainsA Short-term capital gain

1 From slump salea Full value of consideration 1ab Net worth of the under taking or division 1bc Short term capital gains from slump sale 1cd Deduction under sections 54D/54G/54GA 1de Net short term capital gains from slump sale (1c-1d) 1e

2 In case of NON-RESIDENT to which first proviso to section 48 is applicable From assets (shares/units) where section 111A is applicable (STT paid) 2a From assets where section 111A is not applicable 2b

3 From assets (shares/units) in the case of others where section 111A is applicable (STT paid)a Full value of consideration 3ab Deduction under section 48

i Cost of acquisition biii Cost of improvement biiiii Expenditure on transfer biiiiv Total (bi + bii + biii) biv

c Balance (3a-biv) 3cd Loss, if any, to be ignored under section 94(7) or 94(8) (enter positive

value only)3d

e Short-term capital gain (3c+3d) A3e4 From Assets in case of others where section 111A is not applicable

a Full Value of considration 4ab Deductions under section 48

i Cost of Acquisition biii Cost of Improvement biiiii Expenditure on transfer biiiiv Total (i+ii+iii) biv

c Balance (4a-biv) 4cd Loss, if any, to be ignored under section 94(7) or 94(8) (Enter positive

value only)4d

e Deduction under section 54D/54G/54GA 4ef Short-term capital gain(4c+4d-4e) 4f

5 Deemed short term capital gain on depreciable assets (6 of Schedule-DCG) A56 Amount deemed to be short term capital gains under sections 54D/54G/54GA A67 Total short term capital gain (1e +2a+2b+A3e+4f+A5+A6) A7

B Long term capital gain1 From slump sale

a Full value of consideration 1ab Net worth of the under taking or division 1bc Long term capital gains from slump sale 1cd Deduction under sections 54D/54EC/54G/54GA 1de Net long term capital gain from slump sale (1c-1d) 1e

2 From asset in case of non-resident to which first proviso to section 48 is applicable 23 From asset in the case of others where proviso under section 112(1) is not applicable

a Full value of consideration 3ab Deductions under section 48

i Cost of acquisition after indexation biii Cost of improvement after indexation biiiii Expenditure on transfer biiiiv Total (bi + bii +biii) biv

c Balance (3a - biv) 3cd Deduction under sections 54D/54EC/54G/54GA 3de Net balance (3c - 3d) B3e

4 From asset where proviso under section 112(1) is applicable (without indexation)a Full value of consideration 4ab Deductions under section 48

i Cost of acquisition without indexation biii Cost of improvement without indexation biiiii Expenditure on transfer biiiiv Total (bi + bii + biii) biv

c Balance (4a -biv) 4cd Deduction under sections 54D/54EC/54G/54GA 4de Net balance (4c - 4d) B4e

5 From unlisted securities in case of non-resident as per section 112(1)(c)(iii) B56 Amount deemed to be long term capital gains under sections 54D/54EC/54G/54GA B67 Total long term capital gain (1e + 2 + B3e +B4e + B5+B6) B7

C Income chargeable under the head "CAPITAL GAINS" (A7 + B7) (enter B7 as nil ,if loss) CD Information about accrual/receipt of capital gain

Date Up to 15/9(i)

16/9 to 15/12(ii)

16/12 to 15/3(iii)

16/3 to 31/3 (iv)

1 Long- term [where proviso under section 112(1) is applicable (WithoutIndexation)+non-residents as per section 112(1)(c)(iii)]- Tax Rate is 10% ;Enter only positive value from Item B4e+B5 of Schedule CG AFTER lossadjustment under this category in Schedule CYLA and BFLA, if any.

2 Long- term where proviso under section 112(1) is NOT applicable (WithIndexation)- Tax Rate is 20%;Enter only positive value from Item (B7-B4e-B5) of Schedule CG AFTER lossadjustment under this category in Schedule CYLA and BFLA, if any.

3 Short-term under 111A-Tax Rate is 15% ;Enter only positive value from Item A2a+A3e of Schedule CG AFTER lossadjustment under this category in Schedule CYLA and BFLA, if any.

4 Short-term OTHERS-Taxed at normal rates;Enter only positive value from Item (A7-A2a-A3e) of Schedule CG AFTERloss adjustment under this category in Schedule CYLA and BFLA, if any.

