Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

ITR-4 SUGAM PRESUMPTIVE BUSINESS OR PROFESSION INCOME TAX RETURN

Personal Information

First Name SUDHIR KUMAR PANDEY

Permanent Account Number AWUPP7903R Income Tax Ward/Circle

Sex Male Date of Birth/Formation (DD/MM/ 06/09/1986

YYYY)

Address

Flat/Door/Building 47

Name of Premises/ Building/ Village

Road/Street khargapur

Area/locality gomti nagar

Town/City/District LUCKNOW

State UTTAR PRADESH

Country INDIA

Pin code 226010

Aadhaar Number 235586726610

Status Individual

Mobile No.1 8960087200

Residential/Office Phone Number with STD code -

Mobile No. 2

Email Address pandeysudhirkumar123@gmai l.com

Filing Status

Tax Status Nil Tax Balance

Residential Status Resident

Return filed under section 12 - Voluntarily after the due date under section 139(4)

Whether original or revised return? Original

Whether Person governed by Portuguese Civil Code under section 5A No

If A23 is applicable, PAN of the Spouse

If under section: 139(5)- revised return:

Original Acknowledgement Number.

Date of filing of Original Return(DD/MM/YYYY)

If under section: 139(9)- return in response to defective return notice:

Original Acknowledgement Number.

Notice Number.

Date of filing of Original Return(DD/MM/YYYY)

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

If filed in response to notice u/s 139(9)/142(1)/148/153A/153C,enter the date of

such notice

Part B Gross Total Income

(B1) Income from Business(E8 of Sch BP) 334320

(B2) Income from Salary / Pension(Ensure to fill Sch TDS1) 0

(B3) Type of House Property

Income from One House Property 0

(B4) Income from Other Sources(Ensure to fill Sch TDS2) 1248

(B5) Gross Total Income (B1 + B2 + B3 + B4) 335568

Part C - Deductions and Taxable Total Income

S.No. Section Amount System Calculated

C1. 80C 35400 35400

C2. 80CCC 0 0

C3. 80CCD(1) 0 0

C4. 80CCD(1B) 0 0

C5. 80CCD(2) 0 0

C6. 80CCG 0 0

C7. 80D - 0 0

C8. 80DD (Maximum eligible amount is 75000. For Severe Disability, it is 0 0

125000)

C9. 80DDB (Maximum eligible amount is 40000. For Senior Citizen, it is 60000 0 0

and 80,000 for Very Senior Citizen)

C10. 80E 0 0

C11. 80EE 0 0

C12. 80G 0 0

C13. 80GG 0 0

C14. 80GGC 0 0

C15. 80QQB 0 0

C16. 80RRB 0 0

C17. 80TTA 1248 1248

C18. 80U(Maximum eligible amount 75000. For Severe Disability, it is 125000) 0 0

C19. Total Deductions (Total of C1 to C18) 36648 36648

Note:Total deductions under chapter VI A cannot exceed GTI.

C20. Taxable Total Income (B5 - C19) 298920

PART D TAX COMPUTATIONS AND TAX STATUS

D1. Tax payable on total income(C20) 4892

D2. Rebate on 87A 4892

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

D3. Tax payable after Rebate (D1-D2) 0

D4. Surcharge if C19 exceeds Rs. 1 Crore 0

D5. Cess on (D3+D4) 0

D6. Total Tax, Surcharge and Cess ( D3+D4+D5) 0

D7. Relief u/s 89 0

D8. Balance Tax after Relief (D6-D7) 0

D9. Total Interest u/s 234A 0

D10. Total Interest u/s 234B 0

D11. Total Interest u/s 234C 0

Total Interest Payable (D9+D10+D11) 0

D12. Total Tax and Interest(D8+D9+D10+D11) 0

D13. Total Advance Tax Paid 0

D14. Total Self-Assessment Tax Paid 0

D15. Total TDS Claimed 0

D16. Total TCS Collected 0

D17. Total Taxes Paid (D13+D14+D15+D16) 0

D18. Amount payable (D12 - D17, If D12 > D17) 0

D19. Refund (D17 - D12, If D17 > D12) 0

D20. Exempt income only for reporting purposes (If agricultural income is more than Rs.5,000/-, use ITR 3/5)

D21. Do you have a bank account in India (Non-residents claiming refund with no bank account in India may Yes

select NO)?

a) Bank Account in which refund, if any, shall be credited

S.No. IFS Code of the bank Name of the Bank Account Number (the number Cash deposited during

should be 9 digits or more as 09.11.2016 to 30.12.2016 (if

per CBS system of the bank) aggregate cash deposits during

the period >= Rs.2 lakh)

1 BKID0ARYAGB Bank of India 003830110000006 7000

b) Other Bank account details

S.No. IFS Code of the bank Name of the Bank Account Number (the number Cash deposited during

should be 9 digits or more as 09.11.2016 to 30.12.2016 (if

per CBS system of the bank) aggregate cash deposits during

the period >= Rs.2 lakh)

c) Non-residents, who are claiming income-tax refund and not having bank account in India may, at their option, furnish the details of one foreign bank

account

S.No. IBAN/SWIFT code Name of the bank Country of Location Account Number

Nature of business, if more than one business indicate the three main activities/ products

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

S.No. Nature of Business Tradename Tradename Tradename

1 0202-Retailers SUDHIR GENERAL STORE

Instructions for correct calculation of Profits and gains of Business of plying, hiring or leasing goods carriages u/s 44AE

Vehicles

S No. Period of holding (in months) Income per Vehicle (Must Deemed Income

be >= 7500 p.m. per vehicle)

