About the Author :

V. N. HARI
Partner

Sudhakar & Kumar Associates,

Chartered Accountant
# 10-1-12, II Floor,
Krishna Kamal Enclave,
Asilmetta Junction,
Visakhapatnam - 530 003
Ph. (O) : 0891-2755814
(M) : 9866531022

E-mail ID : vnhari.ca@gmail.com

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 ITR - 3
A.Y. 2010-11

For Individuals /
HUFs being
partners in
firms and not
carrying out
business or
profession
under any
proprietorship
 D.No. 10-
SUDHAKAR & KUMAR ASSOCIAT Krishna K

Chartered Accountants Asilmetta

Visakhap
003 ,
CLIENT DATA SHEET - [ ITR - 3] Ph. 089

email :
vnhari.ca
GENERAL INFORMATION

1. Name of the Assessee

2. Father's Name

3. Date of Birth 30-Dec-1899 Senior Citizen

4. Sex FEMALE

4. Address Flat/Door No./Block No.

2 Name of premises/Building/Village
`
Road / Street / Post Office
Area/ Locality
Town / City /Municipality VISAKHAPATNAM
Pin Code (Please affix { ' } befoe the Number) Search for PIN Code

E-mail ID sudhakar_kumarasst@yahoo.com

5. PAN PAN Verification Status Individual

6. Assessment Year 2010-11

7. Financial Year 2009-10

6. Due date of filing 31-Jul-2010

7. Month of filing 31-Jul-2010

8. Financial Year Ending 31-Mar-2010

9. Name of the Employer

9a. Permanent Account Number TAN

9b. Address of the employer

10. Type of Employer Govt

10a.Type of Return
Original RevisedRevised Type of return

ORIGINAL

TRUE

 10b.Residential Status Resident Non Resident Resident but not ordinarily resident
FALSE
10c.If this return is filed by a representative Assessee Yes No

HEADS OF INCOME

11. INCOME FROM SALARY

Gross Salary Received -

Deduction u/s 10

a) HRA u/s 10(13A) -

b) Conveyance Allowance U/10(14) -

c) Any Other Allowance u/s 10 -

Deduction u/s 16

a) Profession Tax -

INCOME CHARGEABLE UNDER THE HEAD SALARIES -

12. INCOME FROM HOUSE PROPERTY

1. House Property 1 Let Out Self Occupied

Address :
D.No.

Town/City

PIN Code FALSE

Gross Annual Value -

Less: Municipal Taxes -

Less: Deduction U/s 24 Amount IncurredQlf.Amount

a) Standard Deduction @ 30% -
b) Interest on borrowed capital -

c) Prior Period Interest -

Total of Deductions u/s 24 -

Income/loss from house property - 0

Net Income from Property -

2. House Property 2 TRUE

Let Out Self Occupied

Address :
D.No.
Town/City

PIN Code
 Gross Annual Value -

Less: Municipal Taxes -

Net Annual Value -

Less: Deduction U/s 24

Amount IncurredQlf.Amount

a) Standard Deduction @ 30% -

b) Interest on borrowed capital -

c) Prior Period Interest -
Total of Deductions u/s 24 -

Income/loss from house property - 0

Net Income from Property -

3. House Property 3 TRUE

Let Out Self Occupied

Address :
D.No.

Town/City
PIN Code

Gross Annual Value -

Less: Municipal Taxes -

Net Annual Value -

Less: Deduction U/s 24

Amount IncurredQlf.Amount

a) Standard Deduction @ 30% -

b) Interest on borrowed capital -

c) Prior Period Interest -

Total of Deductions u/s 24 -

Income/loss from house property - 0
Net Income from Property -

4. House Property 4 TRUE FALSE

Let Out Self Occupied

Address :
D.No.

