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 NOTARY
DARBHAGNA , BIHAR INDIA
Authorised uls 297 (1) (c) of Cr!P^.
8 (1) (a) of The Notaries Act an'
ale"Q'r^1 c Zoyp Form 26 u/s 139 ( a a) of C .P.C. 1908
(See rule 4A)
Affidavit to be furnished by the candidate before the returning officer for election to- Bihar Legislative
Assembly (name of the House) from- 83- Darbhanga General constituency
(name of the constituency)
I,Sanjay Saraogi son/daughter/ wife of_ Shri Parmeshwar Saraogi aged about- 41 years,resident of
Mohalla-Saifullaganj, Ward No..6(Old) 12 (New),P.O.-Darbhanga (H.O.), P.S.-L.N.M.U. Campus Dist-
Darbhanga candidate at the abbve election, do hereby solemnly affirm/state on oath as under :--
1 I am/am not accused of any offence(s) punishable with imprisonment for two years a nd more in a
pending case(s) in which a charge(s) has/have been framed by the court(s) of competent jurisdiction.

If the deponent is accused of any such offence(s) he shall furnish the following information:

Case/First information report No./Nos

(I)Town P . S. Case No. 66/01
(ii)Town P . S.Case No. 25/98
(iii)Laheriasarai P.S. Case No. 34/05
(iv)L.N.M.U.P.S.Case No. 11/05
(v)Laheriasarai P.S. Case No . 309/05
Police station(s)
Town, ( 11) Laheriasarai ,(III) L.N.M.U. District( s) Darbhanga State(s) Bihar
,,ion(s)of the concerned Act(s) and short description of the offence(s) for which the
an date has been charged
144,353,427,504 I.P.C.
341,323,147,504 I.P.C.
S 3 of the Bihar Prevention of Defacement of Property Act 1985
/S 3 of Bihar Prevention of Defacement of Property Act and 120 of R.P. Act and 171
.C.
(v)U/S 295(A)34 I.P.C.
Court( s) which framed the charge (s) C.I.M. DARBHANGA
Date( s) on which the charge (s) was/were framed
(1)22.8 . 01 (1I)3.11 .04 (111)1.6.05 (IV)26.7.05 ( v)Charge not framed F.F.submitted
vi. Whether all or any of the proceeding (s) have been stayed by any court (s) of competent
jurisdiction ............NO
I have been/ have not been convicted of an offence (s) {other than any offence (s) referred to in sub-
section( I) or sub-section(2),or covered in sub-section ( 3), of section 8 of the Representation of the
People Act, 1951 (43 of 1951) and sentenced to imprisonment for one year or more.

If the deponent is convicted and punished as aforesaid , he shall furnish the following information.
(i) Case/ First information report No./Nos .................................................
(ii) Court( s) which punished ............................................. _..........
 (v) Date(s) on which the sentence(s) was/were pronounced ...............................
(vi) Whether the sentence(s) has/have been stayed by any court(s) of competent
jurisdiction ........................................................

Place: DARBHANGA
Date: 05/10/2010

VERIFICATION
and declare that the contents of this affidavit are true
I, the above named deponent , do hereby verify
and correct to the best of my knowledge ane belief, no part of it is false and nothing material has
been concealed therein.

Verified at Darbhanga this 05th day of October, .2010

re of deponent

r
lumns in this Form which are not applicable to the deponent may be struck off

nonen" olefin nly

Affirmed Before me
r^ / t tike Ott i A nt a^w s
Notary Public
Darbharrga , Bihar India
 NOTARY
DARBHAGNA , BIHAR iNDI
Authorised u/s 297 (1) (c) of r:r/t;
8 (1) (a) of The Notaries Act do:
Affidavit to be furnish' uls 139 (a a) of .P.C. 1"
to alongwith nomination paper
for election to Bihar Legislative AReturning
ssembly(name of the House
Darbhanga General constituency ) from 83-
(name of the constituency)

1, Sanjay,
Reg . No , 2; Date . C.U- ' r.
y Saraogi Son/daughter/wife of Shri Parmeshwar Saraogi aged about 41 years, resident of
Mohalla- Saifullaganj Ward No. 6 (Old),12 (New) P.O.-Darbhanga(H,.O.)PS.- L.N_M_U. Campus,

District-Darbhanga candidate at the above election, do hereby solemnly affirm and state on oath as
under

(Strike out whichever not applicable]

1. The r-11
owing case (
s) is/are pending against me in which cognizance has been
court taken by the

(A)TR.No. 622/10 State Vs. Kriti Jha Azad & others A.K.Ram -1st Class J.M. Darbhanga
(B)TR.No. 2158/10 State Vs.Parmeshwar Saraogi & others Abhay Srivastava -1st Class

TR.No. J.M. Darbhanga

43/10 State Vs. Sanjay Saraogi -
C.J.M.Darbhanga
(D)TR No.
46/10 State Vs. Sanjay Saraogi , -
C.J.M.Darbhanga
(E)Laheriasarai P.S.Case No . 309/05
State Vs Sanjay Saraogi
For hearing
F.F.----------- C.J. M.Darbhanga
t%NC) ;ri Section of the A ct
and desiti f offence for which cognizance taken:
crpon o the
(a) U/S 144,353,427,504 f.P.C.

