Roll No.

C E 1 8 B T E C H 1 1 0 3 0
To,
Deputy Registrar (A.P.)
IIT Hyderabad

Sir,
Sub: Application for Remission of Fee (Academic Year 21-22)
(For those students whose parental income is less than Rs.5,00,000/- (Rupees Five lakhs p.a)

This is to inform you that my family gross income from all sources is Rs. 75900 / (in words Rupees
SEVENTY FIVE THOUSAND NINE HUNDRED RUPEES ONLY) for the financial year 2020-21. In
support of this I am enclosing ITRs of the both the parents along with the acknowledgments.

The Following Are Details myself & my parents

Parent’s Details
Student Details
Father Mother
Student’ Parent’s
S.ADISHWAR PRABHAKAR SAROJANA
s Name Name
Departm Occupat
CIVIL ENGINEERING FARMER HOMEMAKER
ent ion

1-62,BOMMAPUR,
1-62,BOMMAPUR, 1-62,BOMMAPUR,
MAHADEVPUR,
MAHADEVPUR, MAHADEVPUR,
Address Address BHUPALPALLY,
BHUPALPALLY, BHUPALPALLY,
TELANGANA,
TELANGANA, 505504 TELANGANA,
505504.
505504

Aadhaar Aadhaar
338222810448 981224855558 857327766297
No No.
UNION BANK OF UNION BANK OF
Bank Bank
UNION BANK OF INDIA INDIA INDIA
Name Name
AC NO;358302010094514 AC NO; AC NO;
&A/c &A/c
IFSC;UBIN0535834 358302010007608 358302010087735
No. No.
IFSC;UBIN0535834 IFSC;UBIN0535834
PAN PAN
DILPA8375L EDDPP5517B OHKPS7408R
No. No.
Date 13-08-2021 Date 13-08-2021 13-08-2021

Place BOMMAPUR Place BOMMAPUR BOMMAPUR

Signatu Signatu
re re
Accordingly, I request you to kindly exempt me from paying tuition Fee as indicated below.

(1) Rs. 1,00,000/- (Family Income less than Rs. 1,00,000/- per annum.)

(2) Rs. 66,666/- (Family Income lies between Rs. 1,00,000/- and Rs. 5,00,000/-)
---------------------------------------------------------------------------------------------------------------------------

(Strike out which is not applicable)

I further declare that the above information is true to the best of my knowledge and belief, and I am
aware that I am solely responsible for the correctness and accuracy of the above declaration and
understand that providing false information amounts to misconduct and may lead to cancellation of
admission at IIT Hyderabad and further action may be initiated as per law. I further authorize IIT
Hyderabad to verify my family income.
Date: 13 / 08 / 2021 .

Place: BOMMAPUR

Student’s Signature Parent’s Signature

 Assessment Year
INDIAN INCOME TAX RETURN ACKNOWLEDGEMENT
2021-22
[Where the data of the Return of Income in Form ITR-1 (SAHAJ), ITR-2, ITR-3, ITR-4(SUGAM), ITR-5, ITR-6, ITR-7 filed and verified]
(Please see Rule 12 of the Income-tax Rules, 1962)

PAN OHKPS7408R

Name SAROJANA SOMANAPELLY

Address 1-67, Bommapur , Bommapur B.O, Bommapur , KARIM NAGAR, 36-Telangana, 91-India, 505504

Status Individual Form Number ITR-1

Filed u/s 139(5)Revised- Return revised after filing original return e-Filing Acknowledgement Number 290194330140821

Current Year business loss, if any 1 V0

Total Income V 1,900

TaxableIncome and Tax details

Book Profit under MAT, where applicable 2 V0

Adjusted Total Income under AMT, where applicable 3 V0

Net tax payable 4 V0

Interest and Fee Payable 5 V0

Total tax, interest and Fee payable 6 V0

Taxes Paid 7 V0

(+)Tax Payable /(-)Refundable (6-7) 8 (+) V(-) V

Dividend Tax Payable 9 V0

Interest Payable 10 V0
DistributionTax details

Total Dividend tax and interest payable 11 V0

Taxes Paid 12 V0

(+)Tax Payable /(-)Refundable (11-12) 13 V0

Accreted Income as per section 115TD 14 V0

AccretedIncome & Tax Detail

Additional Tax payable u/s 115TD 15 V0

Interest payable u/s 115TE 16 V0

Additional Tax and interest payable 17 V0

Tax and interest paid 18 V0

(+)Tax Payable /(-)Refundable (17-18) 19 V0

Income Tax Return submitted electronically on 14-08-2021 09:48:50 from IP address 103.59.154.151 and verified by SAROJANA SOMANAPELLYhaving PAN OHKPS7408R on 14-08-2021 09:48:50 using
* paper ITR-Verification Form /Electronic Verification Code CGRXI6R63I generated through Digital mode

System Generated Barcode/QR Code

OHKPS7408R01290194330140821430C45A5344016ABB97BCE524BED9E71A84BF301

* Strike of whichever is not applicable

DO NOT SEND THIS ACKNOWLEDGEMENT TO CPC, BENGALURU
 INDIAN INCOME TAX RETURN ACKNOWLEDGEMENT
[Where the data of the Return of Income in Form ITR-1 (SAHAJ), ITR-2, ITR-3, ITR-4(SUGAM), ITR-5, ITR-6, Assessment Year
ITR-7 filed and verified] 2021-22
(Please see Rule 12 of the Income-tax Rules, 1962)

PAN EDDPP5517B

Name SOMANAPELLY PRABHAKAR

Address 1-67 , bommapur , Bommapur B.O , Bommapur , KARIM NAGAR , 36-Telangana , 91-India , 505504

Status Individual Form Number ITR-4

Filed u/s 139(1) Return filed on or before due date e-Filing Acknowledgement Number 285942860130821

Current Year business loss, if any 1 ₹0

Total Income ₹ 74,000

Book Profit under  MAT, where applicable 2 ₹0

Adjusted Total Income under AMT, where applicable 3 ₹0

Net tax payable 4 ₹0

Interest and Fee Payable 5 ₹0

Total tax, interest and Fee payable 6 ₹0

Taxes Paid 7 ₹0

(+)Tax Payable /(-)Refundable  (6-7) 8 ₹ 0

Dividend Tax Payable 9 ₹0

Interest Payable 10 ₹0

Total Dividend tax and interest payable 11 ₹0

Taxes Paid 12 ₹0

(+)Tax Payable /(-)Refundable  (11-12) 13 ₹0

Accreted Income as per section 115TD 14 ₹0

Additional Tax payable u/s 115TD 15 ₹0

Interest payable u/s 115TE 16 ₹0

Additional Tax and interest payable 17 ₹0

Tax and interest paid 18 ₹0

(+)Tax Payable /(-)Refundable (17-18) 19 ₹0

Income Tax Return submitted electronically on 13-08-2021 14:31:53 from IP address 10.1.213.131 and verified by SOMANAPELLY
PRABHAKAR having PAN EDDPP5517B on 13-08-2021 14:31:44 using paper ITR-Verification Form /Electronic Verification Code
CGJXI5MDUI generated through Digital mode

System Generated
Barcode/QR Code

EDDPP5517B04285942860130821F262B808FB7AE7710506B27634B95A4A25CEA3CA

DO NOT SEND THIS ACKNOWLEDGEMENT TO CPC, BENGALURU