Acknowledgement Number : 445389430261221 Date of Filing : 26-Dec-2021

INDIAN INCOME TAX RETURN

FORM

[For Individuals and HUFs not having income from profits and gains of business or profession]
ITR2 Assessment Year
(Please see Rule 12 of the Income-tax Rules, 1962)
(Please refer instructions) 2021-22
Part A-GEN GENERAL
First Name Middle Name Last Name PAN
ANJALI HASANRAO RAUT ASGPR9862B
Flat/Door/Block No. Name of Premises/Building/Village
Individual
A 802 Bluebells Building Gulmohar Renais Baif Road Wagholi
sance HUF

Road/Street/Post Office
Date of Birth/ Formation (DD/MMM/YYYY) 19-Jun-1984
Wagholi
Area/locality Aadhaar Number (12 digit) / Aadhaar Enrolment Id (28 digit) (if eligible for Aadhaar)
PUNE 6xxx xxxx 6202
State
Town/City/District 19 - Maharashtra (A13) Pin code/Zip code
Vagholi S.O Country 412207
91 - India
Mobile No. 1 Mobile No. 2
Residential/Office Phone Number with STD/ISD code
919767214421 918149947897
Email Address-1(self) Email Address-2
pawaryogesh2010@gmail.com anju_raut123@rediffmail.com

139(1)-On or before due date, 139(4)-After due date,

Filed u/s (Tick)[Please see instruction ] 139(5)-Revised Return, 92CD-Modified retur, 119(2)(b)-after
(a)
condonation of delay, 139(8A) - Updated return

Or Filed in response to notice u/s 139(9), 142(1), 148, 153C

(a2) Are you opting for new tax regime u/s 115BAC? Yes No

(b) Are you filing return of income under Seventh proviso to Section 139(1) -(Tick) Yes No
If yes, please furnish following information
Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more current account during the
0
(bi) previous year? (Yes/No)

Yes No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for travel to a foreign country for
0
(bii) yourself or for any other person? (Yes/No)

Yes No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on consumption of electricity during
0
(biii) the previous year? (Yes/No)

Yes No
(c) If revised/defective/modified, then enter Receipt No. and Date of filing original return (DD/MMM/YYYY)
If filed, in response to a notice u/s 139(9)/142(1)/148/153C or order u/s 119(2)(b) enter unique
(Unique Number)
(d) number/ Document Identification Number (DIN) and date of such notice/order, or if filed u/s 92CD,
enter date of advance pricing agreement

.. .. You were in India for 182 days or more during the previous
year [section 6(1)(a)]
A. Resident
.. 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]
Residential Status in
India (for individuals) .. .. You have been a non-resident in India in 9 out of 10 preceding
(e) years [section 6(6)(a)]
(Tick applicable
option) .. You have been in India for 729 days or less during the 7
..

B. Resident but not Ordinarily Resident preceding years [section 6(6)(a)

.. You are a citizen of India or person of Indian origin, being

..

outside India, who comes on a visit to India, and has total income
other than the income from foreign sources exceeding Rs. 15 lakh
and been in India for a period or periods amounting in all to 120

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 days or more but less than 182 days during the previous year
[section 6(6)(c)]

.. You are a citizen of India, who is not resident under clause (1)
..

of section 6 and who is deemed to be resident in India under clause

(1A) of section 6, 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)]

You were a non-resident during the previous year.Whether you

were a resident of any jurisdiction (Yes/No) If yes,
(i) Please specify the jurisdiction(s) of residence during the previous
year -

S.No. Jurisdiction(s) of Taxpayer Identification

C. Non-resident residence Number(s)

(ii) In case you are a Citizen of India or a Person of Indian Origin

(POI), please specify -
Total period of stay in India Total period of stay in India
during the previous year (in days) during the 4 preceding years (in
days)

Residential Status in India (for HUF) (Tick applicable option) D. Resident Resident but not Ordinarily Resident Non-
resident

(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 this return is being filed by a Representative Assesse? Yes No

If yes, please furnish following information -
(1) Name of the representative
(h)
(2) Capacity of representative(drop down to be provided)
(3) Address of the Representative
(4) Permanent Account Number (PAN)/ Aadhaar of the representative

(i) Whether you were Director in a company at any time during the previous year? (Tick) Yes No
If yes, please furnish following information-
Name of company Type of company PAN Whether its shares are Director Identification
listed or unlisted Number (DIN)
(j)
Whether you have held unlisted equity shares at any time during the previous year? Yes No
If yes, please furnish following information in respect of equity shares
Name of Type of PAN Shares transferred
Opening balance Shares acquired during the year Closing balance
company company during the year
No.of Cost of No.of Date of Face value Issue price per Purchase price No.of Sale No.of Cost of
shares acquisition shares subscription/ per share share (incase per share (in shares consideration shares acquisition
purchase of fresh issue) case of purchase
from existing
shareholder)
1a 1b 2 3 4 5 6 7 8 9 10 11 12 13

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 SCHEDULES TO THE RETURN FORM (FILL AS APPLICABLE)

Schedule S Details of Income from Salary

Name of Employer Nature of employer (Tick) TAN of Employer(mandatory if tax is deducted)
UNION BANK OF INDIA Public Sector Unit MUMU07901F
Address of Employer
Town/City State Pincode/Zipcode
ADD_LINE_1 UNION BANK BHAVAN VIDHA
MUMBAI 19 - Maharashtra 400021
N BHAVAN MARG NARIMAN POINT
1 Gross Salary(1a + 1b + 1c) 1 14,02,831

a Salary as per section 17(1) (drop down to be provided) 1a 14,02,831

Basic Salary
I 14,02,831

b Value of perquisites as per section 17(2) (drop down to be provided) 1b 0

c Profit in lieu of salary as per section 17(3) (drop down to be provided) 1c 0

2 Total gross salary (from all employers) 2 14,02,831

3 Less allowances to the extent exempt u/s 10 (drop down to be provided in efiling utility) (please 3 0
refer instructions) (Note: Ensure that it is included in Total Gross salary in (2) above )
SI. No. Nature of Exempt Allowance Amount
4 Net Salary (2 – 3) 4 14,02,831

5 Deduction u/s 16 (5a + 5b + 5c) 5 52,500

A Standard deduction u/s 16(ia) 5a 50,000

B Entertainment allowance u/s 16(ii) 5b 0

C Professional tax u/s 16(iii) 5c 2,500

6 Income chargeable under the Head ‘Salaries’ (4-5) 6 13,50,331

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Schedule HP Details of Income From House Property (Please Refer Instructions)
Address of property 1
1
State
FLAT NO S2 USHA PARADI Town/ City PIN Code/Zip Code
S E BUILDING VRUNDAVAN AKOLA 19 - Maharashtra 444001
NAGAR