Town/City

PIN Code

Gross Annual Value -

Less: Municipal Taxes -

Net Annual Value -

Less: Deduction U/s 24

Amount IncurredQlf.Amount
 a) Standard Deduction @ 30% -

b) Interest on borrowed capital -

c) Prior Period Interest -
Total of Deductions u/s 24 -

Income/loss from house property - 0

Net Income from Property -

5. House Property 5 FALSE FALSE

Let Out Self Occupied

Address :
D.No.

Town/City
PIN Code

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -

Less: Deduction U/s 24

Amount IncurredQlf.Amount
a) Standard Deduction @ 30% -
b) Interest on borrowed capital -
c) Prior Period Interest -
Total of Deductions u/s 24 -

Income/loss from house property - 0

Net Income from Property -

6. House Property 6 TRUE FALSE

Let Out Self Occupied

Address :
D.No.

Town/City

PIN Code

Gross Annual Value -

Less: Municipal Taxes -

Net Annual Value -

Less: Deduction U/s 24

Amount IncurredQlf.Amount
a) Standard Deduction @ 30% -

b) Interest on borrowed capital -

c) Prior Period Interest -

Total of Deductions u/s 24 -

Income/loss from house property - 0

Net Income from Property -

INCOME CHARGEABLE UNDER THE HEAD HOUSE PROPERTY -

12A . INCOME FROM BUSINESS

Number of firms in which you are partner

Sl.No. Name of the firm PAN Designatio Percentage SHAREOF CAPITAL
n of Share in PROFIT ON 31s
the Profits THE
of the firm

1 -

Number of firms in which you are partner

SL.NO. Name of the firm Salary, Interest on Total Expenses
Bonus, Capital relating to
Commission above income
or
Remuneraton
1 - - - -

INCOME FROM BUSINESS

BUSINESS LOSS TO BE CARRIE FORWARD TO THE NEXT YEAR

13. INCOME FROM CAPITAL GAINS

A. Short Term Capital Gains
a. Full Value of Consideration -
Less: Deduction u/s 48
i. Cost of acquisition -

ii. Cost of Improvement - Date of Transfer 30-Oct-2009

iii Expenditure on transfer -
Total : -

b. Short Term Capital Gains -

c. Exemption u/s 54/54B/54D/54EC/54ED/54F -
d. Income from Short Term Capital Gains -

B. Short Term Capital Gains (Chargeable at special Rates (Shares sold within 12 months holding))

a. Full Value of Consideration -

Date of Transfer 30-Aug-2009
Less: Deduction u/s 48
 i. Cost of acquisition -

ii. Expenditure on transfer -

Total : -
b. Income from Short Term Capital Gains chargeable at special rates -

C. Long Term Capital Gains

Description of Long Term Capital Gains

Date of Transfer 16-Mar-2010

a. Full Value of consideration

a. Sale value as mentioned in sale Document -

b. Market Value as mentioned in sale Document -

Full Value of Consideration -

b. Indexed cost of acuisition

a. Cost of acquisition - Index Number

Year of purchase (YYYY-YY) 1992-93
1982-83
1981-82 2 109
Year of Transfer (YYYY-YY) 2008-09 29 632
2009-10

Indexed cost of acquisition -

b. Cost of Improvement - Index Number

Year of Improvement (yyyy-yy) 2001-02

1981-82 1 100

Year of Transfer (yyyy-yy) 2009-10

2009-10 29 632

Indexed cost of Improvement -

c. Expenditure on Transfer -

d. Long Term Capital Gains -

e. Exemption u/s 54/54B/54D/54EC/54ED/54F -

f. Income from Long Term Capital Gains -

INCOME CHARGEABLE UNDER THE HED CAPITAL GAINS -

14. Income from Other Sources

a. Income other than from owning race horse(s):-
a. Dividends -
b. Interest
a. -
b. -
c. -
d. -
e. -
f. -
g. -
-
c. Rental Income from Machinery -
d. Other Income
e. a. -
f. b. -
g. c. -
h. d. -
i. e. -
j. f. -
k. g. -
l. g. -
 m. -

