FORM

ITR-5
r
INDIAN INCOME
RETURN
[For firms, AOPs and BOIs]
(Plas s R!l "# of $% In&om-$a'
- " (
Par$ A-)EN )ENERA*
Nam PAN
Is $%r an+ &%an, in $% nam- If +s, .las f!rnis% $% old nam
Fla$/Door/Blo&0 No Nam of Prmiss/B!ildin,/1illa, Da$ of forma$ion
Page 1 of #2
(DDMMYYYY)
PER3ONA* INFORMATION
?
Road/3$r$/Pos$ Offi& Ara/*o&ali$+ 3$a$!s (firm-1, local
authority- 2, cooperative bank-
3, other cooperative society-4,
LLP-5, any other AOP!O"
artificial #uri$ical person-% &
To4n/Ci$+/Dis$ri&$ 3$a$ Pin &od In&om Ta' 5ard/Cir&l
Co!n$r+
Offi& P%on N!m6r 4i$% 3TD &od/ Mo6il No7 " Mo6il No7 #
Email Addrss -"
Email Addrss -#
R$!rn fild (Tick)'Please see instruction number-%( ?Bfor d! da$ -"89(": ??Af$r d! da$ -"89((: ??R;isd R$!rn-
"89(5: OR In rs.ons $o no$i& ??"89(9:- Df&$i; ??"(#(": ??"(< ??"58A ??"58C
OR ??9#CD
/ /
If revised/in response to notice for Defective, then enter
Receipt No and Date of filing original
return(DD/MM/YYYY)
Rsidn$ial 3$a$!s (Tick) ? ??Rsidn$ ??Non-Rsidn$
FI*IN) 3TATU3
5%$%r an+ in&om in&l!dd in $o$al in&om for 4%i&% &laim !/s 9=/9=A/9" %as 6n mad[applicale onl! in case of resident" ??>s ??
No [If +s, ns!r $o fill 3&%d!l F3I and 3&%d!l TR]
In $% &as of non-rsidn$, is $%r a .rmann$ s$a6lis%mn$ (PE: in India (Tick) ? ??>s ??No
5%$%r $%is r$!rn is 6in, fild 6+ a r.rsn$a$i; assss- (Tick) ? ??>s ??
No If +s, .las f!rnis% follo4in, informa$ion -
(a) Nam of $% r.rsn$a$i;
(b) Addrss of $% r.rsn$a$i;
( &: Prmann$ A&&o!n$ N!m6r (PAN: of $% r.rsn$a$i;
For Offi& Us Onl+ )eceipt *o
+ate
,eal an$ ,i-nature of receivin- official
Page 2 of #2
AUDIT
INFORMAT
ION
a
5%$%r lia6l $o main$ain a&&o!n$s as .r s&$ion ((AA- (Tick) ? ??>s ??No
6
5%$%r lia6l for a!di$ !ndr s&$ion ((AB- (Tick) ? ??>s ??No
&
If (6: is >s, 4%$%r $% a&&o!n$s %a; 6n a!di$d 6+ an a&&o!n$an$- (Tick) ? ??>s
??No If >s,
(i
:
Da$ of f!rnis%in, of $% a!di$ r.or$ (DD/MM/>>>>: / /
(ii
:
Nam of $% a!di$or si,nin, $% $a' a!di$ r.or$
(ii
i:
Mm6rs%i. no7 of $% a!di$or
(i
;:
Nam of $% a!di$or (.ro.ri$ors%i./ firm:
(;
:
Prmann$ A&&o!n$ N!m6r (PAN: of $% a!di$or (.ro.ri$ors%i./ firm:
(;
i:
Da$ of a!di$ r.or$
d If lia6l $o f!rnis% o$%r a!di$ r.or$, mn$ion $% da$ of f!rnis%in, of $% a!di$ r.or$- (DD/MM/YY) (#lease see Instruction $(ii))
9#E ""5?
C
PARTNER3/
MEMBER3
INFORMAT
ION
A
5%$%r $%r 4as an+ &%an, d!rin, $% .r;io!s +ar in $% .ar$nrs/mm6rs of $% firm/AOP/BOI (Tick) ???>s
??No (In &as of so&i$is and &oo.ra$i; 6an0s ,i; d$ails of Mana,in, Commi$$:
B
Is an+ mm6r of $% AOP/BOI a fori,n &om.an+- (Tick) ? ??>s ??No
C
If >s, mn$ion $% .r&n$a, of s%ar of $% fori,n &om.an+ in $% AOP/BOI ???
D
5%$%r $o$al in&om of an+ mm6r of $% AOP/BOI ('&l!din, %is s%ar from s!&% asso&ia$ion or 6od+: '&ds
$% ma'im!m amo!n$ 4%i&% is no$ &%ar,a6l $o $a' in $% &as of $%a$ mm6r- (Tick) ???>s ??No
E
Par$i&!lars of .rsons 4%o 4r .ar$nrs/ mm6rs in $% firm/AOP/BOI on 8"
s$
da+ of Mar&%, #="8
37N
o7
Nam and Addrss
Pr&n$a, of s%ar (if
d$rmina$:
PAN
3$a$!s
(see instruction
no% $)
NAT
URE
OF
BU3I
NE3
3
Na$!r of 6!sinss or .rofssion, if mor $%an on 6!sinss or .rofssion indi&a$ $% $%r main a&$i;i$is/ .rod!&$s
37No7
Cod
'Please see instruction
*o.&/i&(
Ds&ri.$ion
(
i
:
(
ii
:
(
ii
i
Par$ A-B3
3
O
U
R
C
E
3

O
A 3o!r&s of F!nds
" Par$nrs@ / mm6rs@ f!nd
a Par$nrs@ / mm6rs@ &a.i$al
a
6 Rsr;s and 3!r.l!s
i R;al!a$ion Rsr; 6
i
BA*ANCE 3AEET A3 ON 8"
3T
DA> OF MARCA, #="8 /fill items A an$ ! in a case 0here re-ular books of
9#
accounts are maintaine$, other0ise fill item 1&
i
i
Ca.i$al Rsr; 6
i
ii
i
3$a$!$or+ Rsr; 6
i
i
;
An+ o$%r Rsr; 6
i
; Crdi$ 6alan& of Profi$ and loss a&&o!n$ 6
;
;
i
To$al (6i B 6ii B 6iii B 6i; B 6;:
6
;
& To$al .ar$nrs@/ mm6rs@ f!nd (a B 6;i:
"
&
# *oan f!nds
a 3&!rd loans
i Fori,n C!rrn&+ *oans a
i
i
i
R!. *oans
A From Ban0s i
i
B From o$%rs i
i
C To$al ( iiA B iiB: i
i
i
i
To$al s&!rd loans (ai B iiC:
a
i
6 Uns&!rd loans (in&l!din, d.osi$s:
i Fori,n C!rrn&+ *oans 6
i
i
i
R!. *oans
A From Ban0s i
i
B
From .rsons s.&ifid in s&$ion (=A(#:
(6: of $% I7 T7 A&$
i
i
C From o$%rs i
i
D To$al R!. *oans ( iiA B iiB B iiC: i
i
i
i
To$al !ns&!rd loans (6i B iiD:
6
ii
& To$al *oan F!nds (aiii B 6iii:
#
&
8 Dfrrd $a' lia6ili$+
8
( Ad;an&s
i
From .rsons s.&ifid in s&$ion (=A(#:(6: of $% I7
T7 A&$
i
i
i
From o$%rs i
i
i
i
To$al Ad;an&s (i B ii:
(
ii
5 3o!r&s of f!nds ("& B #& B8 B (iii : 5
APP*ICATION
FUND3
B A..li&a$ion of f!nds
" Fi'd ass$s
a )rossC Blo&0 "
a
6 D.r&ia$ion "
6
& N$ Blo&0 (a D 6: "
&
d Ca.i$al 4or0-in-.ro,rss "
d
To$al ("& B "d:
"

# In;s$mn$s
a *on,-$rm in;s$mn$s
i In;s$mn$ in .ro.r$+ i
i
i
EE!i$+ ins$r!mn$s
A *is$d E!i$is i
i
B Unlis$d E!i$is i
i
C To$al i
i
i
i
Prfrn& s%ars i
i
i
;
)o;rnmn$ or $r!s$ s&!ri$is i
;
; D6n$!r or 6onds ;
;
i
M!$!al f!nds ;
i
;
ii
O$%rs ;
i
;
ii
To$al *on,-$rm in;s$mn$s (i B iiC B iii B i; B ; B ;i B ;ii:
a
;
6 3%or$-$rm in;s$mn$s
i EE!i$+ ins$r!mn$s
A *is$d E!i$is
iA
B Unlis$d E!i$is
iB
C To$al
iC
ii Prfrn& s%ars
ii
iii )o;rnmn$ or $r!s$ s&!ri$is
iii
iv D6n$!r or 6onds
i;
v M!$!al f!nds
;
vi O$%rs
;i
;ii To$al 3%or$-$rm in;s$mn$s (iC B ii B iii B i; B ; B ;i:
6;ii
& To$al in;s$mn$s (a;iii B 6;ii:
#&
8
C!rrn$ ass$s, loans and ad;an&s
a
C!rrn$ ass$s
i
In;n$oris
ARa4 ma$rials
iA
B5or0-in-.ro,rss
iB
C Finis%d ,oods
iC
D
3$o&0-in-$rad (in rs.&$ of ,oods a&E!ird
for $radin,:
iD
E
3$ors/&ons!ma6ls in&l!din, .a&0in,
ma$rial
iE
F *oos $ools
iF
GO$%rs
i)
HTo$al (iA B iB B iC B iD B iE B iF B i):
iA
ii
3!ndr+ D6$ors
A O!$s$andin, for mor $%an on +ar
iiA B
O$%rs iiB
C To$al 3!ndr+ D6$ors
iiC
iii
Cas% and 6an0 6alan&s
ABalan& 4i$% 6an0s
iiiA
BCas%-in-%and
iiiB
C O$%rs
iiiC
DTo$al Cas% and &as% E!i;aln$s (iiiA B iiiB B iiiC:
iiiD
i;
O$%r C!rrn$ Ass$s
ai;
;
To$al &!rrn$ ass$s (iA BiiC B iiiD B ai;:
a;
6
*oans and ad;an&s
i
Ad;an&s r&o;ra6l in &as% or in 0ind or for
;al! $o 6 r&i;d
6i
ii
D.osi$s, loans and ad;an&s $o &or.ora$ and
o$%rs
6ii
iii Balan& 4i$% R;n! A!$%ori$is
6iii
iv To$al (6i B 6ii B 6iii:
6i;
v *oans and ad;an&s in&l!dd in 6i; 4%i&% is
a for $% .!r.os of 6!sinss or .rofssion ;a
6 no$ for $% .!r.os of 6!sinss or .rofssion
;6
c To$al (a; B 6i;:
8&
d C!rrn$ lia6ili$is and
.ro;isions i C!rrn$
lia6ili$is
A3!ndr+ Crdi$ors
1 O!$s$andin, for mor $%an on +ar
"
2 O$%rs
#
3 To$al (" B #:
A8
B *ia6ili$+ for lasd ass$s
iB
C In$rs$ A&&r!d and d! on 6orro4in,s i
C
D In$rs$ a&&r!d 6!$ no$ d! on 6orro4in,s i
D
E In&om r&i;d in ad;an& i
E
F O$%r .a+a6ls i
F
) To$al (A8 B iB B iC B iD B iE B iF:
i
)
i
i
Pro;isions
A Pro;ision for In&om Ta' i
i
B Pro;ision for 5al$% Ta' i
i
C
Pro;ision for *a;
n&as%mn$/3!.rann!a$ion/)ra$!i$+
i
i
D O$%r Pro;isions i
i
E To$al (iiA B iiB B iiC B iiD:
i
i
i
i
To$al (iE B iiE:
d
i
N$ &!rrn$ ass$s (8& D diii:
8