Is the property co-owned? Yes No (if "YES" please enter following details)
Your percentage of share in the Property(%) 100
SI.No Name of Other Co- PAN/Aadhaar of Other Co-owner (s) Percentage Share of other Co-owner(s) in Property
owner(s)
SI.No Name(s) of Tenant (if let PAN/ Aadhaar No. of Tenant(s) (Please see note) PAN/TAN of Tenant(s) (if
[Tick the applicable
out) TDS credit is claimed)
option]

Let out

Self-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 (1b + 1c) 1d 0

e Annual value (1a – 1d) (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 1e) 1f 0

g 30% of 1f 1g 0

h Interest payable on borrowed capital 1h 68,101

i Total (1g + 1h) 1i 68,101

j Arrears/Unrealized Rent received during the year Less 30% 1j 0

k Income from house property 1 (1f - 1i + 1j) 1k -68,101

State
2 Address of property 2 Town/ City PIN Code/Zip Code
HANUMAN NAGAR AKOLA AKOLA 19 - Maharashtra 444001

Is the property co-owned? Yes No (if "YES" please enter following details)
Your percentage of share in the Property(%) 100
SI.No Name of Other Co- PAN/Aadhaar of Other Co-owner (s) Percentage Share of other Co-owner(s) in Property
owner(s)
SI.No Name(s) of Tenant (if let PAN/ Aadhaar No. of Tenant(s) (Please see note) PAN/TAN of Tenant(s) (if
[Tick the applicable
out) TDS credit is claimed)
option]

Let out

Self-occupied

Deemed let out

a Gross rent received or receivable or letable value 2a 4,000

b The amount of rent which cannot be realized 2b 0

c Tax paid to local authorities 2c 1,000

d Total (2b + 2c) 2d 1,000

e Annual value (2a – 2d) (nil, if self -occupied etc. as per section 23(2)of the Act) 2e 3,000

f Annual value of the property owned (own percentage share x 2e) 2f 3,000

g 30% of 2f 2g 900

h Interest payable on borrowed capital 2h 1,30,892

i Total (2g + 2h) 2i 1,31,792

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 j Arrears/Unrealized Rent received during the year Less 30% 2j 0

k Income from house property 2 (2f - 2i + 2j) 2k -1,28,792

3 Pass through income/ loss if any * 3 0

4 Income under the head "Income from house property"(1k + 2k + 3) 4 -1,96,893

(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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Schedule CG Capital Gains
A Short-term capital gain (STCG) (Sub-items 3 and 4 are not applicable for residents)
3 For NON-RESIDENT, not being an FII- from sale of shares or debentures of an Indian company (to be
computed with foreign exchange adjustment under first proviso to section 48)
a STCG on transactions on which securities transaction tax (STT) is paid A3a 0

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
a i In case securities sold include shares of a company other than quoted
shares, enter the following details
a Full value of consideration received/receivable in ia 0
respect of unquoted shares
b Fair market value of unquoted shares determined in ib 0
the prescribed manner
c Full value of consideration in respect of unquoted ic 0
shares adopted as per section 50CA for the purpose
of Capital Gains (higher of a or b)
ii Full value of consideration in respect of securities other than aii 0
unquoted shares
iii Total (ic + ii) aiii 0

b Deductions under section 48

i Cost of acquisition without indexation bi 0

ii Cost of Improvement without indexation bii 0

iii Expenditure wholly and exclusively in connection with transfer biii 0

iv Total (i + ii + iii) biv 0

c Balance (4aiii - biv) 4c 0

d Loss to be disallowed u/s 94(7) or 94(8)- for example if security 4d 0

bought/acquired within 3 months prior to record date and dividend/
income/bonus units are received, then loss arising out of sale of 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

5 From sale of assets other than at A1 or A2 or A3 or A4 above

a i In case assets sold include shares of a company other than quoted shares, enter the following
details
a Full value of consideration received/receivable in ia 0
respect of unquoted shares
b Fair market value of unquoted shares determined in ib 0
the prescribed manner
Full value of consideration in respect of unquoted ic
c 0
shares adopted as per section 50CA for the purpose
of Capital Gains (higher of a or b)
ii Full value of consideration in respect of securities other than aii 0
unquoted shares
iii Total (ic + ii) aiii 0

b Deductions under section 48

i Cost of acquisition without indexation bi 0

ii Cost of Improvement without indexation bii 0

iii Expenditure wholly and exclusively in connection with transfer biii 0

iv Total (i + ii + iii) biv 0

c Balance (5aiii - biv) 5c 0

d In case of asset (security/unit) loss to be disallowed u/s 94(7) or 5d 0

94(8)- for example if asset bought/acquired within 3 months prior to
record date and dividend/income/bonus units are received, then loss

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 arising out of sale of such asset to be ignored (Enter positive value
only)
e STCG on assets other than at A1 or A2 or A3 or A4 above (5c + 5d) A5e 0

6 Amount Deemed to be short-term capital gains

a 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?

Yes No Not Applicable. If yes, then provide the details below

Sl. Previous year in which Section under which New asset acquired/constructed Amount not used for
No. asset transferred deduction claimed in that Year in which Amount utilised out of new asset or remained
year asset acquired/ Capital Gains account unutilized in Capital gains
constructed account (X)

b Amount deemed to be short term capital gains, other than at 'a'

0

Total amount deemed to be short term capital gains (aXi + b) A6 0

7 Pass Through Income/ Loss in the nature of Short Term Capital Gain, (Fill up schedule PTI) (A7a + A7b + A7 0
A7c)
a Pass Through Income/ Loss in the nature of Short Term Capital Gain, A7a
0
chargeable @ 15%
b Pass Through Income/ Loss in the nature of Short Term Capital Gain, A7b
0
chargeable @ 30%
c Pass Through Income/ Loss in the nature of Short Term Capital Gain, A7c
0
chargeable at applicable rates
Amount of STCG included in A1 ? A7 but not chargeable to tax in India as per DTAA
8
Sl. Amount of Item no. A1 Country/Region Article of Rate as Whether Section Rate as Applicable rate
No. income to A7 above name & code DTAA per Treaty TRC of I.T. Act per I.T. [lower of (6) or
in which (enter obtained (Y/ Act (9)]
included NIL, if not N)
chargeable)
(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) A9 0

