Form PDF 802989920141122
Form PDF 802989920141122
Form PDF 802989920141122
(A15) Aadhaar Number (12 digit) / Aadhaar Enrolment Id (28 digit) (if eligible for
(A9) Area/locality
Aadhaar)
SOUTH WEST DELHI 8xxx xxxx 6420
(A11) State
(A10) Town/City/District 09-Delhi (A13) Pin code/Zip code
Dwarka Sec-6 (A12) Country 110075
91-India
(A16) Residential/Office Phone Number with STD/ISD Mobile No. 1 (A17) Mobile No. 2
code 919891749876 8447455977
(A18) Email Address-1 (self)
(A19) Email Address-2
[email protected]
139(1)-On or before due date, 139(4)-After due date, ✔ 139(5)-Revised
(a1i) Filed u/s (Tick)[Please see instruction ]
(A20) Return, 92CD-Modified return, 119(2)(b)-after condonation of delay.
Are you opting for new tax regime u/s 115BAC ? Yes ✔ No
Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? – (Tick)
Yes ✔ No
(b) If yes, please furnish following information
[Note: To be filled only if a person is not required to furnish a return of income under section 139(1) but filing return of income due to
fulfilling one or more conditions mentioned in the seventh proviso to section 139(1)]
Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more current
(bi) account during the previous year? (Yes/No) 0
Yes ✔ No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for
(bii) travel to a foreign country for yourself or for any other person? (Yes/No) 0
Yes ✔ No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on
(biii) consumption of electricity during the previous year? (Yes/No) 0
Yes ✔ No
Are you required to file a return as per other conditions prescribed under clause (iv) of seventh proviso to section 139(1) (If yes, please
(biv)
select the relevant condition from the drop down menu) Yes ✔ No
If filed, in response to a notice u/s 139(9)/142(1)/148 or order u/s 119(2)(b) enter unique number/ Document
Identification Number (DIN) and date of such notice/order, or if filed u/s 92CD, enter date of advance pricing (Unique
(d)
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
agreement Number)
✔ You were in India for 182 days or more during the previous year [section 6
(1)(a)]
You were in India for 60 days or more during the previous year, and have
been in India for 365 days or more within the 4 preceding years [section (6)(1)
(c)] [where Explanation 1 is not applicable]
You are a citizen of India, who left India, for the purpose of employment, as
a member of the crew of an Indian ship and were in India for 182 days or
A. Resident more during the previous year and 365 days or more within the preceding 4
years [Explanation 1(a) of section (6)(1)(c)]
You are a citizen of India or a person of Indian origin and have come on a
visit to India during the previous year and were in India for 182 days or more
during the previous year and 365 days or more within the preceding 4 years;
or 120 days or more during the previous year and 365 days or more within the
preceding 4 years if the total income, other than income from foreign sources,
exceeds Rs. 15 lakh. [Explanation 1(b) of section (6)(1)(c)]
Residential Status in India You have been in India for 729 days or less during the 7 preceding years
(for individuals) (Tick [section 6(6)(a)]
applicable option)
(e) You are a citizen of India or person of Indian origin, who comes on a visit to
B. Resident but not India, having total income, other than the income from foreign sources,
Ordinarily Resident exceeding Rs. 15 lakh and have been in India for 120 days or more but less
than 182 days during the previous year [section 6(6)(c)]
You are a citizen of India having total income, other than the income from
foreign sources, exceeding Rs. 15 lakh during the previous year and not liable
to tax in any other country or territory by reason of your domicile or residence
or any other criteria of similar nature [section 6(6)(d) rws 6(1A)]
Total period of stay in India during Total period of stay in India during the
the previous year (in days) 4 preceding years (in days)
(f) Do you want to claim the benefit under section 115H? (applicable in case of resident) Yes ✔ No
(g) Are you governed by Portuguese Civil Code as per section 5A? Tick) Yes ✔ No (If "YES" please fill Schedule 5A)
Whether you were Director in a company at any time during the previous year? (Tick) Yes ✔ No
(i)
If yes, please furnish following information -