-
Less: Deduction U/s 54
a. Expenses -
b. Depreciation -
c. Other Expenses -

b. Winnings from lotteries, crossword puzzles, races, etc., -

c. Income from owning and maintaining race horses

a Receipts -

b Deductions under section 57 -

INCOME CHARGEABLE UNDER THE HED OTHER SOURCES -

COMPUTATION OF TOTAL INCOME

GROSS TOTAL INCOME
15. Income Chargeable under the Head Salaries

Income Chargeable under the Head House Property

Income Chargeable under the Head Business/Profession

Income Chargeable undaer the Head Capital Gains

Income Chargeable under the Head Other Sources

Gross Total Income

16. DEDUCTION UNDER CHAPTER - VIA

Gross Amount Qualifing Amount
a) Deduction U/s 80C
1) Life Insurance Premium -

2) Housing Loan Repayment -

3) Contribution to PF -

4) Purchase of NSC -

5) Investment in MF -
6) Investment in Pension Plan -
7) Children Tuition Fee -
8) Registration Fee of Res. House -
9) Other Savings - -

b) Deduction U/s 80D - -

c) Deduction U/s 80G -

d) Deduction U/s 80GG YES NO

### Least of the below :

a) Amount Specified 24,000

 b) Rent Paid in excess of 10% of Adj. Income -
a) Rent Paid -

b) 10% of Adj. Income -

-

c) 25% of Adj. Income -

-
-

e) Other Deductions (Please Specify)

80E 7 -

Total of Deduction under chapter VIA

TAXABLE INCOME
16. Taxable Income

17. Agricultural Income

18. Agrigate of (Item No. 16 and 17)

COMPUTATION OF TAX LIABILITY

19. Tax at normal rates

20. Tax at special rates

21. Tax Payable on total Income

22. Surcharge

23. Education Cess

24. Total Tax Payable (Item No.21+22+23)

25. Relief U/s 89

26. Relief U/s 90/91

27. Balance Tax Payable

28. Interest Payable U/s 234

a) U/s 234 A -
-
b) U/s 234 B -
c) U/s 234 C -

29. Total Tax Payable

30. Taxes Paid

a) Advance Tax Paid
Sl.N Name of Bank & Branch BSR Code Date of Deposit Serial No. of Amount
o. Challan
1 -
2 -
3 -

TOTAL : -
b) Tax Deducted At Source (As per Form No. 16 issued by the employer)
 Sl. TAN of the Name and Income Chargeable Deduction Tax Payable Total tax Tax
No. Employer address of under the head under (including deposited Payable/
the Employer Chapter VI- surchage) refundable
A

1 - - - - -

TOTAL : -
c) Tax Deducted At Source (As per Form No. 16A issued by the deductee)
Sl. TAN of the Name and address of the deductor Amount Date of Total tax Amount
No. Deductor Paid/ Payment/ deposited claimed for
Credit Credit this year

###
- - -
- -
- -
- -
- -
- -
- -
- -
- -

CLICK HERE TO FINDOUT CORRECT TAN TOTAL : -

c) Self Assessment Tax Paid
Sl. Name of Bank & Branch BSR Code Date of Serial No. of Amount
No. Deposit Challan
1 -
-
-

TOTAL : -

Total Taxes paid

31. Tax Pyable ###

###

32 Refund Receivable 1

DETAILS OF BANK ACCOUNT

-Select Bank Name and Branch-

a) Name of the Bank -Select Bank Name and Branch-

- Select the Branch -

MICR Code - MICR - Type of Account Savings

OTHER INFORMATION
Annual Information Return Particulars
Code Description Yes/No. Amount i