( a Mis&llano!s '.ndi$!r no$ 4ri$$n off or

adF!s$d
(
a
6 Dfrrd $a' ass$ (
6
&
D6i$ 6alan& in Profi$ and loss a&&o!n$/
a&&!m!la$d 6alan&
(
&
d To$al ((a B (6 B (&:
(
d
5 To$al, a..li&a$ion of f!nds (" B #& B 8 B(d:
5
N
O
A
C
C
O
U
N
T
C In a &as 4%r r,!lar 6oo0s of a&&o!n$ of 6!sinss or .rofssion ar no$ main$aind, f!rnis%
$% follo4in, informa$ion as on 8"
s$
da+ of Mar&%, #="8, in rs.&$ of 6!sinss or
.rofssion
" Amo!n$ of $o$al s!ndr+ d6$ors
C
"
# Amo!n$ of $o$al s!ndr+ &rdi$ors
C
#
8 Amo!n$ of $o$al s$o&0-in-$rad
C
8
( Amo!n$ of $% &as% 6alan&
C
(
Par$ A-PG
*
" R;n! from o.ra$ions
A 3als/ )ross r&i.$s of 6!sinss (net of returns and refunds and dut! or ta', if an!)
i 3al of ,oods i
i
i
3al of sr;i&s i
i
i
i
O$%r o.ra$in, r;n!s (specif! nature
and a(ount)
a i
i
6 i
i
& To$al (iiia B iii6: i
i
;
i
To$al (i B ii B iii&:
A
i
B
D!$is, $a's and &ss r&i;d or r&i;a6l in rs.&$ of ,oods and sr;i&s sold or
s!..lid
i Union E'&is d!$is i
i
i
3r;i& $a' i
i
i
i
1AT/ 3als $a' i
i
i
;
An+ o$%r d!$+, $a' and &ss i
;
; To$al (i B ii B iii B i;:
B
;
C To$al R;n! from o.ra$ions (Ai; B B;:
"
C
# O$%r in&om
i Rn$ i
i
i
Commission i
i
i
i
Di;idnd in&om i
i
i
;
In$rs$ in&om i
;
; Profi$ on sal of fi'd ass$s ;
;
i
Profi$ on sal of in;s$mn$ 6in, s&!ri$is
&%ar,a6l $o 3&!ri$is Transa&$ion Ta' (3TT:
;
i
CREDIT3 TO PROFIT AND *O33 ACCOUNT
Profi$ and *oss A&&o!n$ for $% finan&ial +ar #="8-"( /fill items 1 to 52 in a case 0here re-ular books of
accounts are maintaine$, other0ise fill item 53&
;
i
Profi$ on sal of o$%r in;s$mn$ ;
i
;
i
Profi$ on a&&o!n$ of &!rrn&+ fl!&$!a$ion ;
i
i
'
A,ri&!l$!ral in&om i
'
' An+ o$%r in&om (specif! nature and a(ount)
a '
a
6 '
6
& To$al ('a B '6: '
&
'
i
To$al of o$%r in&om (i B ii B iii B i; B ; B ;i B ;ii B ;iii B i' B '&:
#
'
8 Closin, 3$o&0
i Ra4 ma$rial 8
i
i
i
5or0-in-.ro,rss 8
i
i
i
Finis%d ,oods 8
i
To$al (8i B 8ii B 8iii:
8
i
( To$al of &rdi$s $o .rofi$ and loss a&&o!n$ (" B #'i B 8i;:
(
D
EB
IT
3
T
O
PR
O
FI
T
A
N
D
*
O3
3
A
C
C
O
U
N
T
5 O.nin, 3$o&0
i Ra4 ma$rial 5
i
i
i
5or0-in-.ro,rss 5
i
i
i
Finis%d ,oods 5
i
i
;
To$al (5i B 5ii B 5iii:
5
i
H P!r&%ass (n$ of rf!nds and d!$+ or $a', if an+:
H
2 D!$is and $a's, .aid or .a+a6l, in rs.&$ of ,oods and sr;i&s .!r&%asd
i C!s$om d!$+ 2
i
i
i
Co!n$r ;ilin, d!$+ 2
i
i
i
3.&ial addi$ional d!$+ 2
i
i
;
Union '&is d!$+ 2
i
; 3r;i& $a' 2
;
;
i
1AT/ 3als $a' 2
;
;
i
An+ o$%r $a', .aid or .a+a6l 2
;
;
i
To$al (2i B 2ii B 2iii B 2i; B 2; B 2;i B 2;ii:
2
;
< Fri,%$ <
9 Cons!m.$ion of s$ors and s.ar .ar$s 9
"
=
Po4r and f!l "
=
"
"
Rn$s "
"
"
#
R.airs $o 6!ildin, "
#
"
8
R.airs $o ma&%inr+ "
8
"
(
Com.nsa$ion $o m.lo+s
i 3alaris and 4a,s "
(
i
i
Bon!s "
(i
i
i
Rim6!rsmn$ of mdi&al '.nss "(
iii
i
;
*a; n&as%mn$ "
(i
; *a; $ra;l 6nfi$s "
(
;
i
Con$ri6!$ion $o a..ro;d s!.rann!a$ion f!nd "
(
;
i
Con$ri6!$ion $o r&o,nisd .ro;idn$ f!nd "(
;ii
;
i
Con$ri6!$ion $o r&o,nisd ,ra$!i$+ f!nd "(
;ii
i
'
Con$ri6!$ion $o an+ o$%r f!nd "
(i
'
An+ o$%r 6nfi$ $o m.lo+s in rs.&$ of 4%i&% an
'.ndi$!r %as 6n in&!rrd
"
(
'
i
To$al &om.nsa$ion $o m.lo+s ("(i B "(ii B "(iii B "(i; B "(; B "(;i B "(;ii B "(;iii B
"(i' B "(':
"
(
'
'
i
5%$%r an+ &om.nsa$ion, in&l!dd in "('i, .aid $o
non-rsidn$s
'i
ia
>s / No
If >s, amo!n$ .aid $o non-rsidn$s 'i
i6
"
5
Ins!ran&
i Mdi&al Ins!ran& "
5
i
i
*if Ins!ran& "
5
i
i
I+man@s Ins!ran& "
5
i
;
O$%r Ins!ran& in&l!din, fa&$or+, offi&, &ar,
,oods, $&7
"
5
; To$al '.ndi$!r on ins!ran& ("5i B "5ii B "5iii B "5i;: "
5
"
H
5or0mn and s$aff 4lfar '.nss "
H
"
2
En$r$ainmn$ "
2
"
<
Aos.i$ali$+ "
<
"
9
Confrn& "
9
#
=
3als .romo$ion in&l!din, .!6li&i$+ (o$%r $%an ad;r$ismn$: #
=
#
"
Ad;r$ismn$ #
"
#
#
Commission
i
To non-rsidn$ o$%r $%an a &om.an+ or a fori,n
&om.an+
i
i
i
To o$%rs i
i
i
i
To$al (i B ii: #
#
#
8
Ro+al$+
i
To non-rsidn$ o$%r $%an a &om.an+ or a fori,n
&om.an+
i
i
i
To o$%rs i
i
i
i
To$al (i B ii: #
8
#
(
Profssional / Cons!l$an&+ fs / F for $&%ni&al sr;i&s
i
To non-rsidn$ o$%r $%an a &om.an+ or a fori,n
&om.an+
i
i
i
To o$%rs i
i
i
i
To$al (i B ii: #
(
#
5
Ao$l, 6oardin, and *od,in, #
5
#
H
Tra;lin, '.nss o$%r $%an on fori,n $ra;lin, #
H
#
2
Fori,n $ra;llin, '.nss #
2
#
<
Con;+an& '.nss #
<
#
9
Tl.%on '.nss #
9
8
=
)!s$ Ao!s '.nss 8
=
8
"
Cl!6 '.nss 8
"
8
#
Fs$i;al &l6ra$ion '.nss 8
#
8
8
3&%olars%i. 8
8
8
(
)if$ 8
(
8
5
Dona$ion 8
5
8
H
Ra$s and $a's, .aid or .a+a6l $o )o;rnmn$ or an+ lo&al 6od+ ('&l!din, $a's on
in&om:
i Union '&is d!$+ 8
H
i
i
3r;i& $a' 8
H
i
i
1AT/ 3als $a' 8
H
i
;
Css 8
H
; An+ o$%r ra$, $a', d!$+ or &ss in&l 3TT 8
H
;
i
To$al ra$s and $a's .aid or .a+a6l (8Hi B 8Hii B 8Hiii B 8Hi; B 8H;: 8
H
8
2
A!di$ f 8
2
8
<
O$%r '.nss (specif! nature and a(ount)
i i
i
i
i
i
i
i
To$al (i B ii: 8
<
8
9
Bad d6$s (specif! #)N of the person, if availale, for *ho( +ad Det for a(ount of Rs% , lakh or
(ore is clai(ed and a(ount)
i 8
9
i
i
8
9
i
i
8
9i
i
;
O$%rs (mor $%an Rs7 " la0%:
4%r PAN is no$ a;aila6l
8
9i
; O$%rs (amo!n$s lss $%an Rs7 " la0%: 8
9
;
i
To$al Bad D6$ (89i B 89ii B 89iii B 89i; B 89;: 8
9
(
=
Pro;ision for 6ad and do!6$f!l d6$s (
=
(
"
O$%r .ro;isions (
"
(
#
Profi$ 6for in$rs$, d.r&ia$ion and $a's [( D (5i; B H B 2;iii B < $o "8 B "('i B "5; B "H $o
#"
(
#
(
8
In$rs$
i
To non-rsidn$ o$%r $%an a &om.an+ or a
fori,n &om.an+
i
i
i
To o$%rs i
i
i
i
To$al (i B ii: (
8
(
(
D.r&ia$ion (
(
(
5
Profi$ 6for $a's ((# D (8iii D ((: (
5
P
R
O
1
I
3
I
O
N
3

(
H
Pro;ision for &!rrn$ $a' (
H
(
2
Pro;ision for Dfrrd Ta' and dfrrd lia6ili$+ (
2
(
<
Profi$ af$r $a' ((5 - (H - (2: (
<
(
9
Balan& 6ro!,%$ for4ard from .r;io!s +ar (
9
5
=
Amo!n$ a;aila6l for a..ro.ria$ion ((< B (9: 5
=
5
"
Transfrrd $o rsr;s and s!r.l!s 5
"
5
#
Balan& &arrid $o 6alan& s%$ in .ar$nr@s a&&o!n$ (5= D5":
5
#
NO
A
C
C
O
U
N
T

5
8
In a &as 4%r r,!lar 6oo0s of a&&o!n$ of 6!sinss or .rofssion ar no$ main$aind,
f!rnis% $% follo4in, informa$ion for .r;io!s +ar #="#-"8 in rs.&$ of 6!sinss or
.rofssion a
)ross r&i.$s
5
8
6
)ross .rofi$
5
8
&
E'.nss
5
8
d
N$ .rofi$
5
8
Par$ A- OI
O
T
A
E
R

I
N
F
O
R
M
A
T
I
O
N
"
M$%od of a&&o!n$in, m.lo+d in $% .r;io!s +ar (Tick) ? ??mr&an$il ??&as%
#
Is $%r an+ &%an, in m$%od of a&&o!n$in, (Tick) ? ??>s ??No
8
Eff&$ on $% .rofi$ 6&a!s of d;ia$ion, if an+, in $% m$%od of a&&o!n$in, m.lo+d in
$% .r;io!s +ar from a&&o!n$in, s$andards .rs&ri6d !ndr s&$ion "(5A
8
( M$%od of ;al!a$ion of &losin, s$o&0 m.lo+d in $% .r;io!s +ar
a Ra4 Ma$rial (if a$ &os$ or mar0$ ra$s 4%i&%;r is lss 4ri$ ", if a$ &os$ 4ri$ #, if a$ mar0$ ra$ 4ri$ 8:
?
6 Finis%d ,oods (if a$ &os$ or mar0$ ra$s 4%i&%;r is lss 4ri$ ", if a$ &os$ 4ri$ #, if a$ mar0$ ra$ 4ri$ 8:
?
& Is $%r an+ &%an, in s$o&0 ;al!a$ion m$%od (if >s 4ri$ ", and if No 4ri$ #:
?
d Eff&$ on $% .rofi$ or loss 6&a!s of d;ia$ion, if an+, from $% m$%od of ;al!a$ion
.rs&ri6d !ndr s&$ion "(5A
(
d
5
Amo!n$s no$ &rdi$d $o $% .rofi$ and loss a&&o!n$, 6in,
a
$% i$ms fallin, 4i$%in $% s&o. of s&$ion #<
5
a
6
$% .roforma &rdi$s, dra46a&0s, rf!nd of d!$+ of
&!s$oms or '&is or sr;i& $a', or rf!nd of sals
$a' or ;al! addd $a', 4%r s!&% &rdi$s,
dra46a&0s or rf!nds ar admi$$d as d! 6+ $%
a!$%ori$is &on&rnd
5
6
&
s&ala$ion &laims a&&.$d d!rin, $% .r;io!s
+ar
5
&
d
An+ o$%r i$m of in&om
5
d