Note: Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head

Schedule OS Income from other sources1 Income

a Dividends, Gross 1ab Interest, Gross 1bc Rental income from machinery, plants, buildings 1cd Others, Gross (excluding income from owning race

horse ) mention the source and amounti di

e Total (1a + 1b + 1c + 1div) 1ef Deductions under section 57:-

i Expenses/Deductions fiii Depreciation fiiiii Total fiii

g Balance (1e – fiii) 1g2 Winnings from lotteries,crossword puzzles,races,games,gambling,betting etc.(Gross) 23 Income from other sources (other than from owning race horses) (1g + 2)(enter 1g as

nil if loss)3

4 Income from owning and maintaining race horsesa Receipts 4ab Deductions under section 57 in relation to (4) 4bc Balance (4a – 4b) 4c

5 Income chargeable under the head “Income from other sources” ( 3 + 4c)(enter 4c as nilif loss and take 4c loss figure to Schedule CFL)

5

Note: Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head

Schedule CYLA Details of Income after set-off of current years lossesSl.No Head/ Source of

IncomeIncome of current

year (Fill thiscolumn only

if income is zero orpositive)

House property loss ofthe current year set off

Business Loss(other than speculationor specified businessloss) of the current

year set off

Other sources loss(other than loss from

race horses) of thecurrent year set off

Current year’sIncome

remainingafter set off

Total loss (4c ofSchedule –HP)

Total loss (A37 ofSchedule- BP)

Total loss(1g Schedule-OS)

1 2 3 4 5=1-2-3-4Loss to be adjusted -->

i House propertyii Business (excluding

speculation income andincome from specifiedbusiness)

iii Speculation incomeiv Specified business

incomev Short-term capital gainvi Long term capital gainvii Other sources (excluding

profit from owning racehorses)

viii Profit from owning andmaintaining race horses

ix Total loss set-offx Loss remaining after set-off

Schedule BFLA Details of Income after Set off of Brought Forward Losses of earlier yearsSl.No.

Head/ Source of Income Income after set off, ifany, of current year’s

losses as per 5 ofSchedule CYLA)

Broughtforward loss

set off

Brought forwarddepreciation set

off

Brought forwardallowance under

section35(4) set off

Current year’sincome remaining

after set off

1 2 3 4 5i House propertyii Business (excluding

speculation income andincome from specifiedbusiness)

iii Speculation incomeiv Specified business income

u/s 35ADv Short-term capital gainvi Long-term capital gainvii Other sources income

(excluding profit fromowning race horses)

viii Profit from owning andmaintaining race horses

ix Total of brought forward loss set offx Current year’s income remaining after set off Total (i5 + ii5 + iii5 + iv5+v5+vi5+vii5+viii5)

Schedule CFL Details of Losses to be carried forward to future YearsSl.No.

AssessmentYear

Date ofFiling

(DD/MM/YYYY)

Houseproperty loss

Loss frombusiness

otherthan loss

fromspeculative

business andspecifiedbusiness

Loss fromspeculative

business

Loss fromSpecifiedBusiness

Short-termcapital loss

Long-termCapital loss

Othersources

loss(from

owningrace

horses)

i 2005-06ii 2006-07iii 2007-08iv 2008-09v 2009-10vi 2010-11vii 2011-12

viii 2012-13ix Total of earlier

year lossesx Adjustment of

above losses inScheduleBFLA

xi 2013-14(Currentyear losses)

xii Total lossCarriedForward tofuture years

Schedule UD Unabsorbed depreciationSI.No

(1)Assessment Year

(2)Amount of brought forward

unabsorbed deprecation(3)

Amount of depreciation set-off against thecurrent year income

(4)

Balance Carried forward to thenext year

(5)i Current Assessment Year

Total

Schedule 10A Deduction under section 10ADeductions in respect of units located in Special Economic Zone

a Undertaking No.1 ab Undertaking No.2 bc Undertaking No.3 cd Undertaking No.4 de Total (a + b+ c + d) e

Schedule 10AA Deduction under section 10AADeductions in respect of units located in Special Economic Zone

a Undertaking No.1 ab Undertaking No.2 bc Undertaking No.3 cd Undertaking No.4 de Total (a + b + c + d) e

Schedule 80G Details of donations entitled for deduction under section 80GA Donations entitled for 100% deduction without

qualifying limitName and address of donee PAN of Donee Amount of donation Eligible Amount of

donationi

Total

B Donations entitled for 50% deduction withoutqualifying limitName and address of donee PAN of Donee Amount of donation Eligible Amount of

donationi

Total

C Donations entitled for 100% deduction subject toqualifying limitName and address of donee PAN of Donee Amount of donation Eligible Amount of

donationi

Total

D Donations entitled for 50% deduction subject to

qualifying limitName and address of donee PAN of Donee Amount of donation Eligible Amount of

donationi

TotalE Total donations (Avi + Bvi + Cvi + Dvi)

Schedule 80-IA Deductions under section 80-IAa Deduction in respect of profits of an enterprise referred to in section 80-IA (4)

