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 house property, other sources
ITR-1 (Interest etc.), and agricultural income upto Rs.5 thousand] Assessment Year
SAHAJ [Not for an individual who is either Director in a company or has invested in unlisted 2021 - 22
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

PAN Name Date of Birth Aadhaar Number (12 digits)/Aadhaar Enrolment Id (28 digits) (If eligible for
Aadhaar No.)
ASZPS9972Q SUTAPA SAHA 23-Oct-1966
481212592951

Mobile No. Email Address Address:

+ 91 9874491753 [email protected] 11/1, VIVEKANANDA ROAD , Piarapur (P) , HOOGHLY , Sheoraphuli S.O ,
32-West Bengal , 91-India , 712223

Filed u/s (Tick) 139(1)-On or before due date, 139(4)-Belated, 139(5)-Revised, Nature of employment- Central Govt. State Govt.
[Please see instruction] 119(2)(b)- After Condonation of delay Public Sector Undertaking Pensioners Others
Not Applicable (e.g. Family Pension etc.)
Or Filed in response to 139(9), 142(1), 148, 153A, 153C
notice u/s

If revised/defective, then enter Receipt No. and Date of filing original return (DD/MM/YYYY)

If filed in response to notice u/s 139(9)/142(1)/148/153A/153C or order u/s 119(2)(b)- enter Unique
Number/Document Identification Number (DIN) & Date of such Notice or Order

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

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 account during the previous  0
year?
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
yourself or for any other person?
Yes No

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

PART B GROSS TOTAL INCOME Whole- Rupee (  ) only

B1 i Gross Salary (ia+ib+ic) i  0

a Salary as per section 17(1) ia  0

b Value of perquisites as per section 17(2) ib  0

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

ii Less allowances to the extent exempt u/s 10 ii  0

(Ensure that it is included in salary income u/s 17(1)/17(2)/17(3) )

iii Net Salary (i - ii) iii  0

iv Deductions u/s 16 (iva + ivb+ivc) iv  0

a Standard deduction u/s 16(ia) iva  0

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  0

B2 Tick applicable option Self-Occupied Let Out Deemed Let Out

i Gross rent received/ receivable/ lettable value during the year i  0

ii Tax paid to local authorities ii  0

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 negative) B2  0
Note: - Maximum loss from House Property that can be set-off 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  1,50,050

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

1 Interest from Deposit (Bank/Post Office/Cooperative Society) Interest from Deposit (Bank/Post Office/Cooperative  1,50,050
Society)

Less: Deduction u/s 57(iia) (in case of family pension only)  0

B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4  1,50,050
Note: To avail the benefit of carry forward and set off of loss, please use ITR-2

Part C - Deductions and Taxable Total Income

(Refer instructions for Deduction limit as per Income-tax Act. Please note that the deduction in respect of the investment/ deposit/ payments for the
period 01-04-2020 to 31-07-2020 cannot be claimed again, if already claimed in the AY 2020-21)

S.No. Section Amount System Calculated

C1. 80C - Life insurance premia, deferred annuity, contributions to provident fund, subscription to certain 0 0
equity shares or debentures, etc.

C2. 80CCC - Payment in respect Pension Fund,etc. 0 0

C3. 80CCD(1) - Contribution to pension scheme of Central Government 0 0

C4. 80CCD(1B) - Contribution to pension scheme of Central Government 0 0

C5. 80CCD(2) - Contribution to pension scheme of Central Government by employer 0 0

C6. 80D Deduction in respect of Health Insurance premia (Please fill 80D Schedule. This field is auto- 0 0
populated from schedule 80D.)

C7. 80DD - Maintenance including medical treatment of a dependent who is a person with disability 0 0

C8. 80DDB - Medical treatment of specified disease 0 0

C9. 80E - Interest on loan taken for higher education 0 0

C10. 80EE - Interest on loan taken for residential house property 0 0

C11. 80EEA - Deduction in respect of interest on loan taken for certain house property 0 0

C12. 80EEB - Deduction in respect of purchase of electric vehicle 0 0

C13. 80G - Donations to certain funds, charitable institutions, etc. (Please fill 80G Schedule. This field is 0 0
auto-populated from schedule.)