(b) U/S 341,323,147,504 I.P.C.

(c) U/S 3
of Bihar Prevention of Defacement of Property
( Act, 1985
d) U/S 3 of Bihar Prevention of Defacement of Property
R . P . Act an d 171 LP.C Act and 120 of

(e) U/S 295(A)34I.P.C.

The court which has taken cognizance : CJ.M.Darbhanga

Case No.:
(a)Town P.S.Case Na 66/01
Laheriasarai P.S.Case No. 34/05 (b)rown P.S Case No. 25/98
(e)Laheriasarai . No. 1 1/05
P.S.Case No. 305/05 --- Cogn i zan
Date of order of the Court taking g gmzance ce
not taken
n ot ta ken
(a) 22.8.10 cognizance:
21.6.05 (b)3.11.04
 NOTARY r%IA

( immovable , movable , bank balance, etc.)ot'

2. That I give hereinbelow the details of the assets
myself, my spouse and dependents*

A. Details of movable assets. z to be ven)

githe e
Assets in .loint name in if atin offomt oDepen n1); wil l also h ave b Depr a [-3
d ni
-FD
S. Description ^ Name Name Name
No. ame(s)
Shobha Saraogi Bhuwan Rachit Saraogi
Saran
105550.00 40360.00
(1) Cash Nil, NIL NIL
355238.00 105394.00
(ii) Deposits in State Bank of Dena Bank.
Darbhanga
Bank,Financial India,
Axis Bank.
Darbhanga &
Institutions and Patna Darhhanga

Non-Banking Axis Bank,

Iarbhanga 12100.00
Financial r.('O.Bank
Companies Darbhanga
NIL Nil, l, NIL

Bonds,
Debentures and
485975.00
shares in
-7
companies NIL N D, I
Other Financial
Instruments NSS,
Postal havings,
2580.00
LIC policies etc. 1089 133 . 00 202435.00 NIL NI L
NIL Nil,
849408.10
Mahindra
Scorpio Turbo
Model 2005
No.BR. 07P-0837 Nil, NII.
Gold 200 gins Gold 4041 gins Nil,
Jewellery(give Rs. 391000.00 Rs. 7811000.011
Silver 1525 gms
details of weight Silver 150
Its. 5000.00 Rs.58000.00
and values NIL NIL NIL NIl,
416104.00
Other assets,
such as values of Rine (one)
Rs. 5000000
claims/ interests
in respect o
Debentures as per the latest market value in stock Exchange
Note:-Value of Bonds / Shares /
- listed companies
listed com p anies and as per books in the case of non - inco me of the candidate
*)149pTA _ means a person substantially dependents on t 6
 (B) DETAILS OF IMMOVABLE ASSETS

((Note :-- Properties in joint ownership indicating the extent of joint ownership will also have to be

Description Self Spoose(s) Dependent-I Dependent-2 Dependent-3

S.
Name (s) Name Name Name
No.
Shobha Bhuwan Rachit
Saran i Saraogi Saraogi
(i) Agricultural Land NIL NIL NIL NIL NIL
- Location(s)
-Survey number(s)
-Extent(Total measurement)
-Current market value

(ii) Non -Agricultural Land Saifullaganj , Sonhan NIL NIL NIL

Station Road, Basudeopur,
- Location( s) Darbhanga
Darbhanga
-Survey number(s) 7456,7468,7469 1391(o)
-Extent(Total measurement) ,7470,7471, 1827(N)
-Current market value 7472 ( 1 katha 15
(lkatha 5 dhur)
dhur) Rs. 1500000.00
Rs. 2300000.00
(iii) Buildings( commercial and samserganj, Mirzapur,Raj NIL NIL NIL
Gandhi kumarganj,
residential ) Darbhanga
Chowk
- Location( s) Darbhanga 8052 ,8057,8058
-Survey number( s) 12781,12784, New-343
-Extent(Total measurement) 12785, 12786, (7 Dhur
12789,12790, 19 Dhurki)
-Current market value Rs. 950000.00
12791 , 12792/
107,107(A), Samserganj,
108(B) Gandhi
(3katha Chowk,
5 dhur) Darbhanga
Rs. 3800000. 00 12781,
Joint assets 12784, 12785,12
self share 1 /3 786, 12789,1279
0,12791,12792
(Ikatha
15 dhur)
Rs. 6000000.00
joint assets self
share 1/3
(iv) Houses .Apartments ,etc. NIL NIL NIL NIL NIL
- Location(s)
-Survey number(s)
-Extent(Total measurement)
-Current market value

(v) Others NIL NIL NIL NIL NIL

(such as interest in property)

Na
 I

(3) I give hereinbelow the details of my liabilities/ overdues to public financial institutions and
government dues:--
(Note - Please give separate details for each item)

S.No. Description Name and address of Amount outstanding as

Bank/Financial on 31.03.2010
Institution ( s)/Department(s)
(a)(i) Loans from Banks NIL NIL

(ii) Loans from Financial Institutions NIL NIL

(iii) Government dues( other than income tax NIL NIL

and wealth tax)(No dues certificate to be

enclosed in case of holding or having

held any public office)

(b)(i) Income tax including surcharge(Also Income Tax Return filed NIL

indicate the assessment year upto which upto 31.03.2010

Income tax Return filed . Give also PAN AJJPS 4743 E
permanent Account Number(PAN) AQHS4388M(HUF)

(ii) Wealth tax (Also indicate the assessment NIL NIL

year upto which Wealth Tax return filed.)