Ca.i$al r&i.$, if an+

5

f
To$al of amo!n$s no$ &rdi$d $o .rofi$ and loss a&&o!n$ (5aB56B5&B5dB5:
5
f
H
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o $% '$n$
a
Prmi!m .aid for ins!ran& a,ains$ ris0 of
dama, or ds$r!&$ion of s$o&0s or s$or
H
a
O$%r Informa$ion /optional in a case not liable for au$it un$er section 44A!&
6
Prmi!m .aid for ins!ran& on $% %al$% of
m.lo+s
H
6
&
An+ s!m .aid $o an m.lo+ as 6on!s or
&ommission for sr;i&s rndrd, 4%r s!&%
s!m 4as o$%r4is .a+a6l $o %im as .rofi$s or
H
&
d
An+ amo!n$ of in$rs$ .aid in rs.&$ of
6orro4d &a.i$al
H
d

Amo!n$ of dis&o!n$ on a Jro-&o!.on 6ond

H

f
Amo!n$ of &on$ri6!$ions $o a r&o,nisd
.ro;idn$ f!nd
H
f
,
Amo!n$ of &on$ri6!$ions $o an a..ro;d
s!.rann!a$ion f!nd
H
,
%
Amo!n$ of &on$ri6!$ions $o an a..ro;d ,ra$!i$+
f!nd
H
%
i
Amo!n$ of &on$ri6!$ions $o an+ o$%r f!nd
H
i
F
Amo!n$ of 6ad and do!6$f!l d6$s
H
F
0
Pro;ision for 6ad and do!6$f!l d6$s
H
0
l
Amo!n$ $ransfrrd $o an+ s.&ial rsr;
H
l
m
E'.ndi$!r for $% .!r.oss of .romo$in, famil+
.lannin, amon,s$ m.lo+s
H
m
n
An+ s!m r&i;d from m.lo+s as
&on$ri6!$ion $o an+ .ro;idn$ f!nd or
s!.rann!a$ion f!nd or an+ f!nd s$ !. !ndr
E3I A&$ or an+ o$%r f!nd for $% 4lfar of
m.lo+s $o $% '$n$ &rdi$d $o $% m.lo+s
H
n
o An+ o$%r disallo4an&
H
o
. To$al amo!n$ disallo4a6l !ndr s&$ion 8H ($o$al of Ha $o Ho:
H
.
E To$al n!m6r of m.lo+s m.lo+d ((andator! in case the assessee has recogni-ed #rovident
.und)
i d.lo+d in India i
i
i
d.lo+d o!$sid India i
i
i
i
To$al i
i 2
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o $% '$n$
disallo4a6l !ndr s&$ion 82
a E'.ndi$!r of .rsonal na$!rK 2
a
6
E'.ndi$!r on ad;r$ismn$ in an+ so!;nir,
6ro&%!r, $ra&$, .am.%l$ or $% li0, .!6lis%d 6+
a .oli$i&al .ar$+K
2
6
&
E'.ndi$!r 6+ 4a+ of .nal$+ or fin for ;iola$ion
of an+ la4 for $% $im 6in, in for&K
2
&
d
An+ o$%r .nal$+ or finK
2
d

E'.ndi$!r in&!rrd for an+ .!r.os 4%i&% is an

offn& or 4%i&% is .ro%i6i$d 6+ la4K
2

f Amo!n$ of an+ lia6ili$+ of a &on$in,n$ na$!r 2

f
,
An+ o$%r amo!n$ no$ allo4a6l !ndr s&$ion 82
2
,
% To$al amo!n$ disallo4a6l !ndr s&$ion 82($o$al of 2a $o 2,: 2
% <
A
7
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o $% '$n$ disallo4a6l !ndr s&$ion
(=
a
Amo!n$ disallo4a6l !ndr s&$ion (= (a:
(i:, (=(a:(ia: and (=(a:(iii: on a&&o!n$ of
non- &om.lian& 4i$% $% .ro;isions of
C%a.$r L1II-B
A
a
6
Amo!n$ of $a' or ra$ l;id or assssd on
$% 6asis of .rofi$s
A
6
&
Amo!n$ .aid as 4al$% $a'
A
&
d
Amo!n$ of in$rs$, salar+, 6on!s,
&ommission or rm!nra$ion .aid $o an+
.ar$nr or mm6r
A
d

An+ o$%r disallo4an&

A

f
To$al amo!n$ disallo4a6l !ndr s&$ion (=($o$al of Aa $o A: <
A
B
7
An+ amo!n$ disallo4d !ndr s&$ion (= in an+ .r&din, .r;io!s +ar 6!$ allo4a6l
d!rin, $% .r;io!s +ar
<
B
9
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o $% '$n$
disallo4a6l !ndr s&$ion (=A
a
Amo!n$s .aid $o .rsons s.&ifid in s&$ion
(=A(#:(6:
9
a
6
Amo!n$ .aid o$%r4is $%an 6+ a&&o!n$ .a+
&%E! or a&&o!n$ .a+ 6an0 draf$ disallo4a6l
!ndr s&$ion (=A(8: D "==M disallo4an&
9
6
NUANTITATI1E DETAI*3
&
Pro;ision for .a+mn$ of ,ra$!i$+
9
&
d
an+ s!m .aid 6+ $% assss as an m.lo+r for
s$$in, !. or as &on$ri6!$ion $o an+ f!nd, $r!s$,
&om.an+, AOP, or BOI or so&i$+ or an+ o$%r
ins$i$!$ionK
9
d

An+ o$%r disallo4an&

9

f
To$al amo!n$ disallo4a6l !ndr s&$ion (=A ($o$al of 9a $o 9:
9
f
"=
An+ amo!n$ disallo4d !ndr s&$ion (8B in an+ .r&din, .r;io!s
+ar 6!$ allo4a6l d!rin, $% .r;io!s +ar
a
An+ s!m in $% na$!r of $a', d!$+, &ss or f
!ndr an+ la4
"
=
6
An+ s!m .a+a6l 6+ 4a+ of &on$ri6!$ion $o an+
.ro;idn$ f!nd or s!.rann!a$ion f!nd or
,ra$!i$+ f!nd or an+ o$%r f!nd for $% 4lfar of
"
=
6
&
An+ s!m .a+a6l $o an m.lo+ as 6on!s or
&ommission for sr;i&s rndrd
"
=
d
An+ s!m .a+a6l as in$rs$ on an+ loan or
6orro4in, from an+ .!6li& finan&ial ins$i$!$ion or
a 3$a$ finan&ial &or.ora$ion or a 3$a$ Ind!s$rial
in;s$mn$ &or.ora$ion
"
=
d

An+ s!m .a+a6l as in$rs$ on an+ loan or

6orro4in, from an+ s&%d!ld 6an0
"
=
f
An+ s!m .a+a6l $o4ards la; n&as%mn$
"
=
,
To$al amo!n$ allo4a6l !ndr s&$ion (8B ($o$al of "=a $o "=f:
"
=
"
"
An+ amo!n$ d6i$d $o .rofi$ and loss a&&o!n$ of $% .r;io!s +ar 6!$ disallo4a6l !ndr
s&$ion (8BC-
a
An+ s!m in $% na$!r of $a', d!$+, &ss or f
!ndr an+ la4
"
"
6
An+ s!m .a+a6l 6+ 4a+ of &on$ri6!$ion $o an+
.ro;idn$ f!nd or s!.rann!a$ion f!nd or
,ra$!i$+ f!nd or an+ o$%r f!nd for $% 4lfar of
"
"
6
&
An+ s!m .a+a6l $o an m.lo+ as 6on!s
or &ommission for sr;i&s rndrd
"
"
d
An+ s!m .a+a6l as in$rs$ on an+ loan or
6orro4in, from an+ .!6li& finan&ial ins$i$!$ion or
a 3$a$ finan&ial &or.ora$ion or a 3$a$ Ind!s$rial
in;s$mn$ &or.ora$ion
"
"
d

An+ s!m .a+a6l as in$rs$ on an+ loan or

6orro4in, from an+ s&%d!ld 6an0
"
"
f
An+ s!m .a+a6l $o4ards la; n&as%mn$
"
"
,
To$al amo!n$ disallo4a6l !ndr 3&$ion (8B($o$al of ""a $o ""f: "
"
"
#
Amo!n$ of &rdi$ o!$s$andin, in $% a&&o!n$s in rs.&$ of
a
Union E'&is D!$+
"
#
6
3r;i& $a'
"
#
&
1AT/sals $a'
"
#
d
An+ o$%r $a'
"
#

To$al amo!n$ o!$s$andin, ($o$al of "#a $o "#d:

"
#
"
8
Amo!n$s dmd $o 6 .rofi$s and ,ains !ndr s&$ion 88AB or 88ABA or 88AC
"
8
"
(
An+ amo!n$ of .rofi$ &%ar,a6l $o $a' !ndr s&$ion ("
"
(
"
5
Amo!n$ of in&om or '.ndi$!r of .rior .riod &rdi$d or d6i$d $o $% .rofi$ and loss
a&&o!n$ (n$:
"
5
Par$ A D ND N!an$i$a$i; d$ails /optional in a case not liable for au$it un$er section 44A!&
(
a
In $% &as of a $radin, &on&rn
"
O.nin, s$o&0
"
#
P!r&%as d!rin, $% .r;io!s +ar
#
8
3als d!rin, $% .r;io!s +ar
8
(
Closin, s$o&0
(
5 3%or$a,/ '&ss, if an+ 5
(
6
In $% &as of a man!fa&$!rin, &on&rn
H Ra4 ma$rials
a
O.nin, s$o&0
H
a
TOTA* INCOME
6
P!r&%ass d!rin, $% .r;io!s +ar
H
6
&
Cons!m.$ion d!rin, $% .r;io!s +ar
H
&
d
3als d!rin, $% .r;io!s +ar
H
d
Closin, s$o&0 H

f
>ild finis%d .rod!&$s
H
f
,
Pr&n$a, of +ild
H
,
%
3%or$a,/ '&ss, if an+
H
%
2
Finis%d .rod!&$s/ B+-.rod!&$s
a
o.nin, s$o&0
2
a
6
.!r&%as d!rin, $% .r;io!s +ar
2
6
&
E!an$i$+ man!fa&$!rd d!rin, $% .r;io!s +ar
2
&
d
sals d!rin, $% .r;io!s +ar
2
d