Sl. Name of Type of PAN Whether its shares are listed or Director Identification Number
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Whether you have held unlisted equity shares at any time during the previous year? Yes ✔ No
(j)
If yes, please furnish following information in respect of equity shares
Sl. No. Name of Type of PAN Opening balance Shares acquired during the year Shares transferred during the Closing balance
Company company year
No. of Cost of No. of Date of Face value Issue price per Purchase price per share No. of Sale No. of Cost of
shares acquisition shares subscription / per share share (in case (in case of purchase from shares consideration shares acquisition
purchase of fresh issue) existing shareholder)
1a 1b 2 3 4 5 6 7 8 9 10 11 12 13
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Sl. Name of other Co-owner(s) PAN/Aadhaar of other Co-owner(s) Percentage share of other co-owner(s) in
No. property (%)
[Tick the
applicable
option]
Let out Sl. Name(s) of Tenant (if PAN/ Aadhaar No. of Tenant(s) PAN/TAN of Tenant(s) (if TDS credit
✔ Self- No. let out) (Please see note) is claimed)
occupied
Deemed let
out
a Gross rent received or receivable or letable value 1a 0
b The amount of rent which cannot be realized 1b 0
c Tax paid to local authorities 1c 0
d Total ( 1 b + 1 c) 1d 0
e Annual value ( 1 a – 1 d) (nil, if self -occupied etc. as per section 23(2)of the Act) 1e 0
f Annual value of the property owned (own percentage share x 1 e) 1f 0
g 30% of 1 f 1g 0
h Interest payable on borrowed capital 1h 2,00,000
i Total ( 1 g + 1 h) 1i 2,00,000
j Arrears/Unrealised rent received during the year less 30% 1j 0
k Income from house property 1 ( 1 f – 1 i + 1 j) 1k -2,00,000
3 Pass through income/loss if any * 3 0
Income under the head “Income from house property” (1k + 2k + 3)
4 4 -2,00,000
(if negative take the figure to 2i of schedule CYLA)
Please include the income of the specified persons referred to in Schedule SPI and Pass through income referred to in
schedule PTI while computing the income under this head.
Furnishing of PAN/ Aadhaar No. of tenant is mandatory, if tax is deducted under section 194-IB.
Furnishing of TAN of tenant is mandatory, if tax is deducted under section 194-I.
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From sale of equity share or unit of equity oriented Mutual Fund (MF) or unit of a business trust on which STT is paid under section 111A or 115AD(1)
2
(ii) proviso (for FII)
Loss to be disallowed u/s 94(7) or 94(8)- for example if asset bought/acquired within 3 months prior
d to record date and dividend/income/bonus units are received, then loss arising out of sale of such 2d 0
asset to be ignored (Enter positive value only)
e Short-term capital gain on equity share or equity oriented MF (STT paid) (2c +2d) A2e 7,863
For NON-RESIDENT, not being an FII- from sale of shares or debentures of an Indian company (to be computed with foreign exchange adjustment
3
under first proviso to section 48)
b STCG on transactions on which securities transaction tax (STT) is not paid A3b 0
4 For NON-RESIDENT- from sale of securities (other than those at A2) by an FII as per section 115AD
In case securities sold include shares of a company other than quoted shares, enter the following
a i
details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
Loss to be disallowed u/s 94(7) or 94(8)- for example if security bought/acquired within 3 months
d prior to record date and dividend/income/bonus units are received, then loss arising out of sale of 4d 0
such security to be ignored (Enter positive value only)
e Short-term capital gain on sale of securities by an FII (other than those at A2) (4c +4d) A4e 0
a i In case assets sold include shares of a company other than quoted shares, enter the following details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
b Deductions under section 48
In case of asset (security/unit) loss to be disallowed u/s 94(7) or 94(8)- for example if asset bought
d /acquired within 3 months prior to record date and dividend/income/bonus units are received, then 5d 0
loss arising out of sale of such asset to be ignored (Enter positive value only)
Whether any amount of unutilized capital gain on asset transferred during the previous years shown below was deposited in the Capital Gains
Accounts Scheme within due date for that year?