(iii) Sales Tax(Only in case of proprietory NIL NIL

business)
(iv) Property Tax NIL NIL
(4) My educational qualifications are as under :--
(GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION)

(Name of schoolJUniversity and the year in which the course was completed should also be given)

M.B.A. 1993
Uni.Deptt.of Comm. & Business Admin.

L.N.Mithil, University ,Darbhanga

VERIFICATION
do hereby verify and declare that the contents of this affidavit are true and
I,the deponent abovenamed ,
no part of it is false and nothing material has been concealed
correct to the best of my knowledge and belief;

therefrom.

Verified at Darbhanga this the 05i day of October 2010

^)EPONENT

rr a .o^s;i^rta
.,. ponhts solesnnlY
Affirmed fore tme M^ yIoa
^6 Y
Svt^ ^'un^, a fist
t,f_: tiOtac> t ,o
CJ ..1 ^^r_iS^^zr ^
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Date of application for Mfha Date of making over the 7
the copy. Date fixed for notifying
copy to the applicant.
the requisite number of
stamps and folios. I

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 Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT
Received with thanks from SANJAY SARAOGI HUF a return of income in Form No.
ITR 2 for assessment year 2010-11, having
the UP

Name SANJAY SARAOGI HUF

PAN AAQHS4388_M__
Flat/Door/Block No --- - -
Name Of Premises/BuildingNillage
zO N/A
SAIFULLAGANJ
Z a Road/Street/Post Office
O Area/Locality
052 LALBAGH _.
tr STATION ROAD
a O Town/City/District -- - - - Status (fill
Z State
DARBHANGA the code)
BIHAR H
Designation of Assessing Officer (Ward/ Circle) Original or
WARD-2 DBG Revised ORIGINAL
1 Gross total income
2,50,000
2 Deductions under Chapter-Vl-A
3 Total Income 2 NIL
3 C__ 2,50,000
3a Current Year loss
4 Net tax payabl 3a NIL
5 Interest payal 4 9,270
5 ^. _. 184
6 Total tax an^'irA$Elrest payable
Tnvoc Da;dI( 6 9,454

a Adva s e_Tax , - 7a
h Tf1C
NILI
NIL '..
I Tfc
NIL
d Self Assess"rtlet)jjaz r 7d i.._.. __ 9,450
e Total Taxes Paid (7a+7b+7c+7d)
Tax Payable (6 - 7e)
9 Refund (7e - 6)
Receipt No
Date Seal and Signature o

1
 INDIAN INCOME TAX RETURN Assessment Year
[For individuals / HUFs not having Income from Business or Profession ]
(Please see Rule 12 of the Income-tax Rules, 1962)
(Also see attached instructions)
2 0 1 0- 1 1
Part A- GEN GENERAL
First name Middle name Last name PAN
SANJAY SARAOGI HUF AAQHS 4388 M
Flat/Door/Block No Name Of Premises/Building/Village Status (Tick) 0
N/A SAIFULLAGANJ Individual -/ H'UF
Road/Street/Post Office Area/Locality _Date of Birth (in case of individual)
LALBAGH STATION ROAD
Town/City/District State Pin code Sex (in case of individual)l) (Tick) t
DARBHANGA BIHAR 846 004 i Male Female
Email Address (SID code)-Phone Employer Category (if in
Number employment) (Tick) 0
0 - Govt PSI J _
Designation of Assessing Officer(Ward/Circle)
Return filed under section [ Please
a WARD-2 DBG see Instruction number 9(i)] 12
G :y Whether original or Revised return? (Tick) 0 N/ I Original Revised
If revised, then enter Receipt No and Date of filing original return
Residential Status (Tick) 0 I Resident Non-Resident Resident but Not Ordinarily Resident
Whether this return is being filed by a representative assessee ? (Tick) 0 Yes V No
If yes, please furnish following information -
(a) Name of the representative
(b) Address of the representative
',. (c) Permanent Account Number (PAN) of the
representative
PART-B
Prt6
a - TI Computation of total Incom e
1 Salaries (6 of Schedule S) _. _..... _. _... ^_.. NIL
2 Income from house property (3c of Schedule HP) (enter nil if loss)
2 NIL
3 Capital gains -- - -
a Short term
Short-term (u/s 111A) (enter nil, if loss) (A5 of
Schedule -CG) 3al NIL
ii Short-term (others) (A6 of Schedule-CG) 3aii NIL
iii Total short -term (3ai + 3aii) (A4 of Schedule CG) 3aiiil NIL
b Long-term (B5 of Schedule-CG) (enter nil if loss)
3b NIL
c Total capital gains (3aiii + 3b) (enter nil if 3c is a loss)
3c NIL
4 Income from other sources
a From sources other than from owning race horses and W
innings from Lottery (3 of
Schedule OS) 4a 2,50,000
b From owning race horses (4c of Schedule OS) (enter nil if loss)
4b NIL
c Total ( a + b) (enter nil if 4c is a loss)
4c 2 , 50 , 000
5 Total (1+2+3c+4c)
__ 5 2 5 0,000
Do not write or stam p i n thi s are a- ( S pace for bar code ) --
For Office Use Only - - - _