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)
a Full value of consideration 2a 0

b Deductions under section 48

i Cost of acquisition without indexation bi 0

ii Cost of improvement without indexation bii 0

iii Expenditure wholly and exclusively in connection with transfer biii 0

iv Total (bi + bii +biii) biv 0

c Balance (2a - biv) 2c 0

d Deduction under sections 54F (Specify details in item D below) 2d 0

e LTCG on bonds or debenture (2c - 2d) B2e 0

4 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 section 112A
a LTCG u/s 112A (column 14 of Schedule 112A) 4a 0

b Deduction under sections 54F (Specify details in item D below) 4b 0

c Long-term Capital Gains on sale of capital assets at B4 above (4a - 4b) B4c 0

5 For NON-RESIDENTS- from sale of shares or debenture of Indian company (to be computed with foreign
exchange adjustment under first proviso to section 48)
a LTCG computed without indexation benefit 5a 0

b Deduction under sections 54F (Specify details in item D below) 5b 0

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 c LTCG on share or debenture (5a – 5b) B5c 0

7 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 section 112A
a LTCG u/s 112A (column 14 of Schedule 115AD(1)(iii)) 7a 0

b Deduction under sections 54F (Specify details in item D below) 7b 0

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)
a LTCG on sale of specified asset (computed without indexation) 8a 0

b Less deduction under section 115F (Specify details in item D below) 8b 0

c Balance LTCG on sale of specified asset (8a – 8b) B8c 0

d LTCG on sale of asset, other than specified asset (computed without 8d 0

indexation)
e Less deduction under section 115F (Specify details in item D below) 8e 0

f Balance LTCG on sale of asset, other than specified asset (8d – 8e) B8f 0

9 From sale of assets where B1 to B8 above are not applicable

a i In case securities sold include shares of a company other than quoted
shares, enter the following details
a Full value of consideration received/receivable in respect ia 0
of unquoted shares
b Fair market value of unquoted shares determined in the ib 0
prescribed manner
c Full value of consideration in respect of unquoted shares ic 0
adopted as per section 50CA for the purpose of Capital
Gains (higher of a or b)
ii Full value of consideration in respect of assets other than aii 0
unquoted shares
iii Total (ic + ii) aiii 0

b Deductions under section 48

i Cost of acquisition with indexation bi 0

ii Cost of improvement with indexation bii 0

iii Expenditure wholly and exclusively in connection with transfer biii 0

iv Total (bi + bii +biii) biv 0

c Balance (9aiii - biv) 9c 0

d Deduction under sections 54F (Specify details in item D below) 9d 0

e Long-term Capital Gains on assets at B9 above (9c-9d) 0

10 Amount deemed to be long-term capital gains

a 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?

Yes No Not Applicable If yes, then provide the details below

Sl.No.Previous year in which Section under which New asset acquired/constructed Amount not used for
asset transferred deduction claimed in that Year in which Amount utilised out of new asset or remained
year asset acquired/ Capital Gains account unutilized in Capital gains
constructed account (X)

b Amount deemed to be short term capital gains, other than at 'a'

0

Total amount deemed to be long term capital gains (aXi + aXii + b)

0

11 Pass Through Income/ Loss in the nature of Long Term Capital Gain,(Fill up schedule PTI) (B11a1+B11a2 B11
0
+ B11b)
a1 Pass Through Income/ Loss in the nature of Long Term Capital Gain, B11a1
0
chargeable @ 10% u/s 112A
a2 Pass Through Income/ Loss in the nature of Long Term Capital Gain, B11a2
0
chargeable @ 10% under sections other than u/s 112A

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 b Pass Through Income/ Loss in the nature of Long Term Capital Gain, B11b
0
chargeable @ 20%
12 Amount of LTCG included in B1- B11 but not chargeable to tax or chargeable at special rates in India as per
DTAA
SI.No. Amount of Item No. B1 Country name & Code Article of Rate as Whether Section of Rate as per I.T. Applicable
income to B11 above DTAA per Treaty TRC I.T. Act Act rate [lower of
in which (enter obtained (6) or (9)]
included NIL, if not (Y/N)
chargeable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
a Total amount of LTCG not chargeable to tax as per DTAA B12a 0

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 B13 0
+B10 +B11-B12a)
C Income chargeable under the head “CAPITAL GAINS” (A9 + B13) (take B13 as nil, if loss)
C 0

D Information about deduction claimed against Capital Gains

1 In case of deduction u/s 54/54B/54EC/54F/54GB/115F give following details

a Deduction claimed u/s 54

Date of purchase/ Amount deposited in Capital
Date of transfer
construction of Cost of new asset Gains Accounts Scheme Amount of deduction claimed
of original asset
new asset before due date
b Deduction claimed u/s 54B
Date of Amount deposited in Capital
Date of transfer Cost of new
purchase of new Gains Accounts Scheme Amount of deduction claimed
of original asset agricultural land
agricultural land before due date
c Deduction claimed u/s 54EC
Amount invested in specified/
Date of transfer of
notified bonds (not exceeding fifty Date of investment Amount of deduction claimed
original asset
lakh rupees)
d Deduction claimed u/s 54F
Date of purchase/
Amount deposited in Capital
Date of transfer construction of Cost of new residential
Amount of deduction claimed Gains Accounts Scheme
of original asset new residential house
before due date
house
e Deduction claimed u/s 54GB
Amount
Date of Amount utilised
Cost of new plant Date of deposited in
transfer PAN of the for subscription Date of Amount of
and machinery purchase Capital Gains
of original eligible of equity shares subscription deduction
purchased by the of plant and Accounts
residential company of eligible of shares claimed
eligible company machinery Scheme before
property company
due date
f Deduction claimed u/s 115F (for Non-Resident Indians)
Date of transfer
Amount invested in new specified
of original foreign Date of investment Amount of deduction claimed
asset or savings certificate
exchange asset

g Total deduction claimed (1a + 1b + 1c + 1d + 1e + 1f) 1g 0

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
current year (Fill 15% 30% Applicable Covered By 10% 20% Covered By gains remaining after set
this column only if (2) (3) Rate DTAA (6) (7) DTAA off (9=1-2-3-4-6-7-8)
computed figure is (4) (5) (8)
positive)
(1)
i Capital Loss to be set 0 0 0 0 0 0 0
off (Fill this row only
if computed figure is
negative)
ii Short term 15% 0 0 0 0 0
iii capital gain 30% 0 0 0 0 0
iv applicable 0 0 0 0 0
rate
v Covered By 0 0 0 0
DTAA
vi Long term 10% 0 0 0 0 0 0 0 0
vii capital gain 20% 0 0 0 0 0 0 0 0
viii Covered By 0 0 0 0 0 0 0 0
DTAA
ix Total loss set off (ii + iii + iv + v + vi + vii + viii) 0 0 0 0 0 0 0
x Loss remaining after set off (i – ix) 0 0 0 0 0 0 0

The figures of STCG in this table (A1e* etc.) are the amounts of STCG computed in respective column (A1-A6) as reduced by the amount of
STCG not chargeable to tax or chargeable at special rates as per DTAA, which is included there in, if any.