&losin, s$o&0
2

f
s%or$a,/ '&ss, if an+
2
f
Par$ B - TI
" In&om from %o!s .ro.r$+ /4c of ,che$ule-2P& /enter nil if loss& "
#
Profi$s and ,ains from 6!sinss or .rofssion
i Profi$s and ,ains from 6!sinss o$%r $%an s.&!la$i;
6!sinss and s.&ifid 6!sinss /A33 of ,che$ule-!P&
/enter nil if loss&
#
i
i
i
Profi$s and ,ains from s.&!la$i; 6!sinss /!41 of
,che$ule !P& /enter nil if loss an$ carry this fi-ure to ,che$ule
14L&
#
i
i i
i
Profi$s and ,ains from s.&ifid 6!sinss /143 of
,che$ule !P& /enter nil if loss an$ carry this fi-ure to ,che$ule
14L&
#
i
i
;
To$al (#i B #ii B #iii: /enter nil, if loss an$ carry this fi-ure of loss to ,che$ule 15LA& #
i
8
Ca.i$al ,ains
a
3%or$ $rm
i
3%or$-$rm (!ndr s&$ion """A: /A2a 6 A3e of
,che$ule-17&
8
a
i
i
3%or$-$rm (o$%rs: /A3-A2a-A3e of ,che$ule-
17&
8
ai
i
i
To$al 3%or$ $rm (8ai B 8aii: 8a
iii
6
*on, $rm
i *on,-$rm 4i$% ind'a$ion [/!3-!4e-!5& of
,che$ule-17(
8
6
i i
i
*on,-$rm 4i$%o!$ ind'a$ion /!4e6 !5 of
,che$ule-17&
8
6i
i
i
i
To$al *on, $rm (86iB86ii: /enter nil if loss an$
take the fi-ure to sche$ule 14L&
8
6i
ii &
To$al Ca.i$al ,ains (8aiii B 86iii: /take the fi-ure a$#uste$ to ,che$ule 15LA&/"n
case of ne-ative fi-ure enter nil an$ take the fi-ure un$er respective hea$ to sche$ule
14L&
8
&
(
In&om from o$%r so!r&s
a from so!r&s o$%r $%an from o4nin, ra& %orss
and 4innin, from *o$$r+ $&7 /1- of ,che$ule
O,&
(
a
6 4innin,s from lo$$ris, &ross4ord .!JJls, ra&s,
,ams, ,am6lin,, 6$$in, $&. /2 of ,che$ule O,&
(
6
& from o4nin, ra& %orss /4c of ,che$ule O,& /enter
nil if loss&
(
&
d To$al ((a B (6 B (&: (enter nil if loss& (
d
5
To$al (" B #i; B 8& B(d: 5
H *osss of &!rrn$ +ar $o 6 s$ off a,ains$ 5 /total of 2i8,3i8 an$ 4i8 of ,che$ule 15LA& H
2 Balan& af$r s$ off &!rrn$ +ar losss (5 D H: /also total of column 5 of sche$ule 15LA 6 4b& 2
< Bro!,%$ for4ard losss $o 6 s$ off losss a,ains$ 2 /total of 2i8, 3i8 an$ 4i8 of ,che$ule !4LA& <
9 )ross To$al in&om (2 D <: /also 58 of ,che$ule !4LA 6 4b& 9
"
=
In&om &%ar,a6l $o $a' a$ s.&ial ra$ !ndr s&$ion """A, ""# $&7 in&l!dd in 9
"
=
"
"
Dd!&$ions !ndr C%a.$r 1I-A / k of ,che$ule 9"A an$ limite$ to :-1;& "
"
"
#
To$al in&om (9 D "":
"
#
"
8
In&om &%ar,a6l $o $a' a$ s.&ial ra$s ($o$al of (i: of s&%d!l 3I:
"
8
Com.!$a$ion of $o$al in&om
"
(
N$ a,ri&!l$!ral in&om/ an+ o$%r in&om for ra$ .!r.os /4 of ,che$ule <"& "
(
"
5
A,,r,a$ in&om ("# D "8 B "(: 'applicable if /12-13& e8cee$s ma8imum amount not char-eable to ta8(
"
5
"
H
*osss of &!rrn$ +ar $o 6 &arrid for4ard /total of 8i of ,che$ule 14L& "
H
"
2
Dmd $o$al in&om !ndr s&$ion ""5?C /3 of ,che$ule A=>& "
2
Par$ B - TTI
COMPUTATION
*IABI*IT>
"
a Ta' .a+a6l on dmd $o$al in&om !ndr s&$ion ""5?C (( of 3&%d!l AMT: "
a
6 Ed!&a$ion Css on "a a6o; "
6
& To$al Ta' Pa+a6l "
&
#
Ta' .a+a6l on $o$al in&om
a Ta' a$ normal ra$s on "5 of Par$ B-TI #
a
6 Ta' a$ s.&ial ra$s /total of /ii& of ,che$ule-,"& #
6
& R6a$ on a,ri&!l$!ral in&om 'applicable if /12-13& of
Part !->" e8cee$s ma8imum amount not char-eable to ta8(
#
&
d Ta' Pa+a6l on $o$al in&om (#aB#6 -#&::
#
d
8
Ed!&a$ion &ss, in&l!din, s&ondar+ and %i,%r d!&a$ion &ss on #d
8
(
)ross $a' lia6ili$+ (#d B 8:
(
5
)ross $a' .a+a6l (%i,%r of ( or "&:
5
H
Crdi$ !ndr s&$ion ""5?D of $a' .aid in arlir +ars (if ( is mor $%an "&: (5 of 3&%d!l
AMTC:
H
2
Ta' .a+a6l af$r &rdi$ !ndr s&$ion ""5?D (5-H:
2
<
Ta' rlif
a 3&$ion 9=/9=A ($o$al of "B" of /chedule TR:
<
a
6 3&$ion 9"($o$al of "B# of /chedule TR:
<
6
& To$al (<a B <6:
<
&
9
N$ $a' lia6ili$+ (2 D <&:
9
"
=
In$rs$ .a+a6l
a

6
For dfa!l$ in f!rnis%in, $% r$!rn (s&$ion #8(A:
"
=
For dfa!l$ in .a+mn$ of ad;an& $a' (s&$ion
#8(B:
"
=
& For dfrmn$ of ad;an& $a' (s&$ion #8(C:
"
=
d To$al In$rs$ Pa+a6l ("=aB"=6B"=&:
"
=
"
"
A,,r,a$ lia6ili$+ (9 B "=d:
"
"
TALE
3
PAID
"
#
Ta's Paid
a Ad;an& Ta' /from ,che$ule-">& "
#
6 TD3 /total of column& of ,che$ule->+,& "
#
& TC3 /total of column 0 of ,che$ule->1,& "
#
d 3lf-Assssmn$ Ta' /from ,che$ule-">& "
#
To$al Ta's Paid ("#aB"#6B"#&B"#d:
"
#
"
8
Amo!n$ .a+a6l (1nter if ,, is greater than ,2e, else enter 3)
"
8
"
(
Rf!nd (If ,2e is greater than ,,) (give ank account details in /chedule +))
"
(
Com.!$a$ion of $a' lia6ili$+ on $o$al in&om
3&%d!l BA Plas f!rnis% $% follo4in, informa$ion
"
En$r +o!r 6an0 a&&o!n$ n!m6r ((andator! in all
cases and for direct deposit of refund into ank, the nu(er
should e ,, digits or (ore )
# Do +o! 4an$ +o!r rf!nd 6+ ??&%E!, or ??d.osi$d dir&$l+ in$o +o!r 6an0 a&&o!n$- (tick as applicale ??)
8 )i; addi$ional d$ails of +o!r 6an0 a&&o!n$
IF3C
Cod
T+. of A&&o!n$ (tick as applicale ??)
? Cas% &rdi$ ??C!rrn$ ??3a;in,s
Do +o! %a;,-
(i) an+ ass$ (in&l!din, finan&ial in$rs$ in an+ n$i$+: lo&a$d o!$sid India or
(ii) si,nin, a!$%ori$+ in an+ a&&o!n$ lo&a$d o!$sid India-
[applicale onl! in case of a resident" [1nsure /chedule .) is filed up if the ans*er is Yes "
? >s ?No
1ERIFICATION
I, (full a!e i bloc" le##e$%), %o/ daug&#e$ of
, &oldig 'e$!ae# accou# u!be$ %ole!l( decla$e
#&a# #o #&e be%# of !( "o)ledge ad belief, #&e ifo$!a#io give i #&e $e#u$ ad #&e %c&edule% #&e$e#o i% co$$ec# ad co!'le#e
ad #&a# #&e a!ou# of #o#al ico!e ad o#&e$ 'a$#icula$% %&o) #&e$ei a$e #$ul( %#a#ed ad a$e i acco$dace )i#& #&e '$ovi%io% of
#&e Ico!e-#a* Ac#, 1+,1, i $e%'ec# of ico!e c&a$geable #o ico!e-#a* fo$ #&e '$eviou% (ea$ $eleva# #o #&e a%%e%%!e# (ea$
2-13-1./ I fu$#&e$ decla$e #&a# I a! !a"ig #&i% $e#u$ i !( ca'aci#( a% ad I a! al%o co!'e#e# #o !a"e #&i% $e#u$
ad ve$if( i#/
Pla& Da$ 3i,n %r ?
3&%d!l AP D$ails of In&om from Ao!s Pro.r$+ /Please refer instructions&
Addrss of .ro.r$+ " To4n/ Ci$+ 3$a$ PIN Cod
"
Is $% .ro.r$+ &o-o4nd- ??>s ??No (if O>E3P .las n$r follo4in, d$ails:
Assss@s .r&n$a, of s%ar in $% .ro.r$+
Nam of Co-o4nr(s: PAN of Co-o4nr (s: (o.$ional : Pr&n$a, 3%ar in Pro.r$+
I
II
(Tick)
??
if
l$ o!$
?
Nam of Tnan$ PAN of Tnan$ (o.$ional:
a
Ann!al l$a6l ;al! or rn$ r&i;d or r&i;a6l /hi-her of the t0o, if let out for 0hole of
the year, lo0er of the t0o if let out for part of the year&
"a
b T% amo!n$ of rn$ 4%i&% &anno$ 6 raliJd
"6
c Ta' .aid $o lo&al a!$%ori$is
"&
d To$al ("6 B "&:
"d
e Ann!al ;al! ("a D "d: "
AOU3E PROPERT>
f 8=M of "
"f
g In$rs$ .a+a6l on 6orro4d &a.i$al
",
& To$al ("f B ",: "%
i In&om from %o!s .ro.r$+ " (" D "%: "i
Addrss of .ro.r$+ # To4n/ Ci$+ 3$a$ PIN Cod
#
Is $% .ro.r$+ &o-o4nd- ??>s ??No (if O>E3P .las n$r follo4in, d$ails:
Assss@s .r&n$a, of s%ar in $% .ro.r$+
Nam of Co-o4nr(s: PAN of Co-o4nr (s: (o.$ional : Pr&n$a, 3%ar in Pro.r$+
I
II
(Tick)
??
if
l$ o!$
?
Nam of Tnan$ PAN of Tnan$ (o.$ional:
a
Ann!al l$a6l ;al! or rn$ r&i;d or r&i;a6l /hi-her of the t0o, if let out for 0hole
of
the year, lo0er of the t0o, if let out for part of the year&
#a
6
T% amo!n$ of rn$ 4%i&% &anno$ 6
raliJd
#6
&
Ta' .aid $o lo&al a!$%ori$is
#&
d To$al (#6 B #&:
#d
e Ann!al ;al! (#a D #d:
#
f 8=M of #
#f
g In$rs$ .a+a6l on 6orro4d &a.i$al
#,
& To$al (#f B #,:
#%
i In&om from %o!s .ro.r$+ # (# D #%:
#i
Addrss of .ro.r$+ 8 To4n/ Ci$+ 3$a$ PIN Cod
8
Is $% .ro.r$+ &o-o4nd- ??>s ??No (if O>E3P .las n$r follo4in, d$ails:
Assss@s .r&n$a, of s%ar in $% .ro.r$+
Nam of Co-o4nr(s: PAN of Co-o4nr (s: (o.$ional : Pr&n$a, 3%ar in Pro.r$+
I
I
I
(Tick) ??if l$ o!$ ?
Nam of Tnan$ PAN of Tnan$ (o.$ional:
a
Ann!al l$a6l ;al! or rn$ r&i;d or r&i;a6l /hi-her of the t0o, if let out for 0hole
of the year, lo0er of the t0o, if let out for part of the year&
8
a
6 T% amo!n$ of rn$ 4%i&% &anno$ 6 raliJd
8
6
& Ta' .aid $o lo&al a!$%ori$is
8
&
d To$al (86 B 8&:
8
d
Ann!al ;al! (8a D 8d: 8