cash deposit aggregating ten lakh rupees or more in a year in

any savings account by you maintained in abankig company to
001 which the Banking Regulations Act, 1949 (10 of 1949), applied
(including any bank or banking institution referred to in section
51 of that Act) -
Payment made by you against bills raised in respect of a credit
002 card aggregating to tow lakh rupees or more in a year
-
Payment made by you of an amount of two lakh rupees or more
003 for purchase of units of Mutual Fund
-
Payment by you of an amount of five lakh rupees or more for
004 acquiring bonds or debentures issued by a company or
-
institution.
Payment made by you of an amount of one lakh rupees or more
005 for acquiring shares issued by a compnay
-
Purchase by you of any immovable property valued at thirty lakh
006 rupees or more
-
Sale by you of any immovable property valued at thirty lakh
007 -
rupees or more
Payment made by you of an amount of five lakh rupees or more
008 in a year for investment in bonds issued by Reserve Bank of
India -

FALSE
###

###
D.No. 10-1-12, II Floor,

Krishna Kamal Enclave,

Asilmetta Juncton,

Visakhapatnam - 530
003 ,
Ph. 0891-2755814

email :
vnhari.ca@gmail.com

YES

Individual HUF

PAN

Others PSU

urn

REVISED

FALSE
FALSE

FALSE
FALSE
CAPITAL BALANCE AS
ON 31st MARCH IN
THE FIRM

Net Income

-
-

-
-

-
 -

Current Account
Amount in Rs.

- FALSE

- FALSE

- FALSE

- FALSE

- FALSE

- FALSE

- FALSE

- FALSE

FALSE
 Government of India

INCOME-TAX DEPARTMENT

ACKNOWLEDGEMENT

Received with thanks #VALUE! a return of income

from of fringe benefits in Form No. ITR - 3 for assessment year 2009-10, having the following particulars
and/or return

Name PAN

#VALUE!
PERSONAL INFORMATION

Flat/Door/Block No Name of Premises/Building/Village

#VALUE!
Road/Street/Post Office Area/Locality

Town/City/District State
Status (fll the
code)
VISAKHAPATNAM ###
Deisgnation of the Assessing Officer (Ward/Range) Original or Revised ORIGINAL

1 Gross Total Income 1 -

2 Deductions Under Chapter VI-A 2 -

3 Total Income 3 -
COMPUTATION OF INCOME AND TAX THEREON

3a Current Year loss (if any) 3a -

4 Net tax payable 4 -

5 Interest payable 5 -

6 Total tax and interest payable 6 -

7 Taxes paid

a Advance Tax 7a -

b TDS 7b -

c TCS 7c -

d Self Assessment Tax 7d -

e Total Taxes Paid (7a+7b+7c+7d) 7e -

8 Tax Payable (6-7d) 8 -

9 Refund (7e-6) 9 -
Receipt No Seal and Signature of receiving official
Date
Name of the Assessee #VALUE!
Father's Name #VALUE!
Date of Birth 30-Dec-99 Sex :
Address #VALUE!
(Not Applicable )

(Being a Women Assessee) VISAKHAPATNAM

PAN Assessment Year
Status 1 INDIVIDUAL Previous Year
Due date of filing 31-Jul-10 Ward/Circle
Month of filing 31-Jul-10 Previous Year ended on

COMPUTATION OF TOTAL INCOME

(Being a senior citizen)
Since the assessee does not
I. INCOME FROM SALARY:
Gross Exemptions
Less: Salary Received
U/S 10: -
a) HRA u/s 10(13A) -
b) Conveyance Allowance u/s 10(14) -
c) Any other Allowance - -
Balance -
Less: Deductions U/S 16:

(i) Professional Tax -

II. INCOME FROM HOUSE PROPERTY : let out

1. , - LET OUT

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

2. , - LET OUT

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

3. , - LET OUT
 , -

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

4. , - LET OUT

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

5. , - LET OUT

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

6. , - LET OUT

Gross Annual Value -

Less: Municipal Taxes -
Net Annual Value -
Less: Deduction u/s 24
a) Standard Deduction -
b) Interest on borrowed Capital -
-
#VALUE! -

III. INCOME FROM BUSINESS :

Income from Partnership Firm :
Partner in the following Firms

1. #VALUE!