Receipt No

Date

Seal and Signature of receiving official

I
 6 Losses of current year to be set off against 5(total of 2vi and 3vi Schedule CYLA) NIL
7 Balance after set off current year losses ( 5 - 6) (also total of column 4 of Schedule
CYLA) 2,50,000
8 Brought forward losses set off against 7(2vi of Schedule BFLA) 8 NIL
9 Gross Total income (7 - 8) (also 30 of Schedule BFLA) 9 2,50,000
10 Deductions under Chapter VI-A (n of Schedule VIA) 10 NIL
11 Total income (9-10) 11
2,50,000
12 Net agricultural income/ any other income for rate purpose (4 of Schedule EI) 12 NIL'..
13 'Aggregate income' (11 + 12) 13 2,50,000
14 Losses of current year to be carried forward (total of row xi of Schedule CFL) 14 NIL

Part B - TTI Computation of tax liability on total income

1 Tax payable on total income
a Tax at normal rates
b Tax at special rates (11 of Schedule-SI)
c Tax Payable on Total Income (1a + 1b) 9,000
2 Education Cass, including secondary and higher education cess on 1c 270
3 Gross tax liability (lc+2)
9,270
4 Tax relief
a Section 89 4a NIL
b Section 90 4b NIL
c Section 91 4c':.,.,,

d Total (4a + 4b+4c) 4d NIL

j 5 Net tax liability (3-4d) 5. 9,270
0- 6 Interest payable
0 a For default in furnishing the return (section 234A) 6a i 184
b For default in payment of advance tax (section
234B) 6b NIL
c For deferment of advance tax (section 234C) Sc NIL
d Total Interest Payable (6a+6b+6c) 6d 184
7 Aggregate liability (5 + 6d) 7 9 454
8 Taxes Paid
1
a Advance Tax (from Schedule-IT) 8a NIL
C b TDS (Total of column 7 of Schedule-TDSI and
Q- column 7 of Schedule -TDS 2) 8b NIL
W c Self Assessment Tax (from Schedule-17) 8c 9,450
d Total Taxes Paid (8a+8b+8c) 8d 9, 450
9 Amount payable (Enter if 7 is greater than 8d, else enter 0) 9 NIL
10 Refund (If 8d is greater than 7, also give bank account details below)
10 NIL
11 Enter your bank account number (mandatory in case of refund)
Z 12 b
2 Do you want your refund I deposited
Cheque, or directly into your bank account? (tick as

13 Give additional details of your bank account

MICR Code Type of Account (tick as applicableO) Savings Current
 VERIFICATION
I, SANJAY SARAOGI son of PARMESHWAR LAL SARAOGI ,
holding permanent account number AAQHS 4388 M solemnly
declare that to the best of my knowledge and belief, the information given in the return and the schedules thereto is correct and
complete and that the amount of total income and other particulars shown therein are truly stated and are in accordance
provisions of the Income-tax Act, 1961, in respect of income chargeable to income-tax for the previous year relevantwith the
to the
Assessment Year 2010-2011 .
Place DARBHANGA Date 28 -09-2010
Sign here

14 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....... .... (15 NIL --

Schedule S Details of Income from Salary

Name of Employer
PAN of Employer (optional)
Address of empl -er _ -' ownCi
_._.L _ ty_
I Pin code
Salary (Excluding all exempdnon -exempt all I
salary as they, are shown separately below) Pergms/tes & profit In lieu of 1
All
2 owances exempt under section 10 (Not to be NIL
included in 6- below) 2 NIL
3 Allowances not exempt (refer Form 16 from employer) ---
Value of perquisites (refer Fonn 16 from employer)
5 Profits in lieu of salary (refer Form 16 from employer)
6 Income cha rgea bl
eundertha -
eadSalanes '(1+3+4+5)

Schedule HP Details of Income from House Property

(Please refer to instructions)