f 8=M of 8
8
f
, In$rs$ .a+a6l on 6orro4d &a.i$al
8
,
% To$al (8f B 8,: 8
%
i In&om from %o!s .ro.r$+ 8 (8 D 8%: 8
i
( In&om !ndr $% %ad OIn&om from %o!s .ro.r$+P
a Rn$ of arlir +ars raliJd !ndr s&$ion #5A/AA (
a
6 Arrars of rn$ r&i;d d!rin, $% +ar !ndr s&$ion #5B af$r dd!&$in, 8=M (
6
& To$al ((a B (6 B "i B #i B 8i: (
&
3&%d!l BP
INCOME
PROFE33ION
A
From 6!sinss or .rofssion o$%r $%an s.&!la$i; 6!sinss and s.&ifid 6!sinss
"
Profi$ 6for $a' as .r .rofi$ and loss a&&o!n$ (i$m (5 or i$m 58d of Par$ A-PG* : "
#
a
N$ .rofi$ or loss from s.&!la$i; 6!sinss
in&l!dd in "
#
a
#
6
N$ .rofi$ or loss from 3.&ifid B!sinss !/s
85AD in&l!dd in "(n$r D; si,n in &as of loss:
#
6
8
In&om/ r&i.$s &rdi$d $o .rofi$ and loss
a&&o!n$ &onsidrd !ndr o$%r %ads of in&om
8
(
Profi$ or loss in&l!dd in ", 4%i&% is rfrrd $o in
s&$ion
((AD/((AE/((AF/((B/((BB/((BBA/((BBB/
((D/((DA C%a.$r-LII-)/ Firs$ 3&%d!l of
In&om- $a' A&$
(
5
In&om &rdi$d $o Profi$ and *oss a&&o!n$ (in&l!dd in ":4%i&% is 'm.$
a
s%ar of in&om from firm(s:
5
a
6
3%ar of in&om from AOP/ BOI
5
6
&
An+ o$%r 'm.$ in&om
5
&
d
To$al 'm.$ in&om
5
d
H
Balan& ("D #a-#6 D 8 D ( D 5d: H
2
E'.nss d6i$d $o .rofi$ and loss a&&o!n$
&onsidrd !ndr o$%r %ads of in&om
2
<
E'.nss d6i$d $o .rofi$ and loss a&&o!n$ 4%i&%
rla$ $o 'm.$ in&om
<
9
To$al (2 B <:
9
"
=
AdF!s$d .rofi$ or loss (HB9: "
=
"
"
D.r&ia$ion d6i$d $o .rofi$ and loss a&&o!n$ "
"
"
#
D.r&ia$ion allo4a6l !ndr In&om-$a' A&$
i
D.r&ia$ion allo4a6l !ndr s&$ion 8#(":(ii:
/column % of ,che$ule-+<P&
"
#
i
i
i
D.r&ia$ion allo4a6l !ndr s&$ion 8#(":(i:
(=ake your o0n computation refer Appen$i8-"A
of "> )ules&
"
#
ii
i
i
To$al ("#i B "#ii: "
#
"
8
Profi$ or loss af$r adF!s$mn$ for d.r&ia$ion ("= B"" - "#iii: "
8
"
(
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o
$% '$n$ disallo4a6l !ndr s&$ion 8H (H. of
"
(
"
5
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o
$% '$n$ disallo4a6l !ndr s&$ion 82 (2% of
Par$-OI:
"
5
"
H
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o
$% '$n$ disallo4a6l !ndr s&$ion (= (<Af of
Par$-OI:
"
H
Com.!$a$ion of in&om from 6!sinss or .rofssion
"
2
Amo!n$s d6i$d $o $% .rofi$ and loss a&&o!n$, $o
$% '$n$ disallo4a6l !ndr s&$ion (=A (9f of
Par$-OI:
"
2
"
<
An+ amo!n$ d6i$d $o .rofi$ and loss a&&o!n$ of
$% .r;io!s +ar 6!$ disallo4a6l !ndr s&$ion
(8B ("", of Par$-OI:
"
<
"
9
In$rs$ disallo4a6l !ndr s&$ion #8 of $%
Mi&ro, 3mall and Mdi!m En$r.riss
D;lo.mn$ A&$,#==H
"
9
#
=
Dmd in&om !ndr s&$ion ("
#
=
#
"
Dmd in&om !ndr s&$ion
88AB/88ABA/85ABB/ 2#A/<=AAD/<=-IA
#
"
#
#
An+ o$%r i$m or i$ms of addi$ion !ndr s&$ion
#< $o ((DA
#
#
#
8
An+ o$%r in&om no$ in&l!dd in .rofi$ and loss
a&&o!n$/an+ o$%r '.ns no$ allo4a6l
(in&l!din, in&om from salar+, &ommission, 6on!s
and in$rs$ from firms in 4%i&% assss is a
.ar$nr:
#
8
#
(
To$al ("( B "5 B "H B "2 B "< B "9 B #= B #"B## B#8:
#
(
#
5
Dd!&$ion allo4a6l !ndr s&$ion 8#(":(iii:
#
5
#
H
Amo!n$ of dd!&$ion !ndr s&$ion 85 in '&ss of
$% amo!n$ d6i$d $o .rofi$ and loss a&&o!n$ /item
vii/4& of ,che$ule <,)&
#
H
#
2
An+ amo!n$ disallo4d !ndr s&$ion (= in an+
.r&din, .r;io!s +ar 6!$ allo4a6l d!rin, $%
.r;io!s +ar(<Bof Par$-OI:
#
2
#
<
An+ amo!n$ disallo4d !ndr s&$ion (8B in
an+ .r&din, .r;io!s +ar 6!$ allo4a6l
d!rin, $% .r;io!s +ar("=, of Par$-OI:
#
<
#
9
Dd!&$ion !ndr s&$ion 85AC
a Amo!n$, if an+, d6i$d $o .rofi$ and
loss a&&o!n$
#
9
a
6 Amo!n$ allo4a6l as dd!&$ion
#
9
& E'&ss amo!n$ allo4a6l as dd!&$ion
(#96 D #9a:
#
9
&
8
=
An+ o$%r amo!n$ allo4a6l as dd!&$ion
8
=
8
"
To$al (#5 B #H B #2B#< B#9& B8=:
8
"
8
#
In&om ("8 B #( D 8":
8
# 8
8
Profi$s and ,ains of 6!sinss or .rofssion dmd $o 6 !ndr -
i
3&$ion ((AD
8
8
i
i
3&$ion ((AE
8
8
i
i
3&$ion ((AF
8
8i
i
;
3&$ion ((B
8
8i
;
3&$ion ((BB
8
8
;
i
3&$ion ((BBA
8
8
;
i
3&$ion ((BBB
8
8
;
i
3&$ion ((D
8
8
i
'
3&$ion ((DA
8
8i
'
C%a.$r-LII-)
8
8
'
i
Firs$ 3&%d!l of In&om-$a' A&$
8
8
'
i
To$al (88i $o 88'i:
8
8
8
(
Profi$ or loss 6for dd!&$ion !ndr s&$ion "=A/"=AA (8# B 88':
8
(
8
5
Dd!&$ions !ndr s&$ion-
i "=A /e of ,che$ule-1;A& 8
5
i
i
"=AA /e of ,che$ule-1;AA& 8
5
i
i
To$al (85i B 85ii: 8
5
8
H
N$ .rofi$ or loss from 6!sinss or .rofssion o$%r $%an s.&!la$i; 6!sinss and
s.&ifid 6!sinss (8( D 85iii:
8
H
8
2
N$ Profi$ or loss from 6!sinss or .rofssion o$%r $%an s.&!la$i; 6!sinss and
s.&ifid 6!sinss af$r a..l+in, r!l 2A, 2B or 2C, if a..li&a6l /"f rule 3A, 3! or 31 is not
applicable, enter same fi-ure as in 3%&
A
8
2
B
Com.!$a$ion of in&om from s.&!la$i; 6!sinss
8
<
N$ .rofi$ or loss from s.&!la$i; 6!sinss as .r .rofi$ or loss a&&o!n$
8
<
8
9
Addi$ions in a&&ordan& 4i$% s&$ion #< $o ((DA
8
9
(
=
Dd!&$ions in a&&ordan& 4i$% s&$ion #< $o ((DA
(
=
(
"
Profi$ or loss from s.&!la$i; 6!sinss (8<B89-(=:
B
(
C
Com.!$a$ion of in&om from s.&ifid 6!sinss
(
#
N$ .rofi$ or loss from s.&ifid 6!sinss as .r .rofi$ or loss a&&o!n$
(
#
(
8
Addi$ions in a&&ordan& 4i$% s&$ion #< $o ((DA
(
8
(
(
Dd!&$ions in a&&ordan& 4i$% s&$ion #< $o ((DA (other than deduction u/s 40)D)
(
(
(
5
Profi$ or loss from s.&ifid 6!sinss ((#B(8-((:
(
5
(
H
Dd!&$ions in a&&ordan& 4i$% s&$ion 85AD
(
H
(
2
Profi$ or loss from s.&ifid 6!sinss ((5-(H: C
(
D
In&om &%ar,a6l !ndr $% %ad QProfi$s and ,ains@ (A82BB("BC(2:
D
3&%d!l DPM
DEPRECIATION
P*ANT AND
MACAINER>
"
Blo&0 of ass$s Plan$ and ma&%inr+
#
Ra$ (M: "
5
8
=
(
=
5
=
H
=
<
=
"==
(
i
(ii: (
ii
(
i
(
;
(
;
(;ii:
8
5ri$$n do4n ;al! on $% firs$ da+
of .r;io!s +ar
(
Addi$ions for a .riod of "<= da+s or
mor in $% .r;io!s +ar
5
Considra$ion or o$%r raliJa$ion
d!rin, $% .r;io!s +ar o!$ of 8 or
( H
Amo!n$ on 4%i&% d.r&ia$ion a$
f!ll ra$ $o 6 allo4d (8 B ( -5:
/enter ;, if result is ne-ative&
2
Addi$ions for a .riod of lss $%an
"<= da+s in $% .r;io!s +ar
<
Considra$ion or o$%r raliJa$ions
d!rin, $% +ar o!$ of 2
9
Amo!n$ on 4%i&% d.r&ia$ion a$
%alf ra$ $o 6 allo4d (2-<: /enter
;, if result in ne-ative&
"
=
D.r&ia$ion on H a$ f!ll ra$
"
"
D.r&ia$ion on 9 a$ %alf ra$
"
#
Addi$ional d.r&ia$ion, if an+, on (
"
8
Addi$ional d.r&ia$ion, if an+, on 2
"
(
To$al d.r&ia$ionR ("=B""B"#B"8:
"
5
E'.ndi$!r in&!rrd in &onn&$ion
4i$% $ransfr of ass$/ ass$s
"
H
Ca.i$al ,ains/ loss !ndr s&$ion
5=R (5 B < -8-( -2 -"5: /enter
ne-ative only if block ceases to e8ist&
"
2
5ri$$n do4n ;al! on $% las$ da+
of .r;io!s +arR (HB 9 -"(: /enter ;
if result is ne-ative&
D.r&ia$ion on Plan$ and Ma&%inr+
3&%d!l DOA
D
E
P
R
E
C
I
A
T
I
O
N
O
N
O
T
A
E
R
"
Blo&0 of ass$s B!ildin, F!rni$!r
and
fi$$in,s
In$an,i
6l
ass$
3%i.s
#
Ra$ (M: 5 "
=
"== "
=
#
5
#=
(
i
(
i
(iii: (
i
(
;
(;i:
8
5ri$$n do4n ;al! on $% firs$ da+
of .r;io!s +ar
(
Addi$ions for a .riod of "<= da+s or
mor in $% .r;io!s +ar
5
Considra$ion or o$%r raliJa$ion
d!rin, $% .r;io!s +ar o!$ of 8 or
H
Amo!n$ on 4%i&% d.r&ia$ion a$
f!ll ra$ $o 6 allo4d (8 B ( -5:
/enter ;, if result is ne-ative&
2
Addi$ions for a .riod of lss $%an
"<= da+s in $% .r;io!s +ar
D.r&ia$ion on o$%r ass$s
<
Considra$ion or o$%r raliJa$ions
d!rin, $% +ar o!$ of 2
9
Amo!n$ on 4%i&% d.r&ia$ion a$
%alf ra$ $o 6 allo4d (2-<: /enter
;, if result in ne-ative&
"
=
D.r&ia$ion on H a$ f!ll ra$
"
"
D.r&ia$ion on 9 a$ %alf ra$
"
#
Addi$ional d.r&ia$ion, if an+, on (
"
8
Addi$ional d.r&ia$ion, if an+, on 2
"
(
To$al d.r&ia$ionR ("=B""B"#B"8:
"
5
E'.ndi$!r in&!rrd in &onn&$ion
4i$% $ransfr of ass$/ ass$s
"
H
Ca.i$al ,ains/ loss !ndr s&$ion 5=
(5 B < -8-( -2 -"5: /enter ne-ative only
if block ceases to e8ist&
"
2
5ri$$n do4n ;al! on $% las$ da+
of .r;io!s +arR (HB 9 -"(: /enter ;
if result is ne-ative&
3&%d!l DEP
3UMMAR>
DEPRECIATION ON
A33ET3
"
Plan$ and ma&%inr+
a Blo&0 n$i$ld for d.r&ia$ion S "5 .r &n$
/ ,che$ule +P= - 14 i&
"
a
6 Blo&0 n$i$ld for d.r&ia$ion S 8= .r &n$
/ ,che$ule +P= - 14 ii&
"
6
& Blo&0 n$i$ld for d.r&ia$ion S (= .r &n$
/ ,che$ule +P= - 14 iii&
"
&
d Blo&0 n$i$ld for d.r&ia$ion S 5= .r &n$
/ ,che$ule +P= - 14 iv&
"
d
Blo&0 n$i$ld for d.r&ia$ion S H= .r &n$
/ ,che$ule +P= - 14 v&
"