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 The figures of LTCG in this table (B1e* etc.) are the amounts of LTCG computed in respective column (B1-B10) as reduced by the amount of
LTCG not chargeable to tax or chargeable at special rates as per DTAA, which is included there in, if any.
F Information about accrual/receipt of capital gain
Type of Capital gain / Date Upto 15/6 16/6 to 16/9 to 16/12 to 16/3 to 31/3
(i) 15/9 15/12 15/3 (v)
(ii) (iii) (iv)
1 Short-term capital gains taxable at the rate of 15%
0 0 0 0 0
Enter value from item 3iii of schedule BFLA, if any.
2 Short-term capital gains taxable at the rate of 30%
0 0 0 0 0
Enter value from item 3iv of schedule BFLA, if any.
3 Short-term capital gains taxable at applicable rates
0 0 0 0 0
Enter value from item 3v of schedule BFLA, if any.
4 Short-term capital gains taxable at DTAA rates
0 0 0 0 0
Enter value from item 3vi of schedule BFLA, if any.
5 Long- term capital gains taxable at the rate of 10%
0 0 0 0 0
Enter value from item 3vi of schedule BFLA, if any.
6 Long- term capital gains taxable at the rate of 20%
0 0 0 0 0
Enter value from item 3vii of schedule BFLA, if any.
7 Long term capital gains taxable at the rate DTAA rates
0 0 0 0 0
Enter value from item 3ix 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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 Schedule-112A 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 section 112A
SI. Share/ Unit Acquired ISIN Code Name of the No. of Sale- Full Value of Cost of Cost of If the long Fair Market Total Fair Expenditure Total Balance (6–
No Share/Unit Shares/ price per Considera acquisition acquisition term capital Value per Market wholly and deductions 13) Item 4(a)
Units Share/Unit tion (Total without asset was share/unit Value of exclusively (7+12) of LTCG
Sale Value) indexation acquired as on 31st capital in Schedule
(4*5) Higher before January,2018 asset as connectiom of ITR2
of 8 & 9 01.02.2018, per section with transfer
-Lower 55(2)(ac)-
of 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)

Total 0 0 0 0 0 0 0 0

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 115AD(1)(b)(iii) proviso 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 section 112A
SI. Share/ Unit Acquired ISIN Code Name of the No. of Sale- Full Value of Cost of Cost of If the long Fair Market Total Fair Expenditure Total Balance (6–
No Share/Unit Shares/ price per Considera acquisition acquisition term capital Value per Market wholly and deductions 13) Item 7(a)
Units Share/Unit tion (Total without asset was share/unit Value of exclusively (7+12) of LTCG
Sale Value) indexation acquired as on 31st capital in Schedule
(4*5) Higher before January,2018 asset as connectiom of ITR2
of 8 & 9 01.02.2018, per section with transfer
-Lower 55(2)(ac)-
of 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)

Total 0 0 0 0 0 0 0 0

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 Schedule OS Income from Other Sources
1 Gross income chargeable to tax at normal applicable rates (1a+ 1b+ 1c+ 1d + 1e) 1 0

a Dividends Gross (ai+aii) 1a 0

ai Dividend income other than (ii) 1ai 0

aii Dividend income u/s 2(22)(e) 1aii 0

1b
b Interest, Gross (bi + bii + biii + biv+ bv) 0

i From Savings Bank bi 0

ii From Deposits (Bank/ Post Office/ Co-) bii 0

iii From Income-tax Refund biii 0

iv In the nature of Pass through income/ loss biv 0

v Others bv 0

c Rental income from machinery, plants, buildings, etc., Gross 1c 0

Income of the nature referred to in section 56(2)(x) which is chargeable to tax (di + dii + 0
d 1d
diii + div + dv)
Aggregate value of sum of money received
i di 0
without consideration
In case immovable property is received without
ii dii 0
consideration stamp duty value of property
In case immovable property is received for 0
iii inadequate consideration stamp duty value of diii
property in excess of such consideration
In case any other property is received without
iv div 0
consideration, fair market value of property
In case any other property is received for 0
v inadequate consideration, fair market value of dv
property in excess of such consideration
e Any other income (please specify nature) 1e 0
SI.No. Nature Amount
2
2 Income chargeable at special rates (2a + 2b + 2c + 2d + 2e + 2f elements related to Sl. No. 1) 0

a Winnings from lotteries, crossword puzzles etc. chargeable u/s 115BB 2a 0

b Income chargeable u/s 115BBE (bi + bii + biii + biv+ bv + bvi) 2b 0

i Cash credits u/s 68 bi 0

ii Unexplained investments u/s 69 bii 0

iii Unexplained money etc. u/s 69A biii 0

iv Undisclosed investments etc. u/s 69B biv 0

v Unexplained expenditurte etc. u/s 69C bv 0

vi Amount borrowed or repaid on hundi u/s 69D bvi 0

c Accumulated balance of recognised provident fund taxable u/s 111 2c 0

S.No. Assessment Year Income Benefit Tax Benefit

(i) (ii) (iii) (iv)
d Any other income chargeable at special rate (total of di to dxviii) 2d 0
SI.No. Nature Amount
Pass through income in the nature of income from other sources chargeable at special rates (drop down to be
e 2e 0
provided)
SI.No. Nature Amount
Amount included in 1 and 2 above, which is chargeable at special rates in India as per DTAA(total of column (2) of
f 2f 0
table below)

13 of 36
 SI. Amount Item No.1 & Country name Article of Rate as per Whether TRC Section of I.T. Rate as per Applicable rate
No. of income 2 in which & Code DTAA Treaty (enter obtained (Y/N) Act I.T. Act [lower of (6) or
included NIL, if not (10)]
chargeable)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
3 Deductions under section 57 (other than those relating to income chargeable at special rates under 2a, 2b & 2d)
Expenses / Deductions (in case other than family
ai 3ai 0
pension) Expenses / Deductions
Interest expenditure u/s 57(1) (available only if income
aii 3aii
offered in 1a)

Interest expenditure claimed 0

Eligible amount of interest expenditure 0

aiii Deduction u/s 57(iia) (in case of family pension only) 3aiii 0

Depreciation (available only if income offered in 1c of

b 3b 0
schedule OS)

c Total 3c 0

4 Amounts not deductible u/s 58 4 0

5 Profits chargeable to tax u/s 59 5 0

Net Income from other sources chargeable at normal applicable rates (1(after reducing income
6 6 0
related to DTAA portion) - 3 + 4 + 5) (If negative take the figure to 3i of schedule CYLA)

7 Income from other sources (other than from owning race horses)(2+6) (enter 6 as nil, if negative) 7 0

8 Income from the activity of owning and maintaining race horses

a Receipts 8a 0
Deductions under section 57 in relation to receipts at 8a 0
b 8b
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 6xii of Schedule CFL) 8e 0

9 Income under the head"Income from other sources" (7 + 8e) (take 8e as nil if negative) 9 0

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
(i) (ii) (iii) (iv) (v)
Dividend Income u/s
1 0 0 0 0 0
115BBDA
Income by way
of winnings from
lotteries, crossword
2 puzzles, races, games, 0 0 0 0 0
gambling, betting etc.
referred to in section
2(24)(ix)
Dividend Income
3 chargeable under 0 0 0 0 0
DTAArates
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.

