Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022

INDIAN INCOME TAX RETURN

[For individuals being a resident (other than not ordinarily resident)
having total income upto Rs.50 lakh, having Income from Salaries, one
Assessment
FORM

ITR-1 house property, other sources (Interest etc.), and agricultural income upto
Year
SAHAJ Rs.5 thousand]
[Not for an individual who is either Director in a company or has 2022-23
invested in unlisted equity shares or in cases where TDS has
been deducted u/s 194N or if income-tax is deferred on ESOP]
(Refer instructions for eligibility)

PART A GENERAL INFORMATION

(A1) PAN (A2) First Name (A2a) Middle Name (A3) Last Name (A4) Date of Birth (A5) Aadhaar Number (12 digits)/
HPYPS3719L SURENDER SINGH 17-Mar-1997 Aadhaar Enrolment Id (28 digits) (If
eligible for Aadhaar No.)
5xxxxxxx8961
(A6) Mobile No. (A7) Email Address (A8) Flat/Door/Block No. (A9) Name of Premises/ (A10) Road/Street/Post
+ 91 8059816203 surendermalik4250@gm 1176 JAKHOLI Building/Village Office, Area/Locality
ail.com Jakholi B.O, Jakholi (56)
(A11) Town/City/District (A12) State (A13) Country/Region (A14) PIN Code/ZIP Code
KAITHAL 12 - Haryana 91 - India 136027
(A15) Filed u/s (Tick) 139(1)-On or before due date (A16) Nature of Employment -
[Please see instruction] 139(4)-Belated 139(5)-Revised Central Govt. State Govt. Public Sector Undertaking
119(2)(b)- After Condonation of delay CG - Pensioners SG - Pensioners PSU -
139(8A) Pensioners Other Pensioners Others Not
(A17)Or Filed in 139(9) 142(1) 148 Applicable (e.g. Family Pension etc.)
response to notice u/s
(A18)If revised/defective, then enter Receipt No. and Date of filing original
return (DD/MM/YYYY)
(A19) If filed in response to 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 or Order

(A20) Are you opting for new tax regime u/s 115BAC ? Yes No
(A21) 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
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)]
(i) Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more
current account during the previous year?
Yes No
(ii) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for
travel to a foreign country for yourself or for any other person?
Yes No
(iii) Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on
consumption of electricity during the previous year?
Yes No
(iv) 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
select the relevant condition from the drop down menu) Yes No

S.No. Amount

PART B GROSS TOTAL INCOME Whole - Rupee only

B1 i Gross Salary (ia+ib+ic+id+ie) i 2,88,000

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Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022

a Salary as per section 17(1) ia 2,88,000

b Value of perquisites as per section 17(2) ib 0
SALARY / PENSION

c Profit in lieu of salary as per section 17(3) ic 0

d Income from retirement benefit account maintained in a id 0

notified country u/s 89A
e Income from retirement benefit account maintained in a ie 0
country other than notified country u/s 89A
ii Less allowances to the extent exempt u/s 10 (Ensure that it is included in salary income u/s ii 0
17(1)/17(2)/17(3) )
iia Less: Income claimed for relief from taxation u/s 89A iia 0

iii Net Salary (i – ii - iia) iii 2,88,000

iv Deductions u/s 16 (iva + ivb + ivc) iv 50,000

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

b Entertainment allowance u/s 16 (ii) ivb 0

c Professional tax u/s 16(iii) ivc 0

v Income chargeable under the head ‘Salaries’ (iii – iv) B1 2,38,000

B2 Tick applicable option 139(1) Let Out Deemed Let Out
i Gross rent received/ receivable/ lettable value during the year i 0
HOUSE PROPERTY