a
yes No Not applicable. If yes, then provide the details below
Sl. Previous year in which Section under which deduction New asset acquired/constructed Amount not used for new asset or remained unutilized in
No. asset transferred claimed in that year Capital gains account (X)
Year in which asset Amount utilised out of Capital
acquired/constructed Gains account
7 Pass Through Income/ Loss in the nature of Short Term Capital Gain, (Fill up schedule PTI) (A7a + A7b + A7c) A7 0
a Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 15% A7a 0
b Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable @ 30% A7b 0
Pass Through Income/ Loss in the nature of Short Term Capital Gain, chargeable at applicable
c A7c 0
rates
8 Amount of STCG included in A1 – A7 but not chargeable to tax in India as per DTAA
Sl. Amount of Item No. A1 to A7 above in Country name Article of Rate as per Treaty Whether TRC Section of I. Rate as per I. Applicable rate [lower of
No. income which included & Code DTAA (enter NIL, if not obtained T. Act T. Act (6) or (9)]
chargeable (Y/N)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
a Total amount of STCG not chargeable to tax in India as per DTAA A8a 0
b Total amount of STCG chargeable to tax at special rates in India as per DTAA A8b 0
9 Total Short-term Capital Gain (A1e+ A2e+ A3a+ A3b+ A4e+ A5e+A6 + A7 - A8a) A9 7,863
B Long-term capital gain (LTCG) (Sub-items, 5 , 6, 7 & 8 are not applicable for residents)
2 From sale of bonds or debenture (other than capital indexed bonds issued by Government)
From sale of, (i) listed securities (other than a unit) or zero coupon bonds where proviso under section 112
3
(1) is applicable (ii) GDR of an Indian company referred in sec. 115ACA
Cost of
acquisition
i bi 0
without
indexation
Cost of
Improvement
ii bii 0
without
indexation
Expenditure
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wholly and
iii exclusively in biii 0
connection
with transfer
From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which
4
STT is paid under section 112A
c Long-term Capital Gains on sale of capital assets at B4 above (4a – 4b) B4c 43,972
For NON-RESIDENTS- from sale of shares or debenture of Indian company (to be computed with foreign
5
exchange adjustment under first proviso to section 48)
For NON-RESIDENTS- from sale of, (i) unlisted securities as per sec. 112(1)(c), (ii) bonds or GDR as referred in sec. 115AC, (iii) securities by FII as
6
referred to in sec. 115AD (other than securities referred to in section 112A for which column B7 is to be filled up)
In case securities sold include shares of a company other than quoted shares, enter the following
a i
details
ii Full value of consideration in respect of securities other than unquoted shares aii 0
e Long-term Capital Gains on assets at 6 above in case of NON-REESIDENT (6c - 6d) B6e 0
For NON-RESIDENTS - From sale of equity share in a company or unit of equity oriented fund or unit of a business trust on which STT is paid under
7
section 112A
c Long-term Capital Gains on sale of capital assets at B7 above (7a – 7b) B7c 0
8 From sale of foreign exchange asset by NON-RESIDENT INDIAN (If opted under chapter XII-A)
d LTCG on sale of asset, other than specified asset (computed without indexation) 8d 0
f Balance LTCG on sale of asset, other than specified asset (8d- 8e) B8f 0
In case securities sold include shares of a company other than quoted shares, enter the following
A i
details
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
b Fair market value of unquoted shares determined in the prescribed manner ib 0
ii Full value of consideration in respect of securities other than unquoted shares aii 0
Whether any amount of unutilized capital gain on asset transferred during the previous year shown below was deposited in the Capital Gains Accounts
a Scheme within due date for that year?
Yes No Not applicable. If yes, then provide the details below
Sl. Previous year in which Section under which deduction New asset acquired/constructed Amount not used for new asset or remained unutilized in
No. asset transferred claimed in that year Capital gains account (X)
Year in which asset Amount utilised out of Capital
acquired/constructed Gains account
11 Pass Through Income/ Loss in the nature of Long Term Capital Gain,(Fill up schedule PTI) (B11a1+ B11a2 + B11b) B11 0
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 10% u/s
a1 B11a1 0
112A
Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 10% under
a2 B11a2 0
sections other than u/s 112A
b Pass Through Income/ Loss in the nature of Long Term Capital Gain, chargeable @ 20% B11b 0