Address of property
Town/ tate -
City State -PIN Cod
Name
(Tick) _ if let out of Tenant PAN of Tenant(optional)
a Annual letable value/ rent received or receivable (higher if let out for whole of the
year, lower if l et out for part of the year )
NIL
The amount of rent which cannot be realized NIL...,
lb !:
Tax paid to local authorities
1c' NIL
Total (l b + 1 c)
1d NIL
Balance (1a -1d)
30% of le NIL
1f NIL
Interest payable on borrowed capital
1g NIL
Total (1f+ 1g)
Income from house property (1 a -1h) 1h NIL
1i --- NIL
Income under the head "Income from house property "
a Rent of earlier years realized under section 25A/AA
b Arrears of rent received during the year under
section 258 after deducting 30% 3b NIL
c Total (3a+3b+1i+2i
...
) NIL
NOTE Please include the income of the s ec^ed 3c NIL
p persons referred to
in Schedule SPl whie computing the income under this head
Schedule CG
_..... -_.,,,.__ Capital Gains
 b Deductions under section 48
i Cost of acquisition ---- NIL
bi NIL
ij Cost of Improvement bii
NIL
in Expenditure on transfer
biii NIL
iv Total (j + ii + iii) biv
NIL
c Balance (2a - biv) 2c
NIL
d Loss, if any, to be ignored under section 94(7) or
94(8) (enter positive values only) 2d NIL
e Deduction under sections 54B/54D 2e
NIL
f Short-term capital gain (2c + 2d - 2e)
3 A moun t d eemed to be short term capital gains under sections 2f L
54B/54D/54EC/54 ED/54G/54GA A3 NIL
4 Total short term capital gain (1+ 2f +A3 )
A4 NIL
5 Short term capital gain under section 111A included in 4
6 Sh ort term capital gain other than referred to in section I I1A (A4 - A5) A5 NIL
B Long term capital gain A6 NIL

1 Assef in case of non-resident to which first proviso to section 48 i s app li

cable 1 -- - - --- NIL
2 Asset in the case of others where proviso under section 112(1) is not e
xercised
a Full value of consideration 2a r
NIL
b Deductions under section 48
Cost of acquisition after indexation
bi . NIL
Cost of improvement after indexation bii
NIL
Expenditure on transfer
i NIL
iv Total (bi +bjj +biii) biv
c Balance (2a - biv)
NIL
d Deduction under sections 2c NIL
54/54B/54D/54EC/54F/54G/54GA 2d NIL
e Net balance (2c-2d)
3 Asset in the case of others ze NIL
where proviso under section 112(1) is exercised
a Full va l ue o f consideration
3a NIL
b Deductions under section 48
I Cost of acquisition without indexation
bi NIL
ii Cost of improvement without indexation bi NIL
in Expenditure on transfer
biii NIL
iv Total (bi + bjj +bill)
biv NIL
c Balance (3a - biv)
3c NIL
d Ded
uction under sections 54/54B/54D/54EC/54F 3d NIL
e Net balance (3c-3d)
4 Amount d eemed to be long term capital gains and 3e NI L
und er sections
54/54B/54D/54EC/54ED/54F 4;
5 Total l ong term capital gain 1+ 2e NIL
((enter 2e as nil if loss) + 3e (enter 3e as nil if loss)) B5
+4)]
C I ncome chargeable under the head "CAPITAL GAINS" (A4 + B5) NIL
(enter B5 as nil if loss) C
D Information a b out accrual/receipt of capital gain NIL
-------- - -
Date UP 0 15/9
P 16/9 to 15 /12' 16 /12 to 3
15/16/3 to 31/3
1 Long-term where proviso under section 112(1 ) (ii) (iv)
i s exercised (Without Indexation)-
Code in SI Schedule is 22, Tax Rate is 10%;
Enter only positive value from Item B3e of NILi
Schedule CG AFTER loss adjustment under this NIL
category in Schedule CYLA and BFLA, if any
2 Long- term where proviso under secti on -11 2 (1 )
is NOT exercised (With Indexation)-
Code in St Schedule is 21, Tax Rate is 20%;
':. Enter only positive value from Item (B5-B3e) of NIL NIL
ScheduleCG AF TER loss adjustm en t under this NIL
category in Schedule CYLA and BFLA, if any.

4
 T

3 Short-term under 111A-

Code in St Schedule is 1A, Tax Rate is 15%;
Enter only positive value from Item A 7 of
Schedule CG AFTER loss adjustment under this
category in Schedule CYLA BFLA, if any. _
4 Short-term OTHERS-
Taxed at normal rates;
Enter only positive value from Item A8 of NILI NIL NIL I NIL
Schedule CG AFTER loss 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 sources

1 Income
a Dividends , Gross la NIL
b Interest , Gross lb NIL '..
c Rental income from machinery , plants, buildings , Icl NIL
d Others , Gross ( excluding iricome from owning race horses ) 1d 2,50,000
e Total ( la+lb+lc+ld) le 2,50,000
f Deductions under section 57-
i Expenses / Deductions f
NIL
I Depreciation fii NIL
iii Total fill '.. NIL '..
g Balance (le-fii) Ig 2,50,000
Winnings from lotteries, crossword puzzles, races, etc 2 NIL!
Income from other sources (other than from owning race horses) and Winnings from
Lottery (1g + 2) (enter Ig as nil, if loss) 3 2,50,000
Income from owning and maintaining race horses
a Receipts 4a NIL
b Deductions under section 57 in relation to (4) 4b NIL
c Balance (4a -4b) 4c NIL
5 Income chargeable under the head "Income from other sources" (3 + 4c) (enter 4c as nil if
loss and take 4c loss figure to schedule CFL) 5 2 , 50 , 000
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 losses
SI.No. Head/Source of Income of current! House property loss of Other sources loss (othe Current year's;
Income year (Fill this the current year set off than loss from rac Income remaining after set off
column only if horses) of the current yea
income is zero or set n
positive)'.. Total loss (3c of Total loss (3 of Schedule-1
Schedule-HP ) OS) .,,
2 3 lI(
4=1-2-3
Loss to be
adjusted NIL,
i Salaries NIL'. NIL
House property NIL
iii Short-term
capital gain NIL
Long-term
lv
capital gain
 v Other sources
(incl. profit from
owning race
horses but 2,50,000 NIL. 2,50,000!
excluding
winnings from
lottery)
vi Total loss set-off NIL NIL
vii Loss remaining after set-off out of
283 NIL NIL