f Blo&0 n$i$ld for d.r&ia$ion S <= .r &n$

/ ,che$ule +P= ? 14 vi&
"
f
, Blo&0 n$i$ld for d.r&ia$ion S "== .r &n$
/ ,che$ule +P= - 14 vii&
"
,
%
To$al d.r&ia$ion on .lan$ and ma&%inr+ ( "a B "6 B "& B "dB " B "f B ", :
"
%
#
B!ildin,
a Blo&0 n$i$ld for d.r&ia$ion S 5 .r &n$
/,che$ule +OA- 14i&
#
a
6
Blo&0 n$i$ld for d.r&ia$ion S "= .r &n$
/,che$ule +OA- 14ii&
#
6
&
Blo&0 n$i$ld for d.r&ia$ion S "== .r &n$
/,che$ule +OA- 14iii&
#
&
d
To$al d.r&ia$ion on 6!ildin, ($o$al of #a B #6 B #&: #
d
8
F!rni$!r and fi$$in,s/,che$ule +OA- 14 iv&
8
(
In$an,i6l ass$s /,che$ule +OA- 14 v&
(
5
3%i.s /,che$ule +OA- 14 vi&
5
H
To$al d.r&ia$ion ( "%B#dB8B(B5:
H
3!mmar+ of d.r&ia$ion on ass$s
3&%d!l DC)
"
Plan$ and ma&%inr+
a Blo&0 n$i$ld for d.r&ia$ion S "5 .r &n$
/,che$ule +P= - 1%i&
"
a
6
Blo&0 n$i$ld for d.r&ia$ion S 8= .r &n$
/,che$ule +P= ? 1%ii&
"
6
&
Blo&0 n$i$ld for d.r&ia$ion S (= .r
&n$/,che$ule +P= - 1%iii&
"
&
d Blo&0 n$i$ld for d.r&ia$ion S 5= .r &n$
/,che$ule +P= - 1%iv&
"
d
Blo&0 n$i$ld for d.r&ia$ion S H= .r &n$
/,che$ule +P= ? 1%v&
"

f
Blo&0 n$i$ld for d.r&ia$ion S <= .r &n$
/,che$ule +P= ? 1%vi&
"
f
Dmd Ca.i$al )ains on sal of d.r&ia6l ass$s
CAPITA* )AIN3
, Blo&0 n$i$ld for d.r&ia$ion S "== .r &n$
/,che$ule +P= ? 1%vii&
"
,
%
To$al ( "a B"6 B "& B "d B " B "f B ",:
"
%
#
B!ildin,
a Blo&0 n$i$ld for d.r&ia$ion S 5 .r &n$
/,che$ule +OA- 1%i&
#
a
6
Blo&0 n$i$ld for d.r&ia$ion S "= .r &n$
/,che$ule +OA- 1%ii&
#
6
& Blo&0 n$i$ld for d.r&ia$ion S "== .r &n$
/,che$ule +OA- 1%iii&
#
&
d
To$al ( #a B #6 B #&: #
d
8 F!rni$!r and fi$$in,s / ,che$ule +OA- 1%iv& 8
( In$an,i6l ass$s /,che$ule +OA- 1%v& (
5 3%i.s /,che$ule +OA- 1%vi& 5
H
To$al ( "%B#dB8B(B5: H
3&%d!l E3R
3
l
N
o
E'.ndi$!r of $%
na$!r rfrrd $o in
s&$ion
(":
Amo!n$, if an+, d6i$d $o .rofi$
and loss a&&o!n$
(#:
Amo!n$ of dd!&$ion
allo4a6l (8:
Amo!n$ of dd!&$ion in '&ss of
$% amo!n$ d6i$d $o .rofi$ and
loss a&&o!n$
((: T (8: - (#:
i
85(":(i:
i
i
85(":(ii:
i
i
85(":(iii:
i
;
85(":(i;:
;
85(#AA:
;
i
85(#AB:
;
i
$o$al
Dd!&$ion !ndr s&$ion 85
3&%d!l C)
A 3%or$-$rm &a.i$al ,ain
" From sl!m. sal
a F!ll ;al! of &onsidra$ion "
a
6 N$ 4or$% of $% !ndr $a0in, or di;ision "
6
& 3%or$ $rm &a.i$al ,ains from sl!m. sal "
&
d Dd!&$ion !ndr s&$ions 5(D/5()/5()A "
d
N$ s%or$ $rm &a.i$al ,ains from sl!m. sal ("& D "d: "

# In &as of NON-RE3IDENT $o 4%i&% firs$ .ro;iso $o s&$ion (< is a..li&a6l

From ass$s (s%ars/!ni$s: 4%r s&$ion """A is a..li&a6l (3TT .aid: #
a
From ass$s 4%r s&$ion """A is no$ a..li&a6l #
6
8 From ass$s (s%ars/!ni$s: in $% &as of o$%rs 4%r s&$ion """A is a..li&a6l (3TT
.aid:
a F!ll ;al! of &onsidra$ion 8
a
6 Dd!&$ions !ndr s&$ion (<
i Cos$ of a&E!isi$ion 6i
ii Cos$ of Im.ro;mn$ 6i
i
iii E'.ndi$!r on $ransfr 6i
ii
i; To$al (i B ii B iii: 6i
;
& Balan& (8a D 6i;: 8
&
d *oss, if an+, $o 6 i,nord !ndr s&$ion 9((2:
or 9((<: (En$r .osi$i; ;al! onl+:
8
d
3%or$-$rm &a.i$al ,ain (8& B8d: A
8
( From ass$s in &as of o$%rs 4%r s&$ion """A is no$ a..li&a6l
a F!ll ;al! of &onsidra$ion (
a
6 Dd!&$ions !ndr s&$ion (<
i Cos$ of a&E!isi$ion 6i
ii Cos$ of Im.ro;mn$ 6i
i
iii E'.ndi$!r on $ransfr 6i
ii
i; To$al (i B ii B iii: 6i
;
& Balan& ((a D 6i;: (
&
d *oss, if an+, $o 6 i,nord !ndr s&$ion 9((2:
or
(
d
Ca.i$al )ains
Dd!&$ion !ndr s&$ion 5(D/5()/5()A (

f 3%or$-$rm &a.i$al ,ain ((& B (d D (: (

f
5 Dmd s%or$ $rm &a.i$al ,ain on d.r&ia6l ass$s (H of 3&%d!l D DC): A
5
H Amo!n$ dmd $o 6 s%or$ $rm &a.i$al ,ains !ndr s&$ions 5(D/5()/ 5()A A
H
2 To$al s%or$ $rm &a.i$al ,ain (" B #a B #6 B A8 B (f B A5 B AH: A
2
B *on, $rm &a.i$al ,ain
" From sl!m. sal
a F!ll ;al! of &onsidra$ion "
a
6 N$ 4or$% of $% !ndr $a0in, or di;ision "
6
& *on, $rm &a.i$al ,ains from sl!m. sal "
&
d Dd!&$ion !ndr s&$ions
5(D/5(EC/5()/5()A
"
d
N$ lon, $rm &a.i$al ,ain from sl!m. sal ("& D "d: "

# From ass$ in &as of non-rsidn$ $o 4%i&% firs$ .ro;iso $o s&$ion (< is a..li&a6l #
8 From ass$ in $% &as o$%r 4%r .ro;iso !ndr s&$ion ""#(": is no$ a..li&a6l
a F!ll ;al! of &onsidra$ion 8
a
6 Dd!&$ions !ndr s&$ion (<
i