12 Amount of LTCG included in B1 - B11 but not chargeable to tax or chargeable at special rates in India as per DTAA
Sl.No. Amount of income Item No. B1 to B11 above in which included Country name & Code Article of DTAA Rate as per Treaty Whether TRC obtained Section of I.T. Act Rate as per I.T. Act Applicable rate [lower of (6) or (9)]
(enter NIL, if not chargeable) (Y/N)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
b Total amount of LTCG chargeable to tax at special rates as per DTAA B12b 0
13 Total long term capital gain chargeable under I.T. Act (B1e+B2e+B3e+B4c+B5c+B6e+B7c+B8c+B8f+B9e+B10 + B11 - B12a) B13 43,972
C Income chargeable under the head "CAPITAL GAINS" (A9 + B13) (take B13 as nil, if loss) C 51,835
Date of Transfer of Date of purchase/ Cost of new asset Amount deposited in Amount of deduction
Original Asset construction of new Capital Gains Accounts claimed
asset Scheme before due date
Date of Transfer of Original Date of purchase of new agricultural Cost of new agricultural Amount deposited in Capital Gains Accounts Scheme before due Amount of
Asset land land date deduction
claimed
Date of Transfer of Amount invested in specified/notified bonds (not exceeding fifty lakh rupees) Date of investment Amount of deduction claimed
Original Asset
Date of Transfer Date of purchase/construction of new residential Cost of new residential Amount of Amount deposited in Capital Gains Accounts Scheme before due
of house house deduction date
Original Asset claimed
Date of transfer of PAN of the Amount utilised for Date of Cost of new plant and Date of purchase Amount deposited in Capital Amount of
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
original residential eligible subscription of equity shares of subscription machinery purchased by the of plant and Gains Accounts Scheme before deduction
property company eligible company of shares eligible company machinery due date claimed
Date of Transfer of Amount invested in new specified asset or savings certificate Date of investment Amount of deduction claimed
foreign exchange asset
E Set-off of current year capital losses with current year capital gains (excluding amounts included in A8a & B12a which is not chargeable under DTAA)
Sl.No Type of Capital Gain Capital Gain of Short term capital loss Long term capital loss Current year’s capital gains
off
figure is negative)
Term
iii 30% 0 0 0 0 0
Capital
Gain
iv Applicable 0 0 0 0 0
Rate
v Covered 0 0 0 0 0
By DTAA
Term
vii 20% 0 0 0 0 0 0 0 0
Capital
Gain
viii Covered 0 0 0 0 0 0 0 0
By DTAA
(i-ix)
The figures of STCG in this table (A1e* etc.) are the amounts of STCG computed in respective column (A1-A6) as reduced by theamount of STCG not chargeable to tax or chargeable at special rates as
per DTAA, which is included therein, if any.
The figures of LTCG in this table (B1e* etc.) are the amounts of LTCG computed in respective column (B1-B10) as reduced by theamount of LTCG not chargeable to tax or chargeable at special rates as
per DTAA, which is included therein, if any.
Type of Capital gain / Date Upto 15/6 16/6 to 15/9 16/9 to 15/12 16/12 to 15/3 16/3 to 31/3
(i) (ii) (iii) (iv) (v)
1 Short-term capital gains taxable at the rate of 15% 0 0 0 7,863 0
Enter value from item 3iii of schedule BFLA, if any.
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while computing the income under this head
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
From sale of equity share in a company or unit of equity oriented fund or unit of a business trust
Schedule 112A
on which STT is paid under section 112A
Sl. No. Share/Unit acquired ISIN Code Name of No. of Sale-price Full Value of Cost of Cost of If the long Fair Total Fair Expenditure Total Balance (6-
the Share Shares per Share Consideration acquisition acquisition term Market Market wholly and deductions 13) Item 4
/Unit /Units /Unit (Total Sale without capital Value per Value of exclusively (7+12) (a) of
-Lower of (2)(ac)-
6 & 11 (4*10)
(Col 1) (col 1a) (Col 2) (Col 3) (Col 4) (Col 5) (Col 6) (Col 7) (Col 8) (Col 9) (Col 10) (Col 11) (Col 12) (Col 13) (Col 14)
1 After 31st January, 2018 INNOTREQUIRD CONSOLID 0 0 1,13,972 70,000 70,000 0 0 0 0 70,000 43,972
ATED
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
115AD(1)(b)(iii) For NON-RESIDENTS - From sale of equity share in a company or unit of equity oriented fund or
proviso unit of a business trust on which STT is paid under section 112A
Sl. Share ISIN Name No. of Sale- Full Value of Cost of acquisition Cost of If the long term capital asset Fair Market Value per Total Fair Market Value of Expenditure wholly and Total Balance (6-13)
