SAHAJ INDIVIDUAL INCOME TAX RETURN Assessment

Year

FORM
ITR-1 (For Individuals having Income from Salaries, One House Property, Other Sources
(Interest etc.) Refer to Instructions for eligibililty.) 2 0 16 - 1 7

First Name Middle Name Last Name PAN

PERSONAL INFORMATION PALLAVI LAXMINARAYAN PITLA AQNPP9929N

Flat / Door / Building Name of Premises / Building / Village Status

31 GURUWAR I - Individual
PETHBHAGI
Road / Street Area / Locality Date of birth Sex
SHITALADEVI CHOWCK 13/11/1983 Female
Town/ City/ District State Country Pincode

PUNE 19-MAHARASHTRA 91-INDIA 411028

Email Address Mobile No. 1 (STD Code) Phone No Mobile No. 2 Employer Category

pallavi.pitla@gmail.com 8411017578 OTH

Income Tax Ward / Circle Return filed under section
12 - After DueDt 139(4)
Whether Person governed by Portuguese Civil Code under section 5A ? Enter PAN of Spouse
No if applicable

Whether Original or
FILING STATUS

Original Tax Status Tax Payable

Revised return?
If Revised/Defective, then Enter Receipt Date of Filing
Number of Original Return Original Return
If filed in response
Notice No (Where the Original Return filed to a notice u/s
was defective and a notice is issued to the 139(9)/142(1)/148/15
assessee to file a fresh return Sec 139(9) 3A/153C enter date
of such notice
Residential Status
RES-Resident
 If Yes, Please provide Aadhaar
Whether you have Aadhaar Number? Yes
Number
1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1 1236358

2 Income from One House Property Self Occupied 2 -200000

3 Income from Other Sources (Ensure to fill Sch TDS2) 3

4 Gross Total Income (1+2+3) 4 1036358
5 Deductions under Chapter VI A (Section) System Calculated
a 80 C 5a 150000 150000
b 80 CCC 5b 0

c 80 CCD (1) 5c 0
INCOME & DEDUCTIONS

d 80 CCD(1B) 5d 0
e 80 CCD (2) 5e 0
f 80 CCG 5f 0
g 80 D 5g 11688 11688
h 80 DD 5h 0
i 80 DDB 5i 0
j 80 E 5j 0
k 80 G 5l 0 0
l 80 GG 5m 0
m 80 GGA 5n 0
n 80 GGC 5o 0
o 80 QQB 5p 0
p 80 RRB 5q 0
q 80 TTA 5r 0
r 80 U 5s 0
6 Total Deductions (Total of 5a to 5r) 6 161688 6 161688
7 Taxable Total Income (4 - 6) 7 874670
8 Tax Payable on Total Income 8 99934
9 Rebate u/s 87A 9 0
10 Tax Payable After Rebate (8-9) 10 99934
11 Surcharge if Taxable Total Income (7) exceeds 1 crore 11 0
12 Education Cess, including secondary and higher education cess on 10+11 12 2998
13 Total Tax,Surcharge and Education Cess (Payable) (10+11+12) 13 102932
14 Relief under Section 89 14
15 Balance Tax after Relief (13-14) 15 102932
a Interest payable u/s 234 A 16a 9680
16 b Interest payable u/s 234 B 16b 11616
c Interest payable u/s 234 C 16c 1789
17 Total Interest u/s 234A 234B 234C 17 23085
18 Total Tax and Interest Payable (15 + 17) 18 126017
 19 Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)]
TDS1
Tax Deduction
Account Number Income under
SI.No Name of the Employer Tax Deducted
(TAN) of the salary
Employer
(1) (2) (3) (4)
PNEP00909G PERSISTENT SYSTEMS 701153 8359
1
LIMITED
MUMT11446B TATA CONSULTANCY 662845 44975
2 SERVICES LIMITED
MUMT05749C TATA CONSULTANCY 11750 1175
SERVICES EMPLOYEES
3 PROVIDENT FUND
4
Total 1375748 54509
                                     (Do Not Delete Blank Rows)

20 Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)]
TDS2
SI.No If covered by
Tax Deduction
Portuguese Civil
Account Number Unique TDS Amount out of (5)
Name of the Deductor Deducted Year Tax Deducted Code, Amount
(TAN) of the Certificate No. claimed this year
claimed in the
Deductor
hands of spouse
(1) (2) (3) (4) (5) (6) (7)
1 (Select)
2 (Select)
3 (Select)
4 (Select)
Total 0
                                        (Do Not Delete Blank Rows)
 21 IT Details of Advance Tax and Self Assessment Tax Payments
Date of Deposit
BSR Code Challan No Tax Paid
Sl.No (DD/MM/YYYY)
(1) (2) (3) (4)
1
2
3
4
Total 0
                                         (Do Not Delete Blank Rows)