INDIAN INCOME TAX RETURN Assessment Year

FORM
[For Individuals having Income from Salary/ Pension/ family pension) &
ITR-1 Interest]
(Please see Rule 12 of the Income-tax Rules,1962) 2008 - 09
(Also see attached instructions)

First name Middle name Last name PAN

PERSONAL INFORMATION

Flat/Door/Block No Name Of Premises/Building/Village Date of Birth (DD/MM/YYYY)

/ /
Road/Street/Post Office Area/Locality Employer Category (Tick);
† Govt † PSU † Others
Town/City/District State Pin code Sex (Tick) ;
† Male † Female
Email Address (STD code)-Phone Number ( )
Designation of Assessing Officer (Ward/Circle) Return filed under Section -
FILING STATUS

[Please see instruction number-9(i)]

Whether original or Revised return? (Tick) ; † Original † Revised
If revised, enter Receipt No and Date of filing original
return (DD/MM/YYYY) / /
Residential Status (Tick) ; † Resident † Non-Resident † Resident but Not Ordinarily Resident
1 Income chargeable under the Head ‘Salaries’(Salary/ Pension) 1
2 Income chargeable under the Head ‘Other Sources’
a Family pension 2a
b Interest 2b
c Total (2a+2b) 2c
INCOME & DEDUCTIONS

3 Gross Total Income (1+2c) 3

4 Deductions under chapter VI A (Section)
a 80C e 80DD i 80GG
b 80CCC f 80DDB j 80GGA
c 80CCD g 80E k 80GGC
d 80D h 80G l 80U
m Deductions (Total of a to l) 4m
5 Total Income (3-4m) 5
6 Net Agricultural Income (Enter only if greater than Rs 5,000) 6
7 ‘Aggregate Income’ (5+6) 7
8 a Tax Payable on ‘Aggregate Income’ 8a
b Rebate in respect of Net Agricultural income 8b
TAX COMPUTATION

9 a Tax Payable on Total Income( 8a-8b) 9a

b Surcharge on 9a 9b
Education cess, including secondary and higher
c 9c
education cess on (9a+9b)
d Total Tax, Surcharge and Education Cess Payable (9a+9b+9c) 9d
10 Relief under Section 89 10
11 Relief under Section 90/91 11
12 Balance Tax Payable (9d-10-11) 12
Do not write or stamp in this area (Space for bar code) 13 a Interest Payable U/s 234A 13a
b Interest Payable U/s 234B 13b
c Interest Payable U/s 234C 13c
Total Interest Payable
d 13d
(13a+13b+13c)
Total Tax and Interest Payable
14 14
(12+13d)
For Office Use Only Seal and Signature of receiving official

Receipt No

Date
 15 Taxes Paid
TAXES PAID
a Advance Tax (from item 23) 15a
b TDS (column 7 of item 21 +column 7 of item 22) 15b
c Self Assessment Tax (from item 23) 15c
d Total Taxes Paid (15a+15b+15c) 15d
16 Tax Payable (14-15d) (Enter if 14 is greater than 15d, else leave blank) 16
17 Refund (15d-14) (enter if 15d is greater than 14, also give Bank Account details below) 17
18 Enter your bank account number (mandatory in case of refund)
REFUND

19 Do you want your refund by † cheque, or † deposited directly into your bank account? (tick as applicable ; )
20 In case of direct deposit to your bank account give additional details
MICR Code Type of Account (tick as applicable ; ) † Savings † Current

21 Details of Tax Deducted at Source from Salary [As per Form 16 issued by Employer(s)]
Sl Tax Deduction Account Name and address of the Employer Income Deduction Tax payable Total tax Tax payable/
No Number (TAN) of the chargeable under (incl. surch. deducted refundable
TDS ON SALARY

Employer under the Chapter VI-A and edn. cess)

head Salaries
(1) (2) (3) (4) (5) (6) (7) (8)
i

ii

22 Details of Tax Deducted at Source on Interest [As per Form 16 A issued by Deductor(s)]
Sl Tax Deduction Account Name and address of the Deductor Amount paid/ Date of Payment Total tax Amount out of
No Number (TAN) of the credited / Credit deducted (6) claimed for
Deductor this year
(1) (2) (3) (4) (5) (6) (7)
TDS ON INTEREST

ii

iii

NOTE ► Enter the total of column (7) of 21 and column (7) of 22 in Sl No. 15b of TAXES PAID

23 Details of Advance Tax and Self Assessment Tax Payments

Sl Name of Bank & Branch BSR Code Date of Deposit Serial Number of Amount (Rs)
No (DD/MM/YYYY) Challan
TAX PAYMENTS

i
ii
iii
iv
v
NOTE ► Enter the totals of Advance tax and Self Assessment tax in Sl No. 15 a and 15c of TAXES PAID

24 Other Information (transactions reported through Annual Information Return) (Please see instruction number-9(ii) for code)
Sl Code Amount (Rs) Sl Code Amount (Rs) Sl Code Amount (Rs)
a 001 d 004 g 007
b 002 e 005 h 008
c 003 f 006

25 Tax-exempt interest income (for reporting purposes only) 25

VERIFICATION
I, son/ daughter of solemnly
declare that to the best of my knowledge and belief, the information given in the return thereto is correct and complete and that the amount of total
income and other particulars shown therein are truly stated and are in accordance with the provisions of the Income-tax Act, 1961, in respect of
income chargeable to Income-tax for the previous year relevant to the Assessment Year 2008-09.

Place Date Sign here Î

26 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 (to be filled by TRP) 27