No. /Unit Code of the Shares price Consideration without indexation acquisition was acquired before share/unit as on 31st capital asset as per section exclusively in deductions Item 7 (a) of
acquired Share /Units per (Total Sale Value) (higher of 8 or 9) 01.02.2018, -Lower of 6 & 11 January,2018 55(2)(ac)- (4*10) connection with transfer (7+12) LTCG Schedule
/Unit
(Col (col 1a) (Col (Col 3) (Col (Col 5) (Col 6) (Col 7) (Col 8) (Col 9) (Col 10) (Col 11) (Col 12) (Col 13) (Col 14)
1) 2) 4)
Total 0 0 0 0 0 0 0 0
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1 Family Pension 0
2 Income from retirement benefit account maintained in a notified country u/s 89A 0
Country Amount
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Amount included in 1 and 2 above, which is chargeable at special rates in India as per
2f 0
DTAA (total of column (2) of table below)
f Sl. Amount Item No.1ai, 1b to Country Article Rate as per Treaty Whether TRC Section Rate as Applicable rate
No. of 2 in which name & of (enter NIL, if not obtained (Y of I.T. per I.T. [lower of (6) or
income included Code DTAA chargeable) /N) Act Act (10)]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Deductions under section 57 (other than those relating to income chargeable at special rates
3
under 2a, 2b & 2d)
Expenses / Deductions other than "aii" (in
ai 3ai 0
case other than family pension)
Interest expenditure u/s 57(i) (available
aii only if income offered in 1a) - entered 3aii
amount
Interest expenditure claimed 0
a Eligible amount of interest expenditure u 3a
0
(iia) /s 57(i) – Computed Amount (iia)
Deduction u/s. 57(iia) (in case of family
aiii 3aiii 0
pension only)
b Depreciation 3b 0
c Total 3c 0
4 Amounts not deductible u/s 58 4 0
5 Profits chargeable to tax u/s 59 5 0
5a Income claimed for relief from taxation u/s 89A 5a 0
Net Income from other sources chargeable at normal applicable rates (1(after reducing
6 income related to DTAA portion) – 3 + 4 + 5 - 5a) (If negative take the figure to 3i of 6 6,327
schedule CYLA )
Income from other sources (other than from owning race horses) (2 + 6) (enter 6 as nil,
7 7 6,327
if negative)
8 Income from the activity of owning and maintaining race horses
a Receipts 8a 0
Deductions under section 57 in
b 8b 0
relation to receipts at 8a only
c Amounts not deductible u/s 58 8c 0
d Profits chargeable to tax u/s 59 8d 0
e Balance (8a - 8b + 8c + 8d) (if negative take the figure to 6xi of Schedule CFL) 8e 0
9 Income under the head"Income from other sources" (7 + 8e) (take 8e as nil if negative) 9 6,327
10 Information about accrual/receipt of income from Other Sources
S.No. Other Source Income Upto 15/6 From 16/6 to 15/9 From 16/9 to 15/12 From 16/12 to 15/3 From 16/3 to 31/3
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
(ix)
in Sl.no.1a(i)
PTI Income)
115AC @ 10%
Income)
DTAA rates
Note: Please include the income of the specified persons (spouse, minor child etc.) referred to in Schedule SPI while
computing the income under this head.
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Schedule CYLA Details of Income after Set off of Current Year Losses
Sl. Head/ Source of Income Income of current year (Fill House property Net loss from Other sources chargeable at normal Current year’s
No. this column only if income is loss of the applicable rates (other than loss from race horses) Income
zero or positive) current year set of the current year set off remaining after
off set off
1 2 3 4=1-2-3
xiii Total loss set off (ii + iii + iv + v + vi + vii + viii + ix + x + xi + 2,00,000 0
xii)
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Schedule BFLA Details of Income after Set off of Brought Forward Losses of earlier years
Sl. Head/ Source of Income Income after set off, if any, of current year’s losses Brought forward Current year’s income
No. as per 4 of Schedule CYLA) loss set off remaining after set off
1 2 3
ii House property 0 0 0
xii Total of brought forward loss set off (2ii + 2iii + 2iv + 2v+ 2vi + 2vii +2viii+ 2ix + 2xi) 0
xiii Current year's income remaining after set off Total of (3i + 3ii + 3iii + 3iv + 3v+ 3vi + 3vii + 3viii+ 3ix + 3x + 3xi) 31,25,439
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1 2 3 4 5 6
i 2014-15 0 0 0
ii 2015-16 0 0 0
iii 2016-17 0 0 0
iv 2017-18 0 0 0
v 2018-19 0 0 0 0
vi 2019-20 0 0 0 0
vii 2020-21 0 0 0 0
viii 2021-22 0 0 0 0
ix Total of 0 0 0 0
earlier year
losses
x Adjustment 0 0 0 0
of above
losses in
Schedule
BFLA
xi 2022-23 0 0 0 0
(Current year
losses)