(i) [Infrastructure facility]a

b Deduction in respect of profits of an undertaking referred to in section80-IA(4)(ii) [Telecommunication services]

b

c Deduction in respect of profits of an undertaking referred to in section80-IA(4)(iii) [Industrial park and SEZs]

c

d Deduction in respect of profits of an undertaking referred to in section80-IA(4)(iv) [Power]

d

e Deduction in respect of profits of an undertaking referred to in section80-IA(4)(v) [Revival of power generating plant]and deduction in respect of profits of an undertaking referred to in section80-IA(4)(vi)[Cross-country natural gas distribution network]

e

f Total deductions under section 80-IA (a + b + c + d + e) f

Schedule 80-IB Deductions under section 80-IBa Deduction in respect of industrial undertaking referred to in section 80-IB(3)

[Small-scale industry]a

b Deduction in respect of industrial undertaking located in Jammu & Kashmir[Section 80-IB(4)]

b

c Deduction in respect of industrial undertaking located in industrially backwardstates specified in Eighth Schedule [Section 80-IB(4)]

c

d Deduction in respect of industrial undertaking located in industrially backwarddistricts [Section 80-IB(5)]

d

e Deduction in the case of multiplex theatre [Section 80- IB(7A)] ef Deduction in the case of convention center [Section 80- IB(7B)] fg Deduction in the case of company carrying on scientific research [Section

80-IB(8A)]g

h Deduction in the case of undertaking which begins commercial production orrefining of mineral oil [Section 80-IB(9)]

h

i Deduction in the case of an undertaking developing and building housing projects[Section 80-IB(10)]

i

j Deduction in the case of an undertaking operating a cold chain facility [Section80-IB(11)]

j

k Deduction in the case of an undertaking engaged in processing, preservation andpackaging of fruits, vegetables, meat, meat products, poultry, marine or dairyproducts [Section 80-IB(11A)]

k

l Deduction in the case of an undertaking engaged in integrated business ofhandling, storage and transportation of food grains [Section 80-IB(11A)]

l

m Deduction in the case of an undertaking engaged in operating and maintaining arural hospital [Section 80-IB(11B)]

m

n Deduction in the case of an undertaking engaged in operating and maintaining ahospital in any area, other than excluded area [Section 80-IB(11C)]

n

o Total deduction under section 80-IB (Total of a to n) o

Schedule 80-IC or 80-IE Deductions under section 80-IC or 80-IE1 Deduction in respect of industrial undertaking located in Sikkim 12 Deduction in respect of industrial undertaking located in Himachal Pradesh 23 Deduction in respect of industrial undertaking located in Uttaranchal 34 Deduction in respect of industrial undertaking located in North-East

a Assam 4ab Arunachal Pradesh 4bc Manipur 4cd Mizoram 4de Meghalaya 4ef Nagaland 4fg Tripura 4gh Total of deduction for undertakings located in North-east (Total of 4a to 4g) 4h

5 Total deduction under section 80-IC or 80-IE (1 + 2 + 3 + 4h) 5

Schedule VI-A Deductions under Chapter VI-A

a 80G f 801C/80-IE (5 of Schedule 80-1C /80-IE)

b 80GGC g 80-IDc 80IA(f of Schedule 80-1A) h 80JJAd 80-IAB i 80LAe 80IB (o of schedule 80-IB) j 80P

k Total deductions under Chapter VI - A ( Total of a to j) k

Schedule AMT Computation of Alternate Minimum Tax payable under section 115JC1 Total Income as per item 12 of PART-B-TI 12 Adjustment as per section 115JC(2)

a Deduction Claimed under any section included in Chapter VI-A underthe heading “C.—Deductions in respect of certain incomes”

2a

b Deduction Claimed u/s 10AA 2bc Total Adjustment (2a+ 2b) 2c

3 Adjusted Total Income under section 115JC(1) (1+2c) 34 Tax payable under section 115JC [18.5% of (3)](In the case of Individual, HUF. AOP, BOI AJP this is

applicable if 3 is greater than Rs.20 lakhs)4

Schedule AMTC Computation of tax credit under section 115JD1 Tax under section 115JC in assessment year 2013-14 (1c of Part-BTTI) 12 Tax under other provisions of the Act in assessment year 2013-14 (4 of Part-B-TTI) 23 Amount of tax against which credit is available [enter (2 – 1) if 2 is greater than 1, otherwise enter 0] 34 Utilisation of AMT credit Available (Sum of AMT credit utilized during the current year is subject to maximum of amount mentioned in 3

above and cannot exceed the sum of AMT Credit Brought Forward)S.No

Assessment Year (AY)(A)

AMT Credit AMT Credit utilisedduring the Curent

Year(C)

Balance AMTCredit

Carried Forward (D)= (B3) –(C)

Gross(B1)

Set-off in earlierYears(B2)

Balance brought forward(B3)=(B1)-(B2)

i 2012-2013ii Current AY (enter 1-2,

if 1>2 else enter 0)Total

5 Amount of tax credit under section 115JD utilised during the year [total of item no 4(C)] 56 Amount of AMT liability available for credit in subsequent assessment years [total item no 4(D)] 6

Schedule SI Income chargeable to Income tax at special rates [Please see instruction No.7(ii) for section and rate of tax]Sl No. Section Special rate

(%)Income

(i)Tax thereon

(ii)1234567891011 Total

Schedule EI Details of Exempt Income (Income not to be included in Total Income)1 Interest income 12 Dividend income 23 Long-term capital gains on which Securities Transaction Tax is paid 34 Net Agriculture income (Other than income to be excluded under rule 7,7A,7B or 8) 45 Share in the income of AOP (Mention PAN of the AOP and amount) 5

i PAN 5iii PAN 5iiiii Total (5i+5ii) 5iii

6 Other 67 Total (1+2+3+4+5iii+6) 7

Schedule IT Details of payments of Advance Tax and Self Assessment TaxSlNo

BSR Code Date of Deposit(DD/MM/YYYY)

Serial Number ofChallan

Amount (Rs)

iNote: Enter the totals of Advance tax and Self Assessment tax in Sl No. 12a & 12d of Part B - TTI

Schedule TDS Details of Tax Deducted at Source on Income [As per Form 16 A issued by Deductor(s)]SlNo

Tax DeductionAccount

Number (TAN)of the Deductor

Name of the Deductor Unique TDSCertificateNumber

Financial year inwhich TDSdeducted

Total taxdeducted

Amount out of(6) claimed during

the year

(1) (2) (3) (4) (5) (6) (7)i

Note: Please enter the total of column 7 Schedule-TDS in 12(b) of part B-TTI

Schedule TCS Details of Tax Collected at Source [As per Form 27D issued by the Collector(s)]SlNo

Tax Deduction andTax Collection

Account Numberof the Collector

Name of the Collector Total taxCollected

Amount out of(4) claimed during

the year

(1) (2) (3) (4) (5)i

Note: Please enter the total of column (5) Sl No. 12c of part B-TTI

Schedule FSI Details of Income accruing or arising outside India.1 Details of Income included in Total Income in Part-B-TI above

CountryCode

TaxpayerIdentification

Number

Income from HouseProperty (included in

PART-B-TI (A)

Business Income(included in

PART-B-TI) (B)

Capital GainIncome (includedin PART-B-TI)

(C)

Other sourceIncome (includedin PART-B-TI)

(D)

Total Income fromOutside India

(E)=A+B+C+D

Total2 Total Income from outside India (Total of E as per item no.1 above) 23 Total Income from outside India where DTAA is applicable 34 Total Income from outside India where DTAA is not applicable (2-3) 4

Note: Please refer to the instructions for filling up this schedule.

Schedule TR Details of Taxes Paid outside India1 Details of Taxes Paid outside India

CountryCode

TaxpayerIdentification

Number

Relevant article ofDTAA

Total taxes paid on incomedeclared in Schedule FSI

Tax Relief(B)

Claimed

(A) Relief claimed u/s 90/90A(B1)

Relief claimed u/s 91(B2)

Total2 Total Taxes Paid outside India (Total of 1A) 23 Total Taxes Paid outside India where DTAA is applicable 34 Total Taxes Paid outside India where DTAA is not applicable (2-3) 4

Note: Please refer to the instructions for filling up this schedule.

Schedule FA Details of Foreign AssetsA Details of Foreign Bank Accounts

SlNo

Country Name Country Code Name and Address of theBank

Name mentioned in theaccount

Account Number Peak Balance During theYear (in rupees)

(1) (2) (3) (4) (5) (6) (7)i

B Details of Financial Interest in any EntitySlNo

Country Name CountryCode

Nature of entity Name and Addressof the Entity

Total Investment(at cost) (in rupees)

(1) (2) (3) (4) (5)i

C Details of Immovable PropertySlNo

Country Name CountryCode

Address of the Property Total Investment(at cost) (in rupees)

(1) (2) (3) (4) (5)i

D Details of any other AssetSlNo

Country Name CountryCode

Nature of Asset Total Investment(at cost) (in rupees)

(1) (2) (3) (4) (5)i

E Details of account(s) in which you have signing authority and which has not been included in A to D above.SlNo(1)

Name of the Institution inwhich the account is held

(2)

Address of the Institution(3)

Name of the account holder(4)

Account Number(5)

Peak Balance/Investmentduring the year (in rupees)

(6)iii

F Details of trusts, created under the laws of a country outside India, in which you are trusteeSlNo(1)

Country Name(2)

CountryCode

(3)

Name and address of thetrust

(4)

Name and address ofother trustees

(5)

Name and address ofsettlor

(6)

Name and Addressof Beneficiaries

(7)(i)(ii)

Note: Please refer to the instructions for filling up this schedule.