14 of 36
Schedule CYLA Details of Income after Set off of current years Losses
Sl.No. Head/ Source of Income Income of current year House property loss of Net loss from Other Current year's Income
(Fill this column only the current year set off sources chargeable remaining after set off
if income is zero or at normal applicable
positive) rates (other than loss
from race horses) of the
current year set off

1 2 3 4=1-2-3

Loss to be set off (Fill this row only

i 1,96,893 0
if computed figure is negative)
ii Salaries 13,50,331 1,96,893 0 11,53,438

iii House property 0 0 0 0

iv Short-term capital gain taxable @ 0 0 0 0

15%
v Short-term capital gain taxable @ 0 0 0 0
30%
vi Short-term capital gain taxable at 0 0 0 0
applicable rates
vii Short-term capital gain taxable at 0 0 0 0
special rates in India as per DTAA
viii Long term capital gain taxable @ 0 0 0 0
10%
ix Long term capital gain taxable @ 0 0 0 0
20%
x Long-term capital gain taxable at 0 0 0 0
special rates in India as per DTAA
xi Net income from Other sources 0 0 0 0
chargeable at normal applicable
rates
xii Profit from the activity of owning 0 0 0 0
and maintaining race horses
xiii Total loss set off (ii + iii + iv + v + vi + vii + viii + ix + x + xi + xii)
1,96,893 0

xiv Loss remaining after set-off (i - xiii)

0 0

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Schedule BFLA Details of Income after Set off of Brought Forward Losses of earlier years
SI. Head/ Source of Income Income after set off, Brought forward Current year's income
No. if any, of current loss set off remaining after set off
year's losses as per
4 of Schedule CYLA)
1 2 3

i Salaries 11,53,438 11,53,438

ii House property 0 0 0

iii Short-term capital gain taxable @ 15% 0 0 0

iv Short-term capital gain taxable @ 30% 0 0 0

v Short-term capital gain taxable at applicable rates 0 0 0

vi Short-term capital gain taxable at special rates in India as per DTAA 0 0 0

vii Long-term capital gain taxable @ 10% 0 0 0

viii Long term capital gain taxable @ 20% 0 0 0

ix Long term capital gains taxable at special rates in India as per DTAA 0 0 0

x Net income from other sources chargeable at normal applicable rates 0 0

xi Profit from owning and maintaining race horses 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) 11,53,438

16 of 36
Schedule CFL Details of Losses to be carried forward to future years
Assessment Year Date of Filing House property loss Short-term capital loss Long-term Capital loss Loss from owning
(DD/MMM/ and maintai- ning race
YYYY) horses

1 2 3 4 5 6

i 2013-14 0 0 0

ii 2014-15 0 0 0

iii 2015-16 0 0 0

iv 2016-17 0 0 0

v 2017-18 0 0 0 0

vi 2018-19 0 0 0 0

vii 2019-20 0 0 0 0

viii 2020-21 0 0 0 0

Total of earlier year

ix 0 0 0 0
losses
Adjustment of above
x 0 0 0 0
losses in Schedule
BFLA
2021-22 (Current
xi 0 0 0 0
year losses)
Total loss Carried
xii 0 0 0 0
Forward to future
years

17 of 36
 Schedule VI-A Deductions under Chapter VI-A
1 Part B- Deduction in respect of certain payments

a 80C 1,50,000 b 80CCC 0

80CCD(1) 0
c 0 d 80CCD(1B)

e 80CCD(2) 0 f 80D 0
g 80DD 0 h 80DDB 0
i 80E 0 j 80EE 0
k 80EEA 0 l 80EEB 0
m 80 G 0 n 80GG 0
o 80GGA 0 p 80GGC 0
2 Part C, CA and D- Deduction in respect of certain incomes/other deduction
q 80QQB 0 r 80RRB 0
s 80TTA 0 t 80TTB 0
u 80 U 0
v Total deductions under Chapter VI-A (Total of a to u) v 1,50,000

18 of 36
Schedule 80G Details of donations entitled for deduction under section 80G
A Donations entitled for 100% deduction without qualifying limit
Name and Address of Donee PAN of Donee Amount of donation Eligible
Donation in Donation in Total Amount of
cash other mode Donation Donation
Total 0 0 0
B Donations entitled for 50% deduction without qualifying limit
Name and Address of donee PAN of Donee Amount of donation Eligible
Donation in Donation in Total Amount of
cash other mode Donation Donation

Total 0 0 0 0

C Donations entitled for 100% deduction subject to qualifying limit

Name and Address of Donee PAN of Donee Amount of donation Eligible
Donation in Donation in Total Amount of
cash other mode Donation Donation

Total 0 0 0 0

D Donations entitled for 50% deduction subject to qualifying limit

Name and Address of Donee PAN of Donee Amount of donation Eligible
Donation in Donation in Total Amount of
cash other mode Donation Donation

Total 0 0 0 0

E Total donations (A + B + C + D) 0

19 of 36
Schedule
Details of donations for scientific research or rural development
80GGA
SI. Relevant clause under which Name and address of PAN of Donee Amount of Donation Eligible
No. deduction is claimed (drop down Donee Donation in Donation in Total Amount
to be provided) Cash Other Mode Donation of
Donation

Total Donation 0 0 0 0

20 of 36
Schedule AMT Computation of Alternate Minimum Tax payable under section 115JC
1 Total Income as per item 12 of PART-B-TI 1 10,03,440

2 Adjustment as per section 115JC(2)

Deduction claimed under any section included in Chapter VI-A under the
a 2a 0
heading “C.- Deductions in respect of certain incomes”

3 Adjusted Total Income under section 115JC(1)(1+2a) 3 10,03,440

4 Tax payable under section 115JC [18.5% of (3)] (if 3 is greater than Rs. 20 lakhs) 4 0

21 of 36
Schedule AMTC Computation of tax credit under section 115JD
1 Tax under section 115JC in assessment year 2021-22 (1d of Part-B-TTI) 1 0