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Schedule 80G Details of donations entitled for deduction under section 80G
Donations entitled for 100% deduction without
A
qualifying limit
Eligible
PAN of Amount
Name and address of Donee Amount of donation
Donee of
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 50% deduction without
B
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 100% deduction subject to
C
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
Donations entitled for 50% deduction subject to
D
qualifying limit
Eligible
Name and address of PAN of
Amount of donation Amount of
Donee Donee
donation
Donation in Donation in Total
cash other mode Donation
Total 0 0 0 0
E Total donations (A + B + C + D) 0
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Schedule
Details of donations for scientific research or rural development
80GGA
Sl. Relevant clause under which deduction is Name and PAN of Amount of donation Eligible
No. claimed (drop down to be provided) address of Donee Amount of
Donee donation
Total donation 0 0 0 0
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Schedule AMT Computation of Alternate Minimum Tax payable under section 115JC
1 Total Income as per item 12 of PART-B-TI 1 29,57,295
2 Adjustment as per section 115JC(2)
Deduction claimed under any section included in Chapter VI-A
a 2a 0
under the heading "C.—Deductions in respect of certain incomes"
3 Adjusted Total Income under section 115JC(1) (1+2a) 3 29,57,295
4 Tax payable under section 115JC [18.5% of (3)] (if 3 is greater than Rs. 20 lakhs) 4 0
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x Current AY (enter 0 0
1-2, if 1>2 else
enter 0)
xi Total 0 0 0 0 0
5 Amount of tax credit under section 115JD utilised during the year [total of item No. 4 (C)] 5 0
6 Amount of AMT liability available for credit in subsequent assessment years [total of 4 (D)] 6 0
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Income of specified persons (spouse, minor child etc.) includable in income of the assessee as
Schedule SPI
per section 64
Sl Name of person PAN/ Aadhaar of person Relationship Amount Head of Income in which
No (optional) (Rs) included
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Income chargeable to tax at special rates (please see instructions No. 9 for rate of tax) Income
Schedule SI
chargeable to tax at special rates
Sl. No. Section Special rate Income Taxable Tax thereon
Income
after
adjusting
for min
chargeable
to tax
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Schedule EI Details of Exempt Income (Income not to be included in Total Income or not chargeable to tax)
1 Interest income 1 0
Gross Agricultural receipts (other than income to be excluded
i i 0
under rule 7A, 7B or 8 of I.T. Rules)
ii Expenditure incurred on agriculture ii 0
2 iii Unabsorbed agricultural loss of previous eight assessment years iii 0
iv Net Agricultural income for the year (i – ii – iii) (enter nil if loss) 2 0
In case the net agricultural income for the year exceeds Rs.5 lakh, please furnish the
v
following details (Fill up details separately for each agricultural land)
3 Other exempt income (including exempt income of minor child) 3 0
SL.No Other exempt income Amount
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Pass Through Income details from business trust or investment fund as per section 115UA,
Schedule PTI
115UB
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Schedule FSI Details of Income from outside India and tax relief (Available in case of resident)
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Details Summary of tax relief claimed for taxes paid outside India (available only in case of
Schedule TR
resident)
1 Summary of Tax relief claimed
Country Taxpayer Total proportionate taxes paid outside Total tax relief available (total of Tax Relief Claimed
Code Identification India (total of (c) of Schedule FSI in (f) of Schedule FSI in respect of under section (specify
Number respect of each country) each country) 90, 90A or 91)
Total 0 0
Total Tax relief available in respect of country where DTAA is applicable (section 90
2 2 0
/90A) (Part of total of 1(d))
Total Tax relief available in respect of country where DTAA is not applicable (section
3 3 0
91) (Part of total of 1(d))
Whether any tax paid outside India, on which tax relief was allowed in India, has been
4 refunded/credited by the foreign tax authority during the year? If yes, provide the 4
details below
Amount of tax Assessment year in which tax relief
a 0 b
refunded allowed in India
Note: Please refer to the instructions for filling out this schedule.
