Form PDF 401621100220322
Form PDF 401621100220322
Form PDF 401621100220322
PAN Name Date of Birth Aadhaar Number (12 digits)/Aadhaar Enrolment Id (28
BYMPM6194A MOOLAPATHAN 07-Jun-1994 digits) (If eligible for Aadhaar No.)
3xxx xxxx 2409
If revised/defective, then enter Receipt No. and Date of filing original return
(DD/MM/YYYY)
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 0
current account during the previous year?
Yes ✔ No
Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for 0
travel to a foreign country for yourself or for any other person?
Yes ✔ No
Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on 0
consumption of electricity during the previous year? Yes ✔ No
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a Sec 10(13A)-Allowance to meet 7,000
expenditure incurred on house
rent
vii Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put B2 0
the figure in negative)
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
- 0
B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4 2,51,138
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)
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g 80DD - Maintenance including medical treatment of a 5g 0 0
dependent who is a person with disability
D10 Fee u/s 1,000 D11 Total Tax, Fee and Interest (D5+D7+D8+D9+D10 - D6) 1,000
234F
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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
Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior citizen? No
(iii) Medical Expenditure (This deduction to be claimed on which health insurance is not 0
claimed at (i) above)
(a) Parents 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 Address City or State Pincode PAN of Amount of donation Eligible Amount of
- 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 the Address City or State Pincode PAN of Amount of donation Eligible Amount of
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- 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 Address City or State Pincode PAN of Amount of donation Eligible Amount of
- 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 Address City or State Pincode PAN of Amount of donation Eligible Amount of
- 0 0 0 0
Total D 0 0 0 0
E. Donations (A + B + C+ D) 0 0 0 0
S No. Relevant Name Address City or State Pincode PAN of Date of Amount of donation Eligible
Clause
of the Town or Code the Donation Amount of
under which Donation Donation Total
Donee District Donee in cash Donation
deduction is
in cash in other Donation
claimed
mode
- 0 0 0 0
Total Donation 0 0 0 0
BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Tax paid
Total 1,000
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 the 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. TAN of Name of the Gross receipt which is Year of Tax Deducted TDS Credit out of (5)
No. the Deductor subject to tax deduction tax claimed this year
Deductor deduction
1 2 3 4 5 6
Total 0
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Schedule TDS3 - Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]
Sl. PAN Aadhaar Name of the Gross receipt which is Year of Tax Deducted TDS Credit out of (6)
No. of the Number Tenant subject to tax claimed this year
Tenant of tax deduction deduction
the
Tenant
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)]
Sl. Tax Name of the Gross payment which is Year of Tax Collected TCS Credit out of (5)
No. Collection Collector subject to tax claimed this year
Account tax collection collection
Number
of
the
Collector
1 2 3 4 5 6
Total 0
VERIFICATION
I, MOOLAPATHAN son/ daughter of ALAGUMALAI 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 BYMPM6194A
Place:
Date: 22-Mar-2022
If the return has been prepared by a Tax Return Preparer (TRP) give further details below:
If TRP is entitled for any reimbursement from the Government, amount thereof 0
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