1 0

Total 0

SCHEDULE BP - DETAILS OF INCOME FROM BUSINESS OR PROFESSION

COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AD

E1. Gross Turnover or Gross Receipts

E1a. Through a/c payee cheque or a/c payee bank draft or bank electronic clearing system received 0

before specified date

E1b. Any other mode 4178990

E2. Presumptive income under section 44AD

a. 6% of E1a 0

b. 8% of E1b 334320

c. Total (a + b) 334320

Note : If Income is less than the above percentage of Gross Receipts, it is mandatory to have a tax audit under 44AB and regular ITR 3 or 5 has to be filled

not this form

Presumptive income under 44ADA (Profession)

E3. Gross Receipts 0

E4. Presumptive income under section 44ADA (>=50% of E3) 0

Note : If income is less tha 50% of Gross Receipts, it is mandatory to have a tax audit under 44AB and Regular ITR 3 or ITR 5 form has to be filled and not

this form

COMPUTATION OF PRESUMPTIVE INCOME UNDER 44AE

E5. Presumptive Income from Goods Carriage under section 44AE 0

Note : If the profits are lower than prescribed under S.44AE or the number of Vehicles owned at any time exceed 10 then the regular ITR 3 or ITR 5 form

has to be filled and not this form

E6. Salary and interest paid to the partners (This is to be filled up only by firms)

E7. Income Chargeable under Business under section 44AE (E5 - E6) 0

E8. Income chargeable under Business & Profession (under section 44AD, 44ADA and 44AE) (E2 + E4 + 334320

E7)

FINANCIAL PARTICULARS OF THE BUSINESS

Note : For E9 to E12, furnish the information as on 31st day of March, 2017

E9. Amount of Total Sundry Debtors 0

E10. Amount of Total Sundry Creditors 0

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

E11. Amount of Total Stock-in-trade 0

E12. Amount of the Cash Balance 24820

TDS1.Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]

S.No. TAN(1) Name of the Employer(2) Income under Salary(3) Tax Deducted(4)

TOTAL 0

Sch TDS2 - Details of Tax Deducted at Source from Income OTHER THAN SALARY [As per Form 16 A issued by Deductor(s)]

S.No. TAN of the Name of the Unique TDS Deducted Details of Tax Deducted(6) Amount out If A23 is applicable,

Deductor(1) Deductor(2) Certificate No.(3) Year(4) Receipt as of (6) claimed amount claimed

mentioned in this year(7) in the hands

Form 26AS(5) of spouse(8)

TOTAL 0

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

S.No. Tax Collection Name of Collector(2) Details of amount Tax Collected (4) Amount out of Amount out of (4) being

Account Number paid as mentioned (4) being claimed claimed in the hands

of the Collector (1) in Form 26AS (3) in the hands of of spouse, if section

spouse, if section 5A is applicable (6)

5A is applicable (5)

TOTAL 0

IT.Details of Advance Tax and Self Assessment Tax Payments

S.No. BSR Code(1) Date of Deposit(DD/MM/YYYY)(2) Challan Number(3) Tax Paid(4)

TOTAL 0

Schedule AL Asset and Liability at the end of the year (Applicable in case where total income exceeds Rs. 50 lakh)

A Do you own any immovable asset ?

Details of immovable asset

S No. Description Address Amount (cost) in Rs.

B Details of movable asset

Sl No. Description Amount (cost) in Rs.

(i) Jewellery, bullion etc.

(ii) Archaeological collections, drawings, painting, sculpture or any work of art

(iii) Vehicles, yachts, boats and aircrafts

Financial asset

(iv) (a) Bank (including all deposits)

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

(b) Shares and securities

(c) Insurance policies

(d) Loans and advances given

(d) Cash in hand

C Do you have any Interest held in the assets of a firm or association of persons (AOP) as a partner or

member thereof ?

Interest held in the assets of a firm or association of persons (AOP) as a partner or member thereof

S No. Name of the firm(s)/ AOP(s) (1) Address of the firm(s)/ AOP(s) (2) PAN of the firm/ AOP (3) Assessees investment in the

firm/ AOP on cost basis (4)

D Liability in relation to Assets at (A+B+C)

80G

Instructions for correct calculation of 80G

A. Donations entitled for 100% deduction without qualifying limit

S No. Name of the Donee Address City or Town State Code Pincode PAN of Amount of Eligible Amount

or District the Donee donation of Donation

1 0

Total A 0 0

B. Donations entitled for 50% deduction without qualifying limit

S No. Name of the Donee Address City or Town State Code Pincode PAN of Amount of Eligible Amount

or District the Donee donation of Donation

1 0

Total B 0 0

C. Donations entitled for 100% deduction subject to qualifying limit

S No. Name of the Donee Address City or Town State Code Pincode PAN of Amount of Eligible Amount

or District the Donee donation of Donation

1 0

Total C 0 0

D. Donations entitled for 50% deduction subject to qualifying limit

S No. Name of the Donee Address City or Town State Code Pincode PAN of Amount of Eligible Amount

or District the Donee donation of Donation

1 0

Total D 0 0

E. Donations (A + B + C+ D) 0 0

VERIFICATION

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Acknowledgement Number : 377346830290118 Assessment Year : 2017-18

I SUDHIR KUMAR PANDEY son/daughter of RAM KUMAR PANDEY solemnly declare that to the best of my knowledge and belief, the information given in
the return is correctand 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 toIncome-tax for the previous year relevant to the Assessment Year 2017-18.

Place Date PAN

LUCKNOW 29/01/2018 AWUPP7903R

If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:

TRP PIN (10 Digit)

Name of TRP

Amount to be paid to TRP

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