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Schedule FA Details of Foreign Assets and Income from any source outside India
A1 Details of Foreign Depository Accounts held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of financial Address of financial ZIP Account Status Account Peak balance during Closing Gross interest paid/credited to the account
No name code institution institution code number opening date the period balance during the period
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A2 Details of Foreign Custodial Accounts held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of Address of ZIP Account Status Account Peak balance Closing Gross interest paid/credited to the account during the period
No name code financial financial code number opening during the balance (drop down to be provided specifying nature of amount viz. interest/dividend
institution institution date period /proceeds from sale or redemption of financial assets/ other income)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
A3 Details of Foreign Equity and Debt Interest held (including any beneficial interest) in any entity at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name Address ZIP Nature Date of Initial value of Peak value of Closing Total gross amount paid/credited with Total gross proceeds from sale or
No name code of of entity code of acquiring the the investment during balance respect to the holding during the period redemption of investment during the
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
A4 Details of Foreign Cash Value Insurance Contract or Annuity Contract held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Country Name of financial institution in which Address of financial ZIP Date of The cash value or surrender value Total gross amount paid/credited with respect to the
No name code insurance contract held institution code contract of the contract contract during the period
B Details of Financial Interest in any Entity held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Nature of Name and Address of Nature of Date Total Investment (at cost) Income accrued from Nature of Income taxable and offered in this return
No and code Code entity the Entity Interest-Direct since held (in rupees) such Interest Income
Amount Schedule Item number of
/Beneficialowner
where offered schedule
/Beneficiary
(1) (2) 2a (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
C Details of Immovable Property held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Address of the Ownership-Direct/ Beneficial Date of Total Investment (at cost) Income derived from Nature of Income taxable and offered in this return
No and code Code Property owner/ Beneficiary acquisition (in rupees) the property Income
Amount Schedule Item number of
(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
D Details of any other Capital Asset held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021
Sl Country Name ZIP Nature of Ownership-Direct/ Beneficial Date of Total Investment (at cost) Income derived from Nature of Income taxable and offered in this return
No and code Code Asset owner/ Beneficiary acquisition (in rupees) the asset Income
Amount Schedule Item number of
(1) (2) 2b (3) (4) (5) (6) (7) (8) (9) (10) (11)
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
E Details of account(s) in which you have signing authority held (including any beneficial interest) at any time during the calendar year ending as on 31st December, 2021 and which has not been included in A to D above.
Sl Name of the Institution Address of Country Zip Name of Account Peak Balance/ Investment during the year Whether income If (7) is yes, If (7) is yes, Income offered in
No in which the account is the Name and Code the account Number (in rupees) Peak Balance/ Investment accrued is taxable in Income accrued in this return
held Institution Code holder during the year your hands? the account
Amount Schedule Item
where number
offered of
schedule
(1) (2) (3) (3a) (3b) (4) (5) (6) (7) (8) (9) (10) (11)
F Details of trusts, created under the laws of a country outside India, in which you are a trustee, beneficiary or settlor
Sl Country ZIP Name and Name and Name and Name and address Date since Whether income derived is If (8) is yes, Income If (8) is yes, Income offered in this
No Name and CODE address of the address of address of of Beneficiaries position taxable in your hands? derived from the trust return
where number of
offered schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
G Details of any other income derived from any source outside India which is not included in,- (i) items A to F above and, (ii) income under the head business or profession
Sl Country Name and ZIP Name and address of the person from whom Income Nature of Whether taxable in your If (6) is yes, Income offered in this return
offered schedule
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9)
Note: Please refer to instructions for filling out this schedule. In case of an individual, not being an Indian citizen, who is in India on a business, employment or student visa, an asset acquired during any previous year in which he was non-resident
is not mandatory to be reported in this schedule if no income is derived from that asset during the current previous year.
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Schedule 5A Information regarding apportionment of income between spouses governed by Portuguese Civil Code
Name of the
spouse
PAN/ Aadhaar
of the spouse
Amount of TDS
Heads of Receipts received Amount apportioned in TDS apportioned in
deducted on income at
Income under the head the hands of the spouse the hands of spouse
(ii)
(i) (ii) (iii) (iv) (v)
House
1 0 0 0 0
Property
2 Capital gains 0 0 0 0
Other
3 0 0 0 0
sources
4 Total 0 0 0 0
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Assets and Liabilities at the end of the year (applicable in a case where total income exceeds Rs.50
Schedule AL
lakh)
A Details of immovable assets
Sl. No. Description Address Pin code Amount (cost) in Rs.