ii Tax paid to local authorities ii

iii Annual Value (i – ii) iii 0
iv 30% of Annual Value iv 0
v Interest payable on borrowed capital v 0
vi Arrears/Unrealised rent received during the year less 30% vi 0
vii Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put the figure in B2 0
negative)
Note: - Maximum Loss from House property that can be set-off in computing income of this
year is INR 2,00,000. To avail the benefit of carry forward and set off of loss, please use ITR-2
B3 Income from Other Sources B3 1,14,980
S.No. Nature of Income Description ( If Any Other Total Amount
selected)
1. Interest from Saving Account 980
2. Any Other Misc. income from part-time work 114000
as freelancer
Quarterly breakup of Dividend Income Quarterly breakup of Income from retirement benefit account
maintained in a notified country u/s 89A (taxable portion)
i Up to 15-Jun-2021 0 i Up to 15-Jun-2021 0
ii From 16-Jun-2021 to 15- 0 ii From 16-Jun-2021 to 15- 0
Sep-2021 Sep-2021
iii From 16-Sep-2021 to 15- 0 iii From 16-Sep-2021 to 15- 0
Dec-2021 Dec-2021
iv From 16-Dec-2021 to 15- 0 iv From 16-Dec-2021 to 15- 0
Mar-2022 Mar-2022
v From 16-Mar-2022 to 31- 0 v From 16-Mar-2022 to 31- 0
Mar-2022 Mar-2022
Less: Deduction u/s 57(iia) (in case of family pension only) 0
Less: Income claimed for relief from taxation u/s 89A 0
B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4 3,52,980
Note: To avail the benefit of carry forward and set of loss, please use ITR-2

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Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022

Part C - Deductions and Taxable Total Income

S.No. Section Amount System Calculated

a 80C - Life insurance premia, deferred annuity, 5a 0 0

contributions to provident fund, subscription to certain
equity shares or debentures, etc.
b 80CCC - Payment in respect Pension Fund,etc. 5b 0 0
c 80CCD(1) - Contribution to pension scheme of Central 5c 0 0
Government
d 80CCD(1B) - Contribution to pension scheme of Central 5d 0 0
Government
e 80CCD(2) - Contribution to pension scheme of Central 5e 0 0
Government by employer
f 80D Deduction in respect of Health Insurance premia 5f 0 0
(Please fill 80D Schedule. This field is auto-populated
from schedule 80D.) 0
g 80DD - Maintenance including medical 5g 0 0
treatment of a dependent who is a
person with disability -
h 80DDB - Medical treatment of specified 5h 0 0
disease -
i 80E - Interest on loan taken for higher education 5i 0 0
j 80EE - Interest on loan taken for residential house 5j 0 0
property
k 80EEA - Deduction in respect of interest on loan taken 5k 0
for certain house property
l 80EEB - Deduction in respect of purchase of electric 5l 0
vehicle
m 80G - Donations to certain funds, charitable institutions, 5m 0 0
etc. (Please fill 80G Schedule. This field is auto-
populated from schedule.)
n 80GG - Rent paid 5n 0 0
o 80GGA - Certain donations for scientific research or 5o 0 0
rural development (Please fill 80GGA Schedule. This
field is auto-populated from schedule.)
p 80GGC - Donation to Political party 5p 0 0
q 80TTA - Interest on deposits in savings Accounts 5q 980 980
r 80TTB- Interest on deposits in case of senior citizens 5r 0 0
s 80U-In case of a person with disability 5s 0 0
Total Deductions (Add items 5a to 5s) 980 980
Note: Total deductions under chapter VI A cannot exceed GTI.
Total Income 3,52,000

Exempt income (For reporting Purposes)

S.No. Nature of Income Description ( If Any Other selected) Total Amount

Total Exempt Income 0

PART D - COMPUTATION OF TAX PAYABLE

D1 Tax payable 5,100 D2 Rebate u/s 5,100 D3 Tax after 0

on total 87A Rebate
income
D4 Health and 0 D5 Total Tax 0 D6 Relief u/s 0
education and Cess 89 (Please

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Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022
Cess @ 4% ensure to
on D3 submit Form
10E to claim
this relief)
D7 Interest u/s 0 D8 Interest u/s 0 D9 Interest u/s 0
234A 234B 234C
D10 Fee u/s 1,000 D11 Total Tax, Fee and Interest (D5+D7+D8+D9+D10 – D6) 1,000
234F
D12 Total Taxes 19,984 D13 Amount 0 D14 Refund 18,980
Paid payable(D11- (D12-D11) (if
D12) (if D12>D11)
D11>D12)

