Government of India

INCOME-TAX DEPARTMENT ACKNOWLEDGEMENT

Received with thanks from _______________________________________________________________ a return of income in Form No. ITR for assessment year 2010-11, having the following particulars.
Name
PERSONALINFORMATION

PAN

Flat/Door/Block No

Name Of Premises/Building/Village

Road/Street/Post Office

Area/Locality

Town/City/District

State

Status (fill the code) Original or Revised

1 2 3 3a 4 5 6

Designation of Assessing Officer (Ward/ Circle)

1 2 3

Gross total income Deductions under Chapter-VI-A Total Income

3a Current Year loss (if any) COMPUTATION OF INCOME AND TAX THEREON 4 5 6

Net tax payable Interest payable Total tax and interest payable Taxes Paid a b c d e Advance Tax TDS TCS Self Assessment Tax Total Taxes Paid (7a+7b+7c +7d) 7a 7b 7c 7d

7e 8 9 Seal and Signature of receiving official

8 9 Receipt No Date

Tax Payable (6-7e) Refund (7e-6)