Schedule BFLA D I 'I 11

ea r so ncome after Set off of Brought Forward Losses of earlier years
SI. Head/ Source of income Income after setoff, if Brought forward loss set Current year's
No
any, of current year's off Income remaining after
losses as per set off
4 of Schedule CYLA

i Salaries
ii House Property
iii Short-term capital gain
iv Long-term capital gain
Other sources (Profit from owning
v race horses but excluding NIL NIL NIL
winnings from lottery)
vi Total of brought forward loss set off NIL
vii uurrenr years income remaining after set off Total (i3 + ii3 + iii3 + i v3+v3)

Schedule CFL Details of Losses to be carried forward to future years

SI. Assessment Year Date of House Short term Long-term Other sources loss
No Filing Property loss capital loss Capital loss (from owning race
(DD/MM/
horses)
YYYY)

2002-03
NIL
2003-04
NIL
2004-05
NIL NIL NIL ',.
2005-06 NIL NIL NIL
2006-07 NIL NIL NIL
L NIL '!
2007-08 NI L 'NIL NIL NIL
2008-09 ' -----
NIL I _ NIL NIL NIL'
2009-10 NIL ! NIL NIL NILii
Total of earlier
year losses NIL NIL NIL I NIL
x Adjustment of
above losses in
NIL NILi
Schedule BFLA
xi 2010-11 (Current
year losses) NIL NIL
xii Total loss Carried
Forward to future NIL NIL NIL
years
Schedule VI-A Deductions under Chapter VI- A (Section)
a 80C NIL h 80G
b 8000C NIL -i 8OGG
c 8000D NIL ! j 80GGA
d 80D NIL k 8OGGC
 e 80DD
f 80DDB
',.'.. g 80E
'.. n Total deductions (Total of a to m) NIL

'.. Schedule SPI Income of specified persons(spouse, minor child etc) includable in income of the assesses (income of the
minor child to be included after Rs. 1,500
SI ' PAN f
Name
No (cotionall of person o person Nature of income Amount (Rs)
Relationship

Schedule SI '.. Income chargeable to Income tax at special rates [Please see instruction No.9(iii) for section code and rate
of tax]
SI. Section _ Special Income Tax thereon SI Section Special Income Tax Thereon
No code rate %) i ii No code rate (%)
1 1A 15 NIL NIL 6 5ACA 10 NIL NIL
2 22 .10 NIL NIL 7 5Ea 20 NIL NILE
3 21 20 NIL ' NIL 8 5Ala 20 NIL NIL
4 5BB 30 NIL NIL 9
5 5AC 10 NIL ; NIL 10
11 Total Mile 10 ii)

Schedule El Details of Exempt Income (Income not to be included in Total Income)

1 Interest income 1 NIL
2 Dividend income 2 NIL
3 Long-term capital gains from transactions on which Securities Transaction Tax is paid 3 NIL
4 Net Agriculture income /any other income for rate purpose 4 NIL
5 Others , including exempt income of minor children 5 NIL
6 Total ( 1+2+3+4+5) 6 NIL

Other r Inf t' t f

Schedule AIR o ma Ion (ransac Ions reporte d t h rough Annual Information Return ) (Please see instruction number
9(n) for code]
SI Code of Transaction 0 Amount ( Rs) SI Code of Transaction 0 Amount (Rs)
NIL 5 005
NIL 6 006
NIL 7 007
NIL 8 008

Schedule IT Details of Advance Tax and Self Assessment Tax Payments of Income-tax
SI Name of Bank & Branch BSR Code Date of Deposit Serial Number of
No 1nrVMMrvvvvl rr ^Ii^
'.. Advance Tax

Self Assessment Tax

STATE BANK OF INDIA, KSDSU
DARBHANGA 0002955 28-09-2010 00001

NOTE Enter the totals of Advance tax and Self Assessment tax in S/ No. 8a & 8c of Part B-TTI

7
 Employer^y__
[As per Form 16 issued by
Deducted at Source from Salary
D etails of Tax
Schedule TDS1 -t - Tax Tax
Tax Income Deduction payable Total tax payable/
Deduction Name and address of the Chargeable Under (incl. edn. Deducted refundable
SI Account under Chapter VI-A cess)
No Number Employer Salaries
(TAN) of the
Employer
(3)