PART E – OTHER INFORMATION

Details of all Bank Accounts held in India at any time during the previous year (excluding dormant accounts)

S1 IFS Code of the Bank Name of the Bank Account Number Select Account for Refund
Credit
1 PUNB0071400 PUNJAB NATIONAL BANK 0714000103063759

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.
Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior citizen? Not claiming for Self/ Family
(a) Self & Family 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(b) Self & Family including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(iii) Medical Expenditure (This deduction to be claimed on which health insurance is 0
not claimed at (i) above)
2 Whether any one of your parents is a senior citizen Not claiming for Parents
(a) Parents 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(b) Parents including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(iii) Medical Expenditure (This deduction can be claimed on which health insurance is 0
not claimed at (i) above)
3 Eligible Amount of Deduction 0
Schedule 80G: Details of donations entitled for deduction under section 80G
A. Donations entitled for 100% deduction without qualifying limit, (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total A 0 0 0 0

B. Donations entitled for 50% deduction without qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)

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Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total B 0 0 0 0

C. Donations entitled for 100% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should
become mandatory)
S No. Name of the Donee Address City or Town or State code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total C 0 0 0 0

D. Donations entitled for 50% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Donee Address City or Town or State Code Pincode PAN of the Amount of donation Eligible
District Donee Amount of
Donation Donation Total Donation
in cash in other Donation
mode

- 0 0 0 0

Total D 0 0 0 0

E. Total Amount of Donations (A + B + C + D) 0 0 0 0

Schedule 80GGA: Details of donations for scientific research or rural development

S No. Relevant Clause under Name of the Address City or State Code Pincode PAN of the Amount of donation Eligible
which deduction is Donee Town or Donee Amount
claimed District Donation Donation Total of
in cash in other Donation Donation
mode

- 0 0 0 0

Total Donations 0 0 0 0

Schedule-IT Details of Advance Tax and Self-Assessment Tax payments

Sl.No. BSR Code Date of Deposit(DD/MM/YYYY) Serial Number of Challan Tax paid
Col (1) Col (2) Col (3) Col (4)
Total 0
Schedule TDS1 - Details of Tax Deducted at Source from Salary [As per form 16 issued by Employer(s)]
Sl.No. TAN of the Deductor Name of Deductor Income chargeable under Total Tax Deducted
Salaries
1 2 3 4
Total 0
Schedule TDS2 - Details of Tax Deducted at Source from Income Other than Salary [As per form 16A issued by Deductor(s)]
Sl.No. Tax Name of the Deductor Gross receipt which Year of tax deduction Tax Deducted TDS Credit out of (5)
Deduction is subject to tax claimed for this Year
Account deduction
Number
(TAN) of the
Deductor
1 2 3 4 5 6
Total 0

Schedule TDS3 - Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]
Sl.No PAN of the Aadhaar Name of the Gross receipt which Year of Tax Deduction Tax Deducted TDS Credit out of (6)
Tenant Number of the Tenant is subject to tax claimed this Year
Tenant Deduction
1 2 3 4 5 6 7
Total 0

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

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Acknowledgement Number : 468763070040922 Date of Filing : 04-Sep-2022

Sl.No. Tax Collection Name of the Collector Gross payment Year of taxcollection Tax Collected TCS Credit out of (5)
Account Number which is subject to claimed this year
ofthe Collector tax collection
1 2 3 4 5 6
1 PTLP11028D PAUL MERCHAN TS 3,99,680 2021 19,984 19,984
LIMITED
Total 19,984

VERIFICATION

I, SURENDER SINGH son/ daughter of DALBIR SINGH solemnly declare that to the best of my knowledge and belief, the
information given in the return is correct and complete and is in accordance with the provisions of the Income-tax Act, 1961. I further
declare that I am making this return in my capacity as Self and I am also competent to make this return and verify it. I am holding
permanent account number HPYPS3719L

Place : 165.225.124.88

Date : 04-Sep-2022

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

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