2 Tax under other provisions of the Act in assessment year 2021-22 (7 of Part-B-TTI) 2 1,18,073

Amount of tax against which credit is available [enter (2 - 1) if 2 is greater than 1, otherwise
3 3 1,18,073
enter 0]
4 Utilisation of AMT credit Available (Sum of AMT credit utilized during the current year is subject to maximum of amount mentioned in 3 above and
cannot exceed the sum of AMT Credit Brought Forward)
S.No Assessment Year AMT Credit AMT Credit Balance AMT Credit
(A) Gross (B1) Set-off in earlier Balance brought Utilised during Carried Forward (D)=
assessment years forward to the Current (B3)-( C)
(B2) the current Assessment Year
assessment year (C)
(B3) = (B1)-(B2)

i 2013-14 0 0 0 0 0

ii 2014-15 0 0 0 0 0

iii 2015-16 0 0 0 0 0

iv 2016-17 0 0 0 0 0

v 2017-18 0 0 0 0 0

vi 2018-19 0 0 0 0 0

vii 2019-20 0 0 0 0 0

viii 2020-21 0 0 0 0 0

Current AY (enter 0 0
Viii 1-2, if 1>2 else enter
0)
Total
ix 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

22 of 36
Schedule SPI Income of specified persons (spouse, minor child etc.) includable in income of the assessee as per section
64 GENERALIncome of specified persons (spouse, minor child etc.) includable in income of the assessee
as per section 64
SI. Name of person PAN/ Aadhaar of person (optional) Relationship Amount(Rs) Head of Income in
No. which included

23 of 36
 Income chargeable to tax at special rates (please see instructions No. 9 for rate of tax)Income chargeable
Schedule SI
to tax at special rates
SI.No Section Special rate Income Taxable Tax thereon
Income after
adjusting
for min
chargeable
to tax
Total 0 0

24 of 36
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 under rule 7A,
i i 0
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
v In case the net agricultural income for the year exceeds Rs.5 lakh, please furnish the following details(Fill up
details separately for each agricultural land)
SI.No Name of district along with pin code in which agricultural Measurement of Whether the Whether the
land is located agricultural land in agricultural land agricultural land
Name of district Pin code Acre is owned or is irrigated or rain-
held on lease fed
3 Other exempt income (including exempt income of minor child) 3 0
SL.No. Other exempt income Amount
4 Income not chargeable to tax as per DTAA
SI. Amount of Income Nature of Country name & Code Article Head Whether TRC obtained
No. Income of of (Y/N)
DTAA Income
III Total Income from DTAA not chargeable to tax 4 0
5 Pass through income not chargeable to tax (Schedule PTI) 5 0
0
6 Total (1+2+3+4+5+6) 6

25 of 36
Schedule PTI Pass Through Income details from business trust or investment fund as per section 115UA, 115UB
SI. Investment Name of PAN of the SI.No Head of income Current year Share of Net Income/ TDS on such
No entity covered business trust/ business trust/ income current Loss 9=(7-8) amount,if
by Section investment fund investment fund year loss any
115UA/115UB distributed
by
Investment
fund
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Note: Please refer to the instructions for filling out this schedule

26 of 36
Schedule FSI Details of Income from outside India and tax relief (Available in case of resident)
Sl Country Code Taxpayer Sl.No Head of Income from Tax paid Tax payable on Tax relief Relevant
Identification income outside outside India such income available in article of
Number India(included under normal India(e)= (c) or DTAA if relief
in PART B-TI) provisions in (d) whichever is claimed u/s
India lower 90 or 90A
(a) (b) (c) (d) (e) (f)
Note: Please refer to the instructions for filling out this schedule

27 of 36
Schedule TR Details Summary of tax relief claimed for taxes paid outside India (available only in case of resident)
1 Summary of Tax relief claimed
Country Code Tax Identification Number Total proportionate taxes Total tax relief available Tax Relief Claimed under
paid outside India (total (total of (f) of Schedule FSI section (specify 90, 90A or
of (c) of Schedule FSI in in respect of each country) 91)
respect of each country)
(a) (b) (c) (d) (e)
Total
0 0

2 Total Tax relief available in respect of country where DTAA is applicable (section 90/90A) (Part of total of 1(d)) 2 0

3 Total Tax relief available in respect of country where DTAA is not applicable (section 91) (Part of total of 1(d)) 3 0

4 Whether any tax paid outside India, on which tax relief was allowed in India, has been refunded/credited by 4
the foreign tax authority during the year? If yes, provide the details below
a Amount of tax refunded b Assessment year in which tax relief allowed in
0 0
India
Note: Please refer to the instructions for filling out this schedule.

28 of 36
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 relevant accounting period

SI. Country Country Name of Address of ZIP code Account Status Account Peak balance Closing Gross interest paid/
No name code financial financial number opening During the balance credited to the account
institution institution date period 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 relevant accounting period

SI. No Country Country Name of Address ZIP code Account Status Account Peak balance Closing Gross interest paid/credited to
name code financial of number opening During the balance the account during the period
institution financial date period (drop down to be provided
institution specifying nature of amount
viz. interest/dividend/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 relevant accounting period

SI. Country Country Name of Address of ZIP code Nature of Date of Initial Peak Closing Total gross Total gross
No. name code entity entity entity acquiring value of value of balance amount proceeds
the interest the invest- investment paid/ from sale or
ment during the credited redemption
Period with respect of investment
to the during the
holding period
during the
period
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Details of Foreign Cash Value Insurance Contract or Annuity Contract held (including any beneficial interest) at any time during the relevant
A4
accounting period
SI. Country name Country code Name of financial Address of ZIP code Date of contract The cash value or Total gross amount paid/credited
No. institution in which financial surrender value of the with respect to the contract during
insurance contract institution contract the period
held
(1) (2) (3) (4) (5) (6) (7) (8) (9)

B Details of Financial Interest in any Entity held (including any beneficial interest) at any time during the relevant accounting period

SI. Country Zip Code Nature Name and Address of Nature of Date Total Investment (at Income Nature of Income taxable and offered in this
No. Name and of entity the Entity Interest- since cost) (in rupees) accrued Income return
code Direct/ held from such Amount Schedule Item
Benefici Interest where number of
al owner/ offered schedule
Beneficia-
ry
(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 relevant accounting period

SI. Country Zip Code Address of the Ownership- Date of Total Income Nature of Income taxable and offered in this return
No Name and Property Direct/ acquisition Investment derived from Income Amount Schedule Item number
code Beneficial (at cost) (in the property where of schedule
owner/ rupees) offered
Beneficiary
(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 relevant accounting period

SI. Country Zip code Nature of Ownership- Date of Total Income Nature of Income taxable and offered in this return
No name and Asset Direct/ acquisition Investment derived from Income Amount Schedule Item number
code Beneficial (at cost) (in the asset where of schedule
owner/ rupees) offered
Beneficiary
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9) (10) (11)
Details of account(s) in which you have signing authority held (including any beneficial interest) at any time during the relevant accounting period and
E
which has not been included in A to D above.
SI. Name of the Address Country Zip Code Name of Account Peak Whether If (7) is yes, If (7) is yes, Income offered in this return
No Institution of the Name and the account Number Balance/ income Income Amount Schedule Item number
in which the Institution Code holder Investment accrued is accrued in where of schedule
account is during the taxable in the account offered
held year (in your hands?
rupees)
Peak
Balance/
Investment
during the
year
(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.