i
i

Cos$ of a&E!isi$ion af$r ind'a$ion 6
i
Cos$ of im.ro;mn$ af$r ind'a$ion 6
i
E'.ndi$!r on $ransfr 6
i
To$al (6i B 6ii B6iii: 6
i
& Balan& (8a D 6i;: 8
&
d Dd!&$ion !ndr s&$ions
5(D/5(EC/5()/5()A
8
d
N$ 6alan& (8& D 8d: B
8
( From ass$ 4%r .ro;iso !ndr s&$ion ""#(": is a..li&a6l (4i$%o!$ ind'a$ion:
a F!ll ;al! of &onsidra$ion (
a
6 Dd!&$ions !ndr s&$ion (<
i Cos$ of a&E!isi$ion 4i$%o!$ ind'a$ion 6
i
i
i
Cos$ of im.ro;mn$ 4i$%o!$ ind'a$ion 6
i
i
i
E'.ndi$!r on $ransfr 6
i
i; To$al (6i B 6ii B6iii: 6
i
& Balan& ((a D 6i;: (
&
d Dd!&$ion !ndr s&$ions 5(D/5(EC/5()/5()A (
d
N$ 6alan& ((&-(d: B
(
5 From !nlis$d s&!ri$is in &as of non-rsidn$ as .r s&$ion ""#(":(&:(iii: B
5
H Amo!n$ dmd $o 6 lon, $rm &a.i$al ,ains !ndr s&$ions 5(D/5(EC/5()/5()A B
H
2 To$al lon, $rm &a.i$al ,ain (" B # B B8 B B( B B5 B BH) B
2
C In&om &%ar,a6l !ndr $% %ad OCAPITA* )AIN3P (A2 B B2: /enter !3 as nil, if loss& C
D Informa$ion a6o!$ a&&r!al/r&i.$ of &a.i$al ,ain
Da$ U.$o "5/9 "H/9 $o "5/"# "H/"# $o "5/8 "H/8 $o
8"/8
" *on,- $rm [4%r .ro;iso !ndr s&$ion
""#(": is a..li&a6l (5i$%o!$ Ind'a$ion: B
non-rsidn$s as .r s&$ion ""#(":(&:(iii:]-
Ta' Rate is ,35 6
1nter onl! positive value fro( Ite( +7e8+0 of
/chedule 9: ).T1R loss ad;ust(ent under this
categor! in /chedule 9Y<) and +.<), if an!%
# *on,- $rm 4%r .ro;iso !ndr s&$ion ""#(":
is NOT a..li&a6l (5i$% Ind'a$ion:-
Ta' Rate is 2356
1nter onl! positive value fro( Ite( (+&=+7e =
+0) of /chedule 9: ).T1R loss ad;ust(ent
under this categor! in /chedule 9Y<) and
8 3%or$-$rm !ndr """A-
Ta' Rate is ,05 6
1nter onl! positive value fro( Ite( )2a8)4e
of /chedule 9: ).T1R loss ad;ust(ent
under this categor! in /chedule 9Y<) and
( 3%or$-$rm OTAER3-
Ta'ed at nor(al rates6
1nter onl! positive value fro( Ite( ()& > )2a = )4e)
of /chedule 9: ).T1R loss ad;ust(ent under this
categor! in /chedule 9Y<) and +.<), if an!
3&%d!l O3
OTAER
" In&om
a Di;idnds, )ross "
6 In$rs$, )ross "
& Rn$al in&om from ma&%inr+, .lan$s, 6!ildin,s, "
d
O$%rs, )ross /e8clu$in- income from o0nin- race
horses&Mention the source and a(ount
i d
i
i
i
d
i
i
i
d
ii
i
;
To$al (di B diiB diii: "
d
To$al ("a B "6 B "& B "di;: "
f Dd!&$ions !ndr s&$ion 52C-
i
E'.nss / Dd!&$ions f
i
i D.r&ia$ion f
i To$al f
, Balan& (" D fiii: "
# 5innin,s from lo$$ris, &ross4ord .!JJls, ra&s, ,ams, ,am6lin,, 6$$in, $&7 ()ross: #
8 In&om from o$%r so!r&s (o$%r $%an from o4nin, ra& %orss: (", B #: /enter1- as nil, if
loss&
8
( In&om from o4nin, and main$ainin, ra& %orss
a R&i.$s (
6 Dd!&$ions !ndr s&$ion 52 in rla$ion $o ((: (
& Balan& ((a D (6: (
5
In&om &%ar,a6l !ndr $% %ad OIn&om from o$%r so!r&sP (8 B (&: /enter 4c as nil if
loss an$ take 4c loss fi-ure to ,che$ule 14L&
5
N?T1
U
Please inclu$e the income of the specifie$ persons referre$ to in ,che$ule ,P" 0hile computin- the income un$er this hea$.
In&om from o$%r so!r&s
3&%d!l C>*A
CURRENT
*O33
AD?U3TMENT
3l7
No
Aad/
3o!r&
of
In&om
In&om of
&!rrn$ +ar
(Fill $%is &ol!mn
onl+ if in&om is
Jro or .osi$i;:
Ao!s .ro.r$+ loss
of $% &!rrn$ +ar
s$ off
B!sinss *oss
(o$%r $%an
s.&!la$ion or
s.&ifid 6!sinss loss:
O$%r so!r&s loss
(o$%r $%an loss from
ra& %orss: of $%
&!rrn$ +ar s$ off
C!rrn$
+ar@s
In&om
rmainin,
af$r s$ off To$al loss
((& of 3&%d!l DAP:
To$al loss
(A82 of 3&%d!l-
To$al loss
(", of 3&%d!l-
" # 8 ( 5T"-#-8-(
*oss $o 6 adF!s$d
-V
i Ao!s .ro.r$+
i
i
B!sinss
('&l!din,
s.&!la$ion
in&om and
i
i
3.&!la$ion in&om
i
;
3.&ifid 6!sinss
in&om
; 3%or$-$rm &a.i$al
,ain
;
i
*on, $rm &a.i$al
,ain
;
ii
O$%r so!r&s
('&l!din, .rofi$
from o4nin, ra&
%orss:
;
ii
i
Profi$ from
o4nin, and
main$ainin, ra&
i
'
To$al loss s$-off
' *oss rmainin, af$r s$-
off
D$ails of In&om af$r s$-off of &!rrn$ +ars losss
3&%d!l BF*A
BROU
)AT
FOR5
ARD
*O33
AD?U3
TMEN
T
3
l
7
N
o
7
Aad/ 3o!r& of In&om In&om af$r s$
off, if an+, of
&!rrn$ +ar@s
losss as .r 5 of
Bro!,%$ for4ard
loss s$ off
Bro!,%$
for4ard
d.r&ia$ion s$
off
Bro!,%$ for4ard
allo4an& !ndr
s&$ion 85((: s$ off
C!rrn$
+ar@s
in&om
rmainin,
" # 8 ( 5
i Ao!s .ro.r$+
i
i
B!sinss ('&l!din,
s.&!la$ion in&om and
in&om from s.&ifid
6!sinss:
i
i
3.&!la$ion In&om
i
;
3.&ifid 6!sinss in&om
!/s 85AD
;
3%or$-$rm &a.i$al ,ain
;
i
*on,-$rm &a.i$al ,ain
;
i
i
O$%r so!r&s
in&om ('&l!din,
.rofi$ from o4nin,
;
i
Profi$ from o4nin, and
main$ainin, ra& %orss
i
'
To$al of 6ro!,%$ for4ard loss s$ off
' C!rrn$ +ar@s in&om rmainin, af$r s$ off To$al (i5 B ii5 B iii5 B i;5B;5B;i5
B;ii5B;iii5:
D$ails of In&om af$r 3$ off of Bro!,%$ For4ard *osss of arlir +ars
3&%d!l CF* D$ails of *osss $o 6 &arrid for4ard $o f!$!r +ars
CARR> FOR5ARD
OF *O33
3
l7
N
o7
Assssmn$
>ar
Da$ of
Filin,
(DD/MM/>>
>>:
Ao!s
.ro.r$+
loss
*oss from
6!sinss
o$%r $%an
loss from
s.&!la$i;
6!sinss
and
*oss
from
s.&!l
a$i;
6!sin
ss
*oss
from
3.&if
id
B!sin
ss
3%or$-
$rm
&a.i$al
loss
*on,-
$rm
Ca.i$al
loss
O$%r
so!r&s
loss
(from
o4nin,
ra&
%orss:
i #==5-=H
i
i
#==H-=2
i
i
#==2-=<
i
;
#==<-=9
; #==9-"=
;
i
#="=-""
;
ii
#=""-"#
;
ii
#="#-"8
i
'
To$al of arlir
+ar losss
' AdF!s$mn$ of
a6o; losss in
3&%d!l BF*A
'
i
#="8-"( (C!rrn$
+ar losss:
'
ii
To$al loss
Carrid
For4ard $o
3&%d!l UD
UNA
B3O
RBE
D
DEP
REC
IATI
ON
3l
N
o
(
"
:
Assssmn$ >ar
(#:
Amo!n$ of 6ro!,%$
for4ard !na6sor6d
d.r&ia$ion (8:
Amo!n$ of d.r&ia$ion s$-
off a,ains$ $% &!rrn$ +ar
in&om ((:
Balan& Carrid
for4ard $o $% n'$
+ar
(5:
i C!rrn$ Assssmn$ >ar
ii
i
i
i
;
;
;
i
;i
i
To$al
Una6sor6d d.r&ia$ion
3&%d!l "=A
DEDUC
T
I
O
N

U
/
Dd!&$ion in rs.&$ of !ni$s lo&a$d in 3.&ial E&onomi& Won
a Undr$a0in, No7" a
6 Undr$a0in, No7# 6
& Undr$a0in, No78 &
d Undr$a0in, No7( d
To$al dd!&$ion !ndr s&$ion "=A /a6b6c6$&
Dd!&$ion !ndr s&$ion "=A
3&%d!l "=AA
DEDU
C
T
I
O
N

U
Dd!&$ions in rs.&$ of !ni$s lo&a$d in 3.&ial E&onomi& Won
a Undr$a0in, No7" a
6 Undr$a0in, No7# 6
& Undr$a0in, No78 &
d Undr$a0in, No7( d
To$al (a B 6 B & B d:
Dd!&$ion !ndr s&$ion "=AA
3&%d!l <=)
D
E
T
A
I
*
3

O
F

D
O
N
A
T
I
O
N
3
A
Dona$ions n$i$ld for "==M dd!&$ion 4i$%o!$
E!alif+in, limi$
Nam and addrss of don
PAN of Don Amo!n$ of
dona$ion
Eli,i6l Amo!n$ of
dona$ion
i
i
i
i
i
i
;
;
;
i
To$al
B
Dona$ions n$i$ld for 5=M dd!&$ion 4i$%o!$
E!alif+in, limi$
Nam and addrss of don
PAN of Don Amo!n$ of
dona$ion
Eli,i6l Amo!n$ of
dona$ion
i
i
i
i
i
i
;
;
;
i
To$al
C
Dona$ions n$i$ld for "==M dd!&$ion s!6F&$ $o
E!alif+in, limi$
Nam and addrss of don
PAN of Don Amo!n$ of
dona$ion
Eli,i6l Amo!n$ of
dona$ion
i
i
i
i
i
i
;
;
;
i
To$al
D
Dona$ions n$i$ld for 5=M dd!&$ion s!6F&$ $o
E!alif+in, limi$
Nam and addrss of don PAN of Don
Amo!n$ of
dona$ion
Eli,i6l Amo!n$ of
dona$ion
i
i
i
i
i
i
;
;
;
i
To$al
E
To$al dona$ions (A;i B B;i B C;i B D;i:
D$ails of dona$ions n$i$ld for dd!&$ion !ndr s&$ion <=)
3&%d!l <=-IA
DEDU
CTIO
N U/3
<=-IA
a
Dd!&$ion in rs.&$ of .rofi$s of an n$r.ris rfrrd
$o in s&$ion <=-IA((:(i: '"nfrastructure facility(
a
6
Dd!&$ion in rs.&$ of .rofi$s of an !ndr$a0in,
rfrrd $o in s&$ion <=-IA((:(ii: '>elecommunication
services(
6
&
Dd!&$ion in rs.&$ of .rofi$s of an !ndr$a0in,
rfrrd $o in s&$ion <=-IA((:(iii: '"n$ustrial park an$
,<@s(
&
d
Dd!&$ion in rs.&$ of .rofi$s of an !ndr$a0in,
rfrrd $o in s&$ion <=-IA((:(i;: 'Po0er(
d

Dd!&$ion in rs.&$ of .rofi$s of an !ndr$a0in,

rfrrd $o in s&$ion <=-IA((:(;: ')evival of po0er
-eneratin- plant( and dd!&$ion in rs.&$ of .rofi$s of
an !ndr$a0in, rfrrd $o in s&$ion <=-IA((:(;i:
'1ross-country natural -as $istribution net0ork(

f
To$al dd!&$ions !ndr s&$ion <=-IA (a B 6 B & B d B : f
Dd!&$ions !ndr s&$ion <=-IA
3&%d!l <=-IB
D
E
D
U
C
T
I
O
N

U
/
3

<
=
-
I
B
a
Dd!&$ion in rs.&$ of ind!s$rial
!ndr$a0in, rfrrd $o in s&$ion <=-
IB(8: ',mall-scale in$ustry(
a
6
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d
in ?amm! G Ias%mir [3&$ion <=-IB((:]
6
&
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d
in ind!s$riall+ 6a&04ard s$a$s s.&ifid in Ei,%$%
3&%d!l [3&$ion <=-IB((:]
&
d
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d
in ind!s$riall+ 6a&04ard dis$ri&$s [3&$ion <=-IB(5:]
d

Dd!&$ion in $% &as of m!l$i.l' $%a$r [3&$ion <=-

IB(2A:]

f
Dd!&$ion in $% &as of &on;n$ion &n$r [3&$ion <=-
IB(2B:]
f
,
Dd!&$ion in $% &as of &om.an+ &arr+in, on
s&in$ifi& rsar&% [3&$ion <=-IB(<A:]
,
%
Dd!&$ion in $% &as of !ndr$a0in, 4%i&% 6,ins
&ommr&ial .rod!&$ion or rfinin, of minral oil
[3&$ion <=-IB(9:]
%
i
Dd!&$ion in $% &as of an !ndr$a0in, d;lo.in, and
6!ildin, %o!sin, .roF&$s [3&$ion <=-IB("=:]
i
F
Dd!&$ion in $% &as of an !ndr$a0in, o.ra$in, a
&old &%ain fa&ili$+ [3&$ion <=-IB("":]
F
0
Dd!&$ion in $% &as of an !ndr$a0in, n,a,d in
.ro&ssin,, .rsr;a$ion and .a&0a,in, of fr!i$s,
;,$a6ls, ma$, ma$ .rod!&$s, .o!l$r+, marin or
dair+ .rod!&$s [3&$ion <=-IB(""A:]
0
l
Dd!&$ion in $% &as of an !ndr$a0in, n,a,d in
in$,ra$d 6!sinss of %andlin,, s$ora, and
$rans.or$a$ion of food ,rains [3&$ion <=-IB(""A:]
l
m
Dd!&$ion in $% &as of an !ndr$a0in, n,a,d in
o.ra$in, and main$ainin, a r!ral %os.i$al [3&$ion <=-
IB(""B:]
m
n Dd!&$ion in $% &as of an !ndr$a0in, n,a,d in
o.ra$in, and main$ainin, a %os.i$al in an+ ara,
o$%r $%an '&l!dd ara [3&$ion <=-IB(""C:
n
o
To$al dd!&$ion !ndr s&$ion <=-IB (To$al of a $o n: o
Dd!&$ions !ndr s&$ion <=-IB
3&%d!l <=-IC or <=-IE
DEDU
CTIO
N U/3
<=-IC
"
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d in 3i00im "
#
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d in Aima&%al Prads% #
8
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d in U$$aran&%al 8
(
Dd!&$ion in rs.&$ of ind!s$rial !ndr$a0in, lo&a$d in Nor$%-Eas$
a Assam (
a
6 Ar!na&%al Prads% (
6
& Mani.!r (
&
d MiJoram (
d
M,%ala+a (

f Na,aland (
f
Dd!&$ions !ndr s&$ion <=-IC or <=-IE
, Tri.!ra (
,
% To$al of dd!&$ion for !ndr$a0in,s lo&a$d in Nor$%-as$ (To$al of (a $o (,: (
%
5
To$al dd!&$ion !ndr s&$ion <=-IC or <=-IE (" B # B 8 B (%: 5
3&%d!l 1I-A
TOT
A*
DED
UCT
ION
3
a
<=)
f
<=IC/ <=-IE /5 of
,che$ule A;-"1 A;-
"<&
6
<=))C
, <=-ID
&
<=-IA /f of
,che$ule A;-
"A&
%
<=??A
i <=*A
d
<=-IAB
F
<=P