Deductor(s)1
per Form 16 A issued by
t Source on income As
Schedule TDS2-1
Details Amount
of Tax Deducted a out of
Deduction Date of Paymen t Total tax (g) claimed for
Tax
Account Name and address of the Amount Paid / Credit deducted this year
Sl Number (TAN) Deductor (-I )
of the 6
(6) -_-_
;Deductor (4) -.

of part &TTI _..--

7 of Schedule -TDS2 in 8 (b)
-TOS land column
Enter total of column 7 of Schedule
NOTE Please

8
 ,axpayers counterfoil (To be fill ed uP by tax payer)
,PAN AAQHS 4388 M
Received from ISANJAY SARAOGI HUF

CASH 1 For Rs. 9450

Rs. (in words ) (NINE THOUSAND FOUR HUNDRED FIFTY ONLY
n
Drawn on
(Name of the Bank and Branch)
On account of Income Tax on OTHER THAN COMPANIES (Y,
Type of payment SELF ASSESSMENT TAX
For the Assessment Year 2010-2011
 00 00 00 00 0
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0 co M
0 O 0 V O
0 V O y Cl)
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N U) U) OC) 0) co
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0
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0
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W (0
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Q 0 o2) Q Q LL Q Q C Y O
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Cl) O CO U)
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Cl) W ot)
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 Government of India

INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT
Received with thanks from SANJAY
SARAOGI a return of income in Form No.
SARAL - 11 (ITR 1) for assessment
having the following particulars. year 2010-11,

Name SANJAYSARAOGI
Flpt/Door/Block No PAN AJJPS 4743 E
z N/A Name Of Premises/Building/Village
Z it Road/ Street/Post Office SAIFULLAGANJ
O< LALBAGH Area/Locality
SAIFULLAGANJ
wO Town/City/District
oz
State Status (fi!/
UAKUHANGA
the code)
BIHAR
Designation of Assessing Officer (Ward/ Circle)
WARD-2 DBG Original or
Cross total income Revised ORIGINAL

Deductions under Chapter-VI-A I 2,76,512

Total Income 2 1,00,000
Current Year loss (if any) 3 1,76,510
4 Net tax payable 3a NIL
5 Interest payable 4 _..1,701
6 Total tax and interest payable 5 34
Taxes Paid 6 1,735
a Advance Tax ........NIL
7a
b TDS 7b
c ICS NIL
7c NIL
d Self Assessment Tax
7d 1 , 740
e Total Taxes Paid (7a+7b+7c+7d)
Tax Payable (6 - 7e) 7e 1,740
9 Refund (7e - 6) 8 NIL
Receipt No 9
Date S eal and Signature ofre.^Siving Official NIL
 INDIAN INCOME TAX RETURN Assessment Year
SARAL-11 [For Individuals having Income from Salary/Pension / Income from One House
Property ( excluding loss brought forward from previous years )/ Income from Other
(ITR-1) Sources ( Excluding Winning from Lottery and Income from Race Horses))
(PIea se see 12 of the Income-tax Rules, 1962)
(Also see attached instructions)
First name PAN
Middle name Last name
SANJAY
SARAOGI AJJPS 4743 E
z Flat/Door/Block No Name Of Premises/BuildingA/illage
z N/A
Date of Birth (DD/MM/YYYY)
SAIFULLAGANJ 01.12-1969
p < Road/Street/Post Office Area/Locality Employer Category (Tick) 0
^ tr LALBAGH SAIFULLAGANJ Govt PSU' Others
ai 2 Town/City/District State Pin code Sex (Tick) l
'.. DARBHANGA BIHAR
846 004 J Male Female
E mail Address (STD code)-Phone Number O -
Designation of Assessing Officer (Ward/Circle)
Return filed under Section -
O ? WARD-2 DBG . [Please see instruction number-9(i)] 12
z C Whether original or revised return? (Tick) 0 '/ Original Revised
w If revised, enter receipt no and date of filing original return
Residential Status (Tick) 2 1/ ',. Resident Non-Resident Resident but Not Ordinarily Resident
1 Income chargeable under the Head ' Salaries ' ( Salary/Pension)
1 2,64,000
2 Income chargeable under the Head 'House Property' (enter-ve sign in case of loss , if any)
3 Income chargeable under the Head 'Other Sources' (enter-ve sign in case of loss, if any)
4 Gross Total Income (1+2+3)
2,76
5 Deductions under chapter VI A (Section)

1,00,000e BODD _+ I ouuV NIL

b 8000C ''. NIL f 80DDB NIL j 8OGGA NIL
c 8000D NIL g 80E NIL k 80GGC NIL
A son
NIL h 8OG *a- CUJ NIL
6 Deductions (Total of 5a to 511
6 1,00,000
7 Total Income (4-6)
7 1,76,510
8 Tax Payable on Total Income
8 1,651
z0 9 Secondary and Higher Education Cess on 8
9 50
10 Total Tax and Education Cess Payable (8+9)
10 1,701
11 Relief under section 89
11 NIL
12 Relief under section 90/91
12 NIL
13 Balance Tax Payable (10-11-12)
13 1 , 701
I- ! 14 Total Interest Payable u/s 234A / 2346 / 234C
14 34
15 Total Tax and Interest Payable (13+14)
15 1,35
Do not write or st am p i n this
area Seal and Signature of the receiving official
For Office Use Only