29 of 36
 SI. Country ZIP Name and Name and address Name and Name and address of Date Whether If (8) If (8) is yes, Income offered in this
No Name and CODE address of the of trustees address of Beneficiaries since income is yes, return
code trust Settlor position derived Income Amount Schedule Item
held is derived where number of
taxable from the offered schedule
in your trust
hands?
(1) (2) (2b) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
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
G
business or profession
SI. Country Name ZIP Code Name and address of the person Income derived Nature of Whether taxable If (6) is yes, Income offered in this return
No and code from whom derived income in your hands? Amount Schedule Item number
where offered of 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.

30 of 36
Schedule 5A Information regarding apportionment of income between spouses governed by Portuguese Civil Code
Name of the spouse

PAN/Aadhar of the spouse

Heads of Income Receipts received under Amount apportioned in Amount of TDS deducted TDS apportioned in the
the head the hands of the spouse on income at (ii) hands of spouse
(i) (ii) (iii) (iv) (v)
1 House Property 0 0 0 0

2 Capital gains 0 0 0 0

3 Other sources 0 0 0 0

4 Total 0 0 0 0

31 of 36
Schedule AL Assets and Liabilities at the end of the year (applicable in a case where total income exceeds Rs.50 lakh)
A Details of immovable assets
SI.No Description Address Pin code Amount (cost) in Rs.
(1) (2) (3) (4) (5)
B Details of movable assets
SI. Amount (cost) in
Description
No Rs.
(1) (2) (3)
(i) Jewellery, bullion etc.
0

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

0

(iii) Vehicles, yachts, boats and aircrafts

0

(iv) Financial assets. Amount (cost) in

Rs.
(a) Bank (including all deposits)
0

(b) Shares and securities

0

(c) Insurance policies

0

(d) Loans and advances given

0

(e) Cash in hand

0

C Liabilities in relation to Assets at (A + B)

0

Note: Please refer to instructions for filling out this schedule.

32 of 36
Part B - TI Computation of total income
1 Salaries(6 of Schedule S) 1 13,50,331

2 Income from house property (4 of Schedule-HP) (enter nil if loss) 2 0

3 Capital Gains
Short term
Short-term chargeable @ 15% (9ii of item E of schedule CG)
i ai 0

Short-term chargeable @ 30% (9iii of item E of schedule CG)

ii aii 0

a Short-term chargeable at applicable rate (9iv of item E of schedule CG)

iii aiii 0

Short-term chargeable at special rates in India as per DTAA (9v of item E of

iv aiv 0
schedule CG)
Total Short-term (ai + aii + aiii + aiv) (enter nil if loss)
v 3av 0

Long-term
Long-term chargeable @ 10% (9vi of item E of schedule CG) (9vi of item E of
i bi 0
schedule CG)
Long-term chargeable @ 20%(9vii of item E of schedule CG)
b ii bii 0

Long-term chargeable at special rates in India as per DTAA (9viii of item E of

iii biii 0
schedule CG)
Total Long-term (bi + bii+biii) (enter nil if loss)
iv 3biv 0

Total capital gains (3av + 3biv) (enter nil if loss)

c 3c 0

4 Income from other sources

Net income from other sources chargeable to tax at normal applicable rates (6 of
a 4a 0
Schedule OS) (enter nil if loss)
Income chargeable to tax at special rates (2 of Schedule OS)
b 4b 0

Income from the activity of owning and maintaining race horses (8e of Schedule OS)
c 4c 0
(enter nil if loss)
Total (4a + 4b + 4c) (enter nil if loss)
d 4d 0

Total of head wise income (1+2+3c+4d)

5 5 13,50,331

Losses of current year set off against 5 (total of (2xiii and 3xiii) of Schedule CYLA)
6 6 1,96,893

Balance after set off current year losses(5-6) (total of column 4 of Schedule CYLA + 2 of
7 7 11,53,438
Schedule OS)
Brought forward losses set off against 7 (2xii of Schedule BFLA)
8 8 0

9 Gross Total income (7-8) (3xiii of Schedule BFLA + 2 of Schedule OS) 9 11,53,438
Income chargeable to tax at special rate under section 111A, 112 , 112A etc. included in 9
10 10 0

Deductions under Chapter VI-A [v of Schedule VIA and limited to(9-10)]

11 11 1,50,000

Total income (9-11)

12 12 10,03,440

Income which is included in 12 and chargeable to tax at special rates (total of column (i) of
13 13 0
schedule SI)
Net agricultural income/ any other income for rate purpose (3 of Schedule EI)
14 14 0

Aggregate income (12-13+14) [applicable if (12-13) exceeds maximum amount not chargeable
15 15 10,03,440
to tax]
Losses of current year to be carried forward (total of row xi of Schedule CFL)
16 16 0

Deemed income under section 115JC (3 of schedule AMT)

17 17 10,03,440

33 of 36
Part B -TTI Computation of tax liability on total income
Tax payable on deemed total income under section 115JC (4 of Schedule
a 1a 0
AMT)
Surcharge on (a) (if applicable)
b 1b 0
1
Health and Education Cess @ 4% on (1a+1b) above
c 1c 0

Total Tax Payable on deemed total income (1a+1b+1c)

d 1d 0

Tax payable on total income

1,13,532

Tax at normal rates on 15 of Part B-TI

a 2a 1,13,532

Tax at special rates (total of col.(ii) of Schedule SI)

2 b 2b 0

Rebate on agricultural income [applicable if (12-13) of Part B-TI exceeds

c 2c 0
maximum amount not chargeable to tax]
Tax Payable on Total Income (2a + 2b - 2c)
d 2d 1,13,532

Rebate under section 87A

3 3 0

Tax payable after rebate (2d - 3)

4 4 1,13,532

5 Surcharge
Surcharge computed before marginal relief

i @ 25% of 16(ii) of Schedule SI 5i 0

@10% or 15%, as applicable of 2(ii), 3(ii), 8(ii), 11(ii), 21 (ii), 23(ii) of

ii 5ii 0
Schedule SI

iii On [(4) - ( 16(ii), 2(ii), 3(ii), 8(ii), 11(ii), 21(ii), 23(ii) of Schedule SI)] 5iii 0

Surcharge after marginal relief

i @ 25% of 16(ii) of Schedule SI 5i 0

@10% or 15%, as applicable of 2(ii), 3(ii), 8(ii), 11(ii), 21 (ii), 23(ii) of

ia 5ia 0
Schedule SI

iia On[(4)–(16(ii),2(ii),3(ii),8(ii),11(ii),21(ii),23(ii)ofScheduleSI)] 5iia 0

Total (ia + iia)

iii 5iii 0

Health and Education cess @4% on (4 + 5iv)

6 6 4,541

Gross tax liability (4 + 5iv + 6)

7 7 1,18,073

Gross tax payable (higher of 1d and 7)

8 8 1,18,073

Tax on income without including income on perquisites referred in section

1,18,073
a 17(2)(vi) received from employer, being an eligible start-up referred to in 8a
section 80-IAC ( Schedule Salary)
Tax deferred - relatable to income on perquisites referred in section 17(2)(vi)
0
b received from employer, being an eligible start-up referred to in section 80- 8b
IAC
Credit u/s 115JD of tax paid in earlier years (applicable only if 7 is higher than 1d) (row 5 of Schedule AMTC)
9 9 0

Tax payable after credit u/s 115JD (8-9)

10 10 1,18,073

11 Tax relief
Section 89 (Please ensure to submit Form 10E)
a 11a 68,476

Section 90/90A (2 of Schedule TR)

b 11b 0

Section 91 (3 of Schedule TR)

c 11c 0

Total (11a + 11b + 11c)

d 11d 68,476

Net tax liability (10 – 11d) (enter zero if negative)

12 12 49,597

13 Interest and fee payable

Interest for default in furnishing the return (section 234A)
a 13a 0

Interest for default in payment of advance tax (section 234B)

b 13b 0

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 Interest for deferment of advance tax (section 234C)
c 13c 0

Fee for default in furnishing return of income (section 234F)

d 13d 0

Total Interest and Fee Payable (13a+13b+13c+13d)

e 13e 0

Aggregate liability (12 + 13e)

14 14 49,597

Taxes Paid
15 1,47,516

Advance Tax (from column 5 of 20A)

a 15a 0

TDS (total of column 5 of 20B and column 9 of 20C)

b 15b 1,47,516

TCS (total of column 5 of 20D)

c 15c 0

Self-Assessment Tax (from column 5 of 20A)

d 15d 0

Total Taxes Paid (15a + 15b + 15c + 15d)

e 15e 1,47,516

Amount payable (Enter if 14 is greater than 15e, else enter 0)

16 16 0

Refund (If 15e is greater than 14) (Refund, if any, will be directly credited into the bank account) .
17 17 97,920

Do you have a bank account in India (Non- Residents claiming refund with no bank account in India may select No)
18 Yes

SI No. IFSC Code of the Name of the Bank Account Number Indicate the account in which you prefer to get
Bank in case of Bank
your refund credited, if any ( tick accounts
Accounts held in India
UNION BANK OF INDIA 320904020060003
1 UBIN0532096

UNION BANK OF INDIA 489402070911228

2 UBIN0532096

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
Rows can be added as required
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
ii
account
SI No. SWIFT Code Name of the Bank Country of Location IBAN
Do you at any time during the previous year :-
(i) hold, as beneficial owner, beneficiary or otherwise, any asset (including financial interest in any entity) located outside India; or
Yes
19 (ii) have signing authority in any account located outside India; or
(iii) have income from any source outside India? No
[applicable only in case of a resident] [Ensure Schedule FA is filled up if the answer is Yes ]

20 TAX PAYMENTS

A Details of payments of Advance Tax and Self-Assessment Tax

SI.No. BSR Code Date of Deposit (DD/MMM/ Serial number of challan Amount(Rs)
YYYY)
(1) (2) (3) (4) (5)
Advance Tax and Self Assessment Tax (total of column 5)
0

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)]

SI.No. Tax Deduction Account Name of the Employer Income chargeable under Total Tax Deducted
Number (TAN) of the Employer Salaries
(1) (2) (3) (4) (5)

1 MUMU07901F UNION BANK OF INDIA 14,02,831 1,47,516

Note: Please enter total of column 5 in 11b of Part B-TTI

C Details of Tax Deducted at Source (TDS) on Income [As per Form 16 A issued or Form 16B/16C furnished by Deductor(s)]
SI. TDS PAN/ Aadhaar of TAN of the Unclaimed TDS TDS of the current TDS credit being claimed this Year (only Corresponding Receipt TDS credit
No. credit Other Person (if Deductor/PAN/ brought forward financial Year (TDS if corresponding income is being offered offered being
relating TDS credit related to Aadhaar No. of (b/f) deducted during the FY for tax this year, not applicable if TDS is carried
to self / other person) Tenant/ Buyer 2020-21) deducted u/s 194N) forward
other

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 person Financial TDS b/f DeductedDeducted in Claimed Claimed in the hands of spouse Gross Head of
[spouse year in in own the hands of in own as per section 5A or any other Amount Income
as per which hands spouse as per hands person as per rule 37BA(2) (if
section TDS is section 5A applicable)
5A/other deducted or any other
person person as per
as per rule 37BA(2) (if
rule applicable)
37BA(2)]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Income TDS Income TDS PAN/
Aadhaar
TDS claimed in own hands (total of column 9) 0

Note: Please enter total column 9 of above in 15b of Part B-TTI

D Details of Tax Deducted at Source (TDS) on Income [As per Form 16A issued or Form 16B/16C/16D furnished by Deductor(s)]
SI. TDS PAN/ Aadhaar of PAN/Aadhaar No. of Unclaimed TDS TDS of the current TDS credit being claimed this Year (only if Corresponding Receipt TDS credit
No. credit Other Person (if the Buyer / Tenant brought forward Financial Year (TDS corresponding income is being offered for offered being
relating TDS credit related (b/f) deducted during the FY tax this year) carried
to self / to other person) 2020-21) forward
other Fin. Year TDS b/f DeductedDeducted in Claimed Claimed in the hands of spouse Gross Head of
person in which in own the hands of in own as per section 5A or any other Amount Income
[spouse deducted hands spouse as per hands person as per rule 37BA(2) (if
as per section 5A applicable)
section or any other
5A/other person as per
person rule 37BA(2) (if
as per applicable)
rule
37BA(2)]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
Income TDS Income TDS PAN/Aadhaar
TDS claimed in own hands (total of column 9) 0

Note: Please enter total of column 9 in15b of Part B- TTI

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

Tax Deduction and Name of the Collector Tax Collected Amount out of (4) Amount out of (4) being claimed in the
SI.
Collection Account being claimed hands of spouse, if section 5A is applicable
No. Number of the
Collector

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

TCS being claimed this year (total of column 5) 0

Note: Please enter total of column (5) in 11c of Part B-TTI

xyz
xyz
xyz
VERIFICATION
xyz
I, ANJALI HASANRAO RAUT son/ daughter of HASANRAO MADHAVRAO RAUT 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) ASGPR9862B A (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 : 26-Dec-2021 Sign Here:
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

If TRP is entitled for any reimbursement from the Government, amount thereof 0

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