<=IB /o of
,che$ule A;-
"!
0
To$al dd!&$ions !ndr C%a.$r 1I-A (To$al of a $o F:
0
Dd!&$ions !ndr C%a.$r 1I-A
3&%d!l AMT
" To$al In&om as .r i$m "# of PART-B-TI
"
# AdF!s$mn$ as .r s&$ion ""5?C(#:
a Dd!&$ion Claimd !ndr an+ s&$ion in&l!dd in
C%a.$r 1I-A !ndr $% %adin, OC7XDd!&$ions
in rs.&$ of &r$ain in&omsP
#
a
6 Dd!&$ion Claimd !/s "=AA #
6
C To$al AdF!s$mn$ (#aB #6: #
&
8 AdF!s$d To$al In&om !ndr s&$ion ""5?C(": ("B#&: 8
( Ta' .a+a6l !ndr s&$ion ""5?C [,@%05 of (4)" (In the case of Individual, AB., )?#, +?I, )C# this
is applicale if 4 is greater than Rs% 23 lakhs)
(
Com.!$a$ion of Al$rna$ Minim!m Ta' .a+a6l !ndr s&$ion ""5?C
3&%d!l AMTC
" Ta' !ndr s&$ion ""5?C in assssmn$ +ar #="8-"( ("& of Par$-B-TTI: "
# Ta' !ndr o$%r .ro;isions of $% A&$ in assssmn$ +ar #="8-"( (( of Par$-B-TTI: #
8 Amo!n$ of $a' a,ains$ 4%i&% &rdi$ is a;aila6l [n$r (# D ": if # is ,ra$r $%an ",
o$%r4is n$r =]
8
( U$ilisa$ion of AMT &rdi$ A;aila6l (/u( of )MT credit utili-ed during the current !ear is su;ect to (a'i(u( of a(ount (entioned in 4
aove and cannot e'ceed the su( of )MT 9redit +rought .or*ard)
37
No
Assssmn$ >ar
(A>: (A:
AMT Crdi$ AMT Crdi$
U$ilisd
d!rin, $%
C!rrn$ >ar
Balan& AMT
Crdi$
Carrid
For4ard (D:T
)r
os
s
3$-off in
arlir +ars
(B#:
Balan& 6ro!,%$
for4ard (B8: T
(B": D (B#:
i #="#-"8
i
i
C!rrn$ A> (enter ,
= 2, if ,D2 else enter
i
i
To$al
5 Amo!n$ of $a' &rdi$ !ndr s&$ion ""5?D !$ilisd d!rin, $% +ar [$o$al of i$m no ( (C:] 5
H Amo!n$ of AMT lia6ili$+ a;aila6l for &rdi$ in s!6sE!n$ assssmn$ +ars [$o$al of ( (D:] H
Com.!$a$ion of $a' &rdi$ !ndr s&$ion ""5?D
3&%d!l 3I
3
P
E
C
I
A
*

3
l
N
3&$ion ? 3.&ial
ra$
(M:
In&o
m
(i:
Ta'
$%r
on " """A (3TC) on s%ars 4%r 3TT .aid: ? "
5
# ""# .ro;iso (*TC) on lis$d s&!ri$is/ !ni$s 4i$%o!$
ind'a$ion:
? "
=
8 ""# (*TC) on o$%rs: ? #
=
( ""5BB (5innin,s from lo$$ris, .!JJls, ra&s, ,ams $&7: ? 8
=
5 ""5BBE (In&om !ndr s&$ion H<, H9, H9A, H9B, H9C or H9D: ? 8
=
In&om &%ar,a6l $o $a' a$ s.&ial ra$s 'Please see instruction *umber-&/ii& for section an$ rate of ta8(
H ?
2 ?
< ?
9 ?
"
=
?
"
"
To$al
3&%d!l EI
ELEMPT
INCOME
"
In$rs$ in&om
"
#
Di;idnd in&om
#
8
*on,-$rm &a.i$al ,ains on 4%i&% 3&!ri$is Transa&$ion Ta' is .aid
8
(
N$ A,ri&!l$!ral in&om (o$%r $%an in&om $o 6 '&l!dd !ndr r!l 2, 2A, 2B or <:
(
5
3%ar in $% in&om of AOP (Mention #)N of the )?# and a(ount)
i PAN
5
i
i
i
PAN
5
i
i
i
To$al (5i B 5ii:
5
ii
H
O$%rs
H
2
To$al ("B#B8B(B5iiiBH:
2
D$ails of E'm.$ In&om (In&om no$ $o 6 in&l!dd in To$al In&om:
3&%d!l IT
T
A
L

P
A
>
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3
l
B3R Cod Da$ of D.osi$
(DD/MM/YYYY)
3rial N!m6r of C%allan Amo!n$ (Rs:
i
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N?T1
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<nter the totals of A$vance ta8 an$ ,elf-Assessment ta8 in ,l *o. 12a B 12$ of Part !->>"
D$ails of .a+mn$s of Ad;an& Ta' and 3lf-Assssmn$
3&%d!l TD3
3
l
N
o
Ta'
Dd!&$ion
A&&o!n$
N!m6r
Nam of $%
Dd!&$or
UniE!
TD3
Cr$ifi&a
$
Finan&ial +ar
in 4%i&% TD3
dd!&$d
To$al Ta' Dd!&$d Amo!n$ o!$ of (H:
&laimd $%is
>ar
( (#: (8: ((: (5: (H: (2:
i
i
i
N?T Please enter total of column & of ,che$ule->+, in 12b of Part !->>"
TD3 ON OTAER INCOME
D$ails of Ta' Dd!&$d a$ 3o!r& on In&om [As .r Form "H A iss!d 6+ Dd!&$or(s:]
3&%d!l TC3
TC3
ON
INC
OME
3
l
N
o

Ta' Dd!&$ion and Ta'
Coll&$ion A&&o!n$
N!m6r of $% Coll&$or
Nam of $% Coll&$or To$al $a' &oll&$d Amo!n$ o!$ of ((:
&laimd d!rin,
$% +ar
(#: (8: ((: (5:
i
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N?T1
U
<nter the total of column /0& in ,l *o. 12c of Part !->>"
D$ails of Ta' Coll&$d a$ 3o!r& [As .r Form #2D iss!d 6+ $% Coll&$or(s:]
3&%d!l F3I
I
N
C
O
M
E

A
C
C
R
U
I
N
)

O
R

A
R
I
" D$ails of In&om in&l!dd in To$al In&om in Par$-B-TI a6o;
Co!n$r+
Cod
Ta'.a+r
Idn$ifi&a$
ion
N!m6r
In&om from
Ao!s
Pro.r$+
(in&l!dd in
B!sinss
In&om
(in&l!dd in
PART-B-TI:
Ca.i$al )ain
In&om
(in&l!dd in
PART-B-TI:
O$%r so!r&
In&om
(in&l!dd in
PART-B-TI:
To$al
In&om
from
O!$sid
To$al
#
To$al In&om from o!$sid India (To$al of E as .r i$m no7" a6o;:
#
8
To$al In&om from o!$sid India 4%r DTAA is a..li&a6l
8
(
To$al In&om from o!$sid India 4%r DTAA is no$ a..li&a6l (#-8:
(
N?T1
E
#lease refer to the instructions for filling up this schedule%
D$ails of In&om a&&r!in, or arisin, o!$sid India
3&%d!l TR
TALE3
OUT3IDE
INDIA
"
D$ails of Ta's Paid o!$sid India
Co!n
$r+
Cod
Ta'.a+r
Idn$ifi&a$
ion
Rl;an$
ar$i&l of
DTAA
To$al $a's .aid on
in&om d&lard in
3&%d!l F3I (A:
Ta' Rlif Claimd
(B:
Rlif &laimd !/s
9=/9=A (B":
Rlif &laimd !/s
9" (B#:
To$al
# To$al Ta's Paid o!$sid India (To$al of "A: #
8 To$al Ta's Paid o!$sid India 4%r DTAA is a..li&a6l 8
( To$al Ta's Paid o!$sid India 4%r DTAA is no$ a..li&a6l (#-8: (
N?T1
E
#lease refer to the instructions for filling up this schedule%
D$ails of Ta's Paid o!$sid India
3&%d!l FA
A D$ails of Fori,n Ban0 A&&o!n$s
3
l
N
Co!n$r+
Nam
Co!n$r+ Cod Nam and Addrss of
$% Ban0
Nam mn$iond
in $% a&&o!n$
A&&o!n$
N!m6r
Pa0 Balan& D!rin, $%
>ar
(in rupees)
(
"
(#: (8: ((: (5: (H: (2:
(
i
:
(
i
i
:
B D$ails of Finan&ial In$rs$ in an+ En$i$+
3
l
N
Co!n$r+
Nam
(":
Co!n$r+
Cod
(#:
Na$!r of
n$i$+
(8:
Nam and
Addrss of $%
En$i$+
To$al In;s$mn$ (at cost)
(in rupees)
(5:
(
i
:
(
i
i
C D$ails of Immo;a6l Pro.r$+
3
l

N
Co!n$r+
Nam
(#:
Co!n$r+
Cod
(8:
Addrss of $%
Pro.r$+ ((:
To$al In;s$mn$ (at cost) (in
rupees)
(5:
DETAI*3 OF FOREI)N A33ET3
D$ails of Fori,n Ass$s
(
i
:
(
i
i
D D$ails of an+ o$%r Ass$ in $% na$!r of in;s$mn$
3
l

N
Co!n$r+
Nam
(#:
Co!n$r+
Cod
(8:
Na$!r of
Ass$
((:
To$al In;s$mn$ (at cost) (in rupees)
(5:
(i:
(ii
:
E
D$ails of a&&o!n$(s: in 4%i&% +o! %a; si,nin, a!$%ori$+ and 4%i&% %as no$ 6n in&l!dd in A $o D a6o;7
3
l

N
Nam of $% Ins$i$!$ion in 4%i&%
$% a&&o!n$ is %ld
(#:
Addrss of $%
Ins$i$!$ion
(8:
Nam of $%
a&&o!n$ %oldr
((:
A&&o!n$
N!m6
r (5:
Pa0 Balan&/In;s$mn$
d!rin, $% +ar (in rupees)
(H:
(
i
:
(
i
i
F D$ails of $r!s$s, &ra$d !ndr $% la4s of a &o!n$r+ o!$sid India, in 4%i&% +o! ar a $r!s$
3
l

N
Co!n$r+
Nam
(#:
Co!n$r+
Cod
(8:
Nam and addrss of
$% $r!s$
((:
Nam and
addrss of
o$%r $r!s$s
(5:
Nam and
addrss of 3$$lor
(H:
Nam and
addrss of
Bnfi&iaris
(2: (
i
(
i
N?T1
E
#lease refer to the instructions for filling up this schedule%