C14. 80GG - Rent paid 0 0

C15. 80GGA - Certain donations for scientific research or rural development (Please fill 80GGA Schedule. This field is 0 0
auto-populated from schedule.)

C16. 80GGC - Donation to Political party 0 0

C17. 80TTA - Interest on deposits in savings Accounts 0 0

C18. 80TTB- Interest on deposits in case of senior citizens 0 0

C19. 80U-In case of a person with disability 0 0

Total Deductions (Add items C1 to C19)  0 0

Note: Total deductions under chapter VI A cannot exceed GTI.

Total Income  1,50,050

Exempt income (For reporting Purposes)

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

selected)

Total Amount 0

PART D - COMPUTATION OF TAX PAYABLE

D1 Tax payable on total income  0 D2 Rebate u/s 87A  0 D3 Tax payable after rebate  0
D4 Health and education Cess  0 D5 Total Tax and Cess  0 D6 Relief u/s 89 (Please  0
@4% on D3 ensure to submit Form 10E
to claim this relief)

D7 Interest u/s 234A  0 D8 Interest u/s 234B  0 D9 Interest u/s 234C  0

D10 Fee u/s 234F  0 D11 Total Tax, Fee and Interest (D5+D7+D8+D9+D10 - D6)  0

D12 Total Taxes Paid  10,697 D13 Amount  0 D14 Refund  10,700
payable(D11-D12) (D12-D11) (if D12>D11)
(if D11>D12)

PART E - OTHER INFORMATION

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

Sl. IFS Code of the Bank Name of the Bank Account Number Select Account for Refund Credit

1 SBIN0001769 State Bank of India 32253427800

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?

(a) Self & Family 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

(b) Self & Family (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 not claimed) 0

2 Whether any one of your parents is a senior citizen

(a) Parents 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

(b) Parents (Senior Citizen) 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

(iii) Medical Expenditure 0

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 Address City or State Pincode PAN of Amount of donation Eligible Amount of
the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total 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)

S No. Name of Address City or State Pincode PAN of Amount of donation Eligible Amount of
the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total 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. Address State Pincode Amount of donation Eligible Amount of

Code Donation
 Name of City or PAN of
S No. the Address Town State Pincode the Donation in cash Amount of donation
Donation in other Total Donation Eligible Amount of
Donee or Code Donee mode Donation

Name of District
City or PAN of
the Town the Donation in cash Donation in other Total Donation
Donee or Donee mode
District
- 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 Address City or State Pincode PAN of Amount of donation Eligible Amount of
the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total Donation
mode

- 0 0 0 0

Total D 0 0 0 0

E. Donations (A + B + C+ D) 0 0 0 0

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

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

- 0 0 0 0

Total Donation 0 0 0 0

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

BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Tax paid

Col (1) Col (2) Col (3) Col (4)

Total  0

Details of Tax Deducted at Source (TDS) on Salary Income

Sl.No. TAN of the Deductor Name of the Deductor Income chargeable under salaries Total Tax Deducted

1 2 3 4

Total  0

Details of Tax Deducted at Source (TDS) from Income Other than Salary

Sl. TAN of the Name of the Gross receipt which is Year of tax Tax TDS Credit out of
No. Deductor Deductor subject to deduction Deducted (5)
tax deduction claimed this year

1 2 3 4 5 6

1 MUMS86182F STATE BANK OF INDIA  27,600 2020  40  40

2 CALP17470F Punjab National Bank - Circle Office -  1,42,082 2020  10,657  10,657
Hooghly

3 MUMS86182F STATE BANK OF INDIA  27,600 2020  40  40

Total  10,697

Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]
Sl. PAN of the Aadhaar Number Name of the Gross receipt which is subject Year of Tax TDS Credit out of
No. Tenant of Tenant to tax Deducted (6)
the Tenant tax deduction deduction claimed this year

1 2 3 4 5 6 7

Total  0

Details of Tax Collected at Source (TCS)

Sl. Tax Collection Account Number Name of the Gross payment which is subject Year of Tax TCS Credit out of (5)
No. of Collector to tax Collected claimed this year
the Collector tax collection collection

1 2 3 4 5 6

Total  0

VERIFICATION
I, SUTAPA SAHA son/ daughter of NARESH SAHA 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 ASZPS9972Q
Date: 23-Jul-2021

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