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Information related to Tax deferred - relatable to income on perquisites referred in section 17(2)
Schedule ESOP
(vi) received from employer, being an eligible start-up referred to insection 80-IAC
Sl. Assessment Amount of Tax deferred Has any of the following events occurred during the previous year relevant to current assessment year Amount of Balance
years Col
(3- 7)
1 2021-22 0 0 0 0
2 2022-23 0
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
10 included in 9 10 51,835
11 Deductions under Chapter VI-A [v of Schedule VIA and limited to (9-10)] 11 1,68,144
12 Total income (9 - 11) 12 29,57,295
Income which is included in 12 and chargeable to tax at special rates (total of
13 13 51,835
column (i) of schedule SI)
14 Net agricultural income/ any other income for rate purpose ( 3 of Schedule EI) 14 0
Aggregate income (12-13+14) [applicable if (12-13) exceeds maximum
15 15 29,05,460
amount not chargeable to tax]
16 Losses of current year to be carried forward (total of row xi of Schedule CFL) 16 0
17 Deemed income under section 115JC (3 of Schedule AMT) 17 29,57,295
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
5 Surcharge 0
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
Credit u/s 115JD of tax paid in earlier years (applicable only if 7 is higher than 1d) (row 5 of
9 9 0
Schedule AMTC)
11 Tax relief
a Section 89(Please ensure to submit Form 10E to claim this relief) 11a 10,234
17 Refund (If 15e is greater than 14) (Refund, if any, will be directly credited into the bank account) 17 0
Do you have a bank account in India (Non- Residents claiming refund with no bank account in India may
18 Yes
select No)
Sl. IFS Code of the Bank in case of Name of the Indicate the account in which you prefer to get
Account Number
No Bank Accounts held in India Bank your refund credited, if any (tick accounts
UNION
1 UBIN0906794 BANK OF 520141001048186 ✔
INDIA
CORPORATI
2 CORP0000679 301120001
ON BANK
CORPORATI
3 CORP0000679 067900301120001
ON BANK
Note:
1. Minimum one account should be selected for refund credit.
2. In case of Refund, multiple accounts are selected for refund credit, then refund will be credited to one of the account decided by CPC
after processing the return
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
ii b) 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:
Sl. No. SWIFT Code Name of the Bank Country of Location IBAN
20 TAX PAYMENTS
Sl No BSR Code Date of Deposit (DD/MMM/YYYY) Serial Number of Challan Amount (Rs)
Note: Enter the totals of Advance tax and Self-Assessment tax in Sl No. 15a & 15d of Part B-TTI
B Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Sl Tax Deduction Account Number (TAN) of Name of the Income chargeable under Total tax deducted
No the Employer Employer Salaries
C Details of Tax Deducted at Source (TDS) on Income [As per Form 16 A issued by Deductor(s)]
Sl TDS credit relating PAN/ Aadhaar TAN of the Unclaimed TDS TDS of the current Financial Year TDS credit being claimed this Year Corresponding TDS
No to self /other of Other Deductor/ brought forward (TDS deducted during FY 2021- (only if corresponding income is Receipt offered credit
person [spouse as Person (if PAN/ (b/f) 22) being offered for tax this year,not being
per section 5A TDS credit Aadhaar of applicable if TDS deducted u/s 194N) carried
deducted hands per section 5A or hands or any other person as per Income
applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Aadhaar
D Details of Tax Deducted at Source (TDS) on Income [As per Form 16B/16C furnished by Deductor(s)]
Sl TDS credit relating PAN/ Aadhaar PAN Unclaimed TDS TDS of the current Financial Year TDS credit being claimed this Year Corresponding TDS
No to self /other person of Other /Aadhaar brought forward (TDS deducted during FY 2021-22) (only if corresponding income is Receipt offered credit
[spouse as per Person (if TDS No. of (b/f) being offered for tax this year) being
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Acknowledgement Number:802989920141122 Date of filing : 14-Nov-2022
applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Aadhaar
E Details of Tax Collected at Source (TCS) [As per Form 27D issued by the Collector(s)]
Sl Tax Deduction and Collection Name of Tax Amount out of Amount out of (4) being claimed in the
No Account Number of the Collector the Collected (4) being hands of spouse, if section 5A is
Collector claimed applicable
VERIFICATION
I, SARMILA LAMA son/ daughter of MANI KUMAR LAMA solemnly declare that to the best of my knowledge and belief,
the information given in the return and schedules thereto is correct and complete and is in accordance with the provisions of
the Income-tax Act, 1961.
I further declare that I am making return in my capacity as Self and I am also competent to make this return and verify it. I
am holding permanent account number (if allotted) ABGPL5183J (Please see instruction) I further declare that the critical
assumptions specified in the agreement have been satisfied and all the terms and conditions of the agreement have been
complied with. (Applicable in a case where return is furnished under section 92CD)
Date: 14-Nov-2022 Sign Here:
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 0
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