Receipt No

Date
 16 Taxes Paid
16a NIL
a ',. a Advance Tax (from item 25)
16b NIL
a b TDS ( column 7 of item 23 + column 7 of item 24)
Co c Self Assessment Tax (from item 25 ) 16c 1,740
1,740
17 Total Taxes Paid (16a+16b+16c) 17
18 NIL
18 Tax Payable (15-17) (Enter if 15 is greater than 17, else leave blank)
dive Bank Account details below) 19 NIL
19 Refund (17-15) (enter if 17 is greater than 15, also
Z 20 Enter your bank account number (mandatory in case of refund)
w 21 Do you want your refund by cheque, or deposited directly into your bank account?
22 Give additional details of your bank account
MICR Code Type of Account (tick as applicable a) Savings

23 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
SI TAN of the Name and address of the Income from Deduction ' Tax paya bl e Total tax Tax payable/
No Employer Employer Salaries U\C VI-A (incl. EC)^ Deducted refundable
(1) (2) (3) (4) ( 5) (6).': (7) (8)

24 Details of Tax Deducted at Source other than salary

SI Cate of Amount nu? c`
TAN of the Name and address of the Total Tax (6) claimed for
No Amount Payment/ deducted
Deductor Deductor paid/credited Credit this year
(3 (4) (5) (6) (7)
NIL NIL NI

25 Details of Advance Tax and Self Assessment Tax Payments

SI Date of Serial Number Amount (Rs)
Name of Bank & Branch BSR Code
No Deposit... ofChallan
Advance Tax
NIL

Self Assessment Tax

STATE BANK OF INDIA, KSDSU 0002955 28-09-2010 00002
1
DARBHANGA

26 Other Information (transactions reported through Annual Information Return) (Please see instruction number-9 (n) for code)
SL Code Amount (Rs) SI Code Amount (Rs) SI Code Amount (Rs)
A 001 NIL d 004 NIL G 007 NIL
B 002 NIL a 005 NIL H 008 NIL

C 003 NIL f 006 NIL

27 Exempt income only for reporting purposes (from Dividend, Capital gains etc) 27 NIL

VERIFICATION
I, SANJAY SARAOGI son of PARMESHWAR LAL SARAOGI 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 sho,sm
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 2010-2011.
Place DARBHANGA Date 28-09-2010 Sign here 4
28 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

29 If TRP is entitled for any reimbursement from the Government , amount thereof (to be filled by TRP)' 29 NIL
 wzasrK'rzsm;,.

(1o be , tilled up by tax payer

ayers cou nterfoil AJJPS 4743_ E ,._.
SANJAY SARAOG p
eceived from (Namel _._ _. t .... .
For Rs. 17 f0 .
CASH D FO TY ONL"
_. _. _.. ... K _ .
) ONE THOUSAND SEVEN H ^^R
2s. (in words
7rawn on d Branc
(Nameof the bank an
Income Tax on OTHER THAN COMPANIES
On account of NT TAX
Type of payment SELF ASSESSME
20`10 -201`1
For the Assessment Y ar

C
 trii / DS-5A

fjnalNfim ' ford 4114f Nomination facility available

UCO BANK "M rRW for:

Awttlfflt + Deposits
Ffi^st + w ftm a#" + Safe Cautody
+ yrw 7m" + Safe Deposit Vault
gir'fizzlofill8's#TMf* Please make use of it. For
Plf$/Vd-7IRtgt 2fattl tit 70 sf^1 '^ ^+4=R YRII1 # Details please enquire at the
1 argil, agt Ala! fq'1N a, arst Branch.
r .'si't xFf aiflTBil'ff t i
!qm I* +? qf# mfkfa^tt VM w UCO Bank
J s# AIR apt A , 3rmtn mw flI i3
Te am is f ma ............................................... kII
Branch

In Account with

RR ........... :.... _._._:............ _ ................................

IMPORTA Name
1. Constituents are requested to to that ys qM ....... ..........:::::...................................................
remitted to the Bank should either IR! ered Address
Post or handed over to the Cash D as no ............1........M..s............ ...........................

individual(s) outside the Cash Department has/have authority

..... ........._r:....._ .................................
to receive cash.
2. The account - holder should insist on delivery of Pass Book
made uptodate as far as possible on the same date;
l8d 7llnTifol4gP
S.B. Account No. dLo go iI 00C38. 9
otherwise he should obtain a receipt indicating when the
Pass Book will be delivered.
3. DepositRulej in vogue can be obtained by account-holder /Asst. Manager
from the Branch on request.

IM a WCIBM* . / S.B. Account No .........................

TIER Balances Tpi7w

Officers
' '`i ; Dab "NWAR's Deposits Initials

OPENING 1ALAYW
a 101000.00 Ali
O1flO(2OIO ^BT OAS$r _ . I049a( ^'-
b0t06
OtYID!20(^ c6ega^

T3
p.iyy.

s y flF ^u'!'.' '

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