First Name Middle Name Last Name PAN

DEEPAK KUMAR CENPK7126J

Flat / Door / Building Name Of Premises / Building / Village Status
HOUSE NO.-198/SECTOR -30 NEAR SHIVAM HOSPTIAL I
INFORMATION

Road/Street Area/Locality Date of Birth (YYYY/MM/DD)

PERSONAL

GURGAON, DELHI NCR 1988-12-28

Town/City/District State Pincode Sex
GURGAON, DELHI NCR HARYANA 122001 M
Country
91- INDIA Employer Category
Email Address Residential/Office Phone Mobile No.
No. with STD Code
[email protected] ( )- 7042079239 OTH
,
Income Tax Ward/Circle Return filed under Section 11

Whether Original or Revised return? O

If revised, Original Ack no Date of filing of Original Return
FILING STATUS

If u/s 139(9)-defective return ,

Original Ack No
If u/s 139(9)-defective return , Notice If u/s 139(9)-defective return , Date
No of Filing of Original Return
Residential Status RES Tax Status TR
Whether Person governed by N If A22 is applicable, PAN of the
Portuguese Civil Code under Sec 5A ? Spouse
If filed in response to notice u/s
139(9)/142(1)/148/153(A)/153(C), date
of such notice
1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1 334537
Type of House Property
2 Income from one House Property 0
3 Income from Other Sources (Ensure to fill Sch TDS2) 0
4 Gross Total Income (1+2+3) 4 334537
5 Deductions under chapter VI A (Section)
a 80C 5178 5178 i 80G 0 0
b 80CCC 0 0j 80GG 0 0
c 80CCD(1) 0 0k 80GGA 0 0
INCOME & DEDUCTIONS

(i) (Employers
Contribution)
c 80CCD(2) 0 0l 80GGC 0 0
(ii) (Employees /
Self Employed
Contribution)
d 80D 0 0m 80U 0 0
e 80DD 0 0n 80CCG 0 0
f 80DDB 0 0o 80RRB 0 0
g 80E 0 0p 80QQB 0 0
h 80EE 0 0q 80TTA 0 0
6 Total Deductions (Total of 5a to 5q) 6 5178
7 Taxable Total Income (4-6) 7 329360
8 Tax Payable on Total Income 8 12936
COMPUTATION

9 Rebate u/s 87A 9 2000

10 Tax Payable After Rebate(8-9) 10 10936
11 Surcharge, if (7) exceeds 1 crore 11 0
TAX

12 Cess on (10+11) 12 328

13 Total Tax, Surcharge and Cess (Payable)(10+11+12) 13 11264
14 Relief u/s 89 14 0
15 Balance Tax After Relief (13-14) 15 11264
 16 (i) Total Interest u/s 234A 16i 0
(ii) Total Interest u/s 234B 16ii 0
(iii) Total Interest u/s 234C 16iii 0
17 Total Interest Payable (16(i) + 16(ii) + 16(iii)) 17 0
18 Total Tax and Interest (15+17) 18 11264
19 Taxes Paid
TAXES PAID

a Total Advance Tax Paid (from item 26) 19a 0

b Total TDS Claimed (Total from item 24 + item 25) 19b 21470
c Total Self Assessment Tax Paid (item 26) 19c 0
Total Taxes Paid(19a + 19b + 19c) 20 21470
20
21 Total Tax Payable (18-20) (if 18 is greater than 20) 21 0
REFUND

22 Refund (20-18) (if 20 is greater than 18) 22 10210

23 Bank Account Number 187801501234
24 IFSC Code ICIC0001878
25 Type of Account SAV
26 SCH TDS1-Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
SI.NO Tax Deduction Name of the Employer Income Tax Deducted
Account Number Under Salary
(TAN) of the
Employer
1 PNED08602G DIPEN CHAUDHARY 0 9120
2 PNEQ00279G QED42 ENGINEERING PVT LTD 0 12350
29 Exempt income for reporting purposes only
VERIFICATION
xyz
I, DEEPAK KUMAR son/daughter of SUBHASH PRASAD solemnly declare that to the best of my knowledge and belief, the information
given in the return is correct and complete and that the amount of total income and other particulars shown therein are truly stated and
are in accordance with the provisions of the Income- tax Act 1961, in respect of income chargeable to Income-tax for the previous year
relevant to the Assessment Year 2014-15.

Place GURGAON, DELHI NCR Date 2014-07-31 PAN CENPK7126J

30 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
TRP PIN [10 Digit] Name of the TRP TRP Signature
31 Amount to be paid to TRP