SAHAJ

FORM

ITR-1

INDIAN INCOME TAX RETURN

[For Individuals having Income from Salary / Pension / Income from One House Property (excluding
loss brought forward from previous years) /
Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)]

Assessment Year
Year

2011-12

FILING
STATUS

PERSONAL INFORMATION

(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)

First Name
AKSHAY

INCOME & DEDUCTIONS

Last Name
SAHOO

PAN
BMHPS3298E

Flat / Door / Building

QR. NO. D-1/2, PWD STORE PREMISES, SATYA NAGAR

Status
I - Individual

Road / Street
BEHIND BHUBANESWAR (R&B) SUBDIVISION NO-IX, SATYA NAGAR

Area / Locallity
Date of birth (DD/MM/YYYY)
BIG BAZAAR AREA, BHUBANESWAR
02/07/1980

Town/City/District
KHURDA

State
24-ORISSA

Email Address
akshay.sahoo@gmail.com
Income Tax Ward / Circle
WARD KENDRAPADA
Whether original or revised return?

Mobile no (Std code) Phone No

Employer Category (if in
9938177044
employment) GOV
Return filed under section
[Pl see Form Instruction] 16 - u/s 139(5)
R-Revised

Pin Code
751001

If revised, enter Receipt no / Date

225608170260611
Residential Status
RES - Resident
1 Income from Salary / Pension (Ensure to fill Sch TDS1)
Income from one House Property
2
3

TAX COMPUTATION

Middle Name
KUMAR

Sex (Select)
M-Male

Date

26/06/2011
1
2

Income from Other Sources (Ensure to fill Sch TDS2)

4 Gross Total Income (1+2c)

5 Deductions under Chapter VI A (Section)
a 80 C
5a
b 80 CCC
5b
c 80 CCD
5c
d 80 CCF
5d
e 80 D
5e
f 80 DD
5f
g 80 DDB
5g
h 80 E
5h
i 80 G (Eligible Amount)
5i
j 80 GG
5j
k 80 GGA
5k
l 80 GGC
5l
m 80 U
5m
6 Deductions (Total of 5a to 5m)
6
7 Total Income (4 - 6)
8 Tax payable on Total Income
9 Education Cess, including secondary and higher secondary cess on 8
10 Total Tax, Surcharge and Education Cess (Payable) (8 + 9)
11 Relief under Section 89
11
12 Relief under Section 90/91
12
13 Balance Tax Payable (10 - 11 - 12)
14 Total Interest Payable
15 Total Tax and Interest Payable (13 + 14)
For Office Use Only
Receipt No/ Date

271,267

3
4

0
24,153
24,153
0
0
0
0
0
0
0
0
0
0
48,306

271,267
System Calculated
0
24,153
24,153
0
0
0
0
0
0
0
0
0
0
6
48,306
7
222,961
8
6,296
9
189
10
6,485

0
0
13
6,485
14
0
15
6,485
Seal and Signature of
Receiving Official

23

Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by
Employer(s)]

24

Tax Deduction
Income charg
Account Number
Name of the
Total tax
SI.No
eable under the
(TAN) of the
Employer
Deducted
head Salaries
Employer
(1)
(2)
(3)
(4)
(5)
1
BBNO00679A OFFICE OF
271,267
6,485
2
THE
ENGINEER3
IN-CHIEF
(Click + to add more rows to 23) TDS onCIVIL,ORIS
Salary above. Do not delete blank rows. )
SA
Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM
16 A issued by Deductor(s)]

SI.No

(1)
1
2
3
4

Tax Deduction
Account Number
(TAN) of the
Deductor

Name of the
Deductor

Total tax
Deducted

Amount out
of
(4) claimed
for
this year

(2)

(3)

(4)

(5)

(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. )

25
Sl No

Details of Advance Tax and Self Assessment Tax Payments

BSR Code

Date of Deposit
(DD/MM/YYYY)

Serial
Number of
Challan

Amount (Rs)

1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )

TAXES PAID

16 Taxes Paid PLEASE NOTE THAT CALCULATED FIELDS (IN WHITE) ARE PICKED UP FROM
OTHER SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below
will get filled up when the Schedules linked to them are filled.
a Advance Tax (from item 25)
b TDS (Total from item 23 + item 24)

16a
16b

6,485

REFUND

0
c Self Assessment Tax (item 25)
16c
6,485
17 Total Taxes Paid (16a+16b+16c)
17
0
18 Tax Payable (15-17) (if 15 is greater than 17)
18
0
19 Refund (17-15) if 17 is greater than 15
19
20 Enter your Bank Account number
30068043205
(Mandatory )
21 Select Yes if you want your refund by direct deposit into your bank account, Select No
No if you want refund by Cheque
22 In case of direct deposit to your bank account give additional details
MICR Code
751002006
Type of Account(As applicable)
Savings
26 Exempt income for reporting purposes only (from Dividends, Agri. income < 5000)
VERIFICATION
I, (full name in block letters),

AKSHAY KUMAR
SAHOO

son/daughter of

SHREENIBAS
H SAHOO

solemnly declare that to the best of my knowledge and belief, the information given in the return thereto is
correct and complete and that the amount of total income and other particulars shown therein are truly
stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of income chargeable
to Income-tax for the previous year relevant to the Assessment Year 2011-12
Place

BHUBANESWAR

Date

07/02/2015

Sign here ->

PAN
BMHPS3298E
27 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
Identification No of TRP
Name of TRP
Counter Signature of TRP

28

If TRP is entitled for any reimbursement from the Government, amount thereof (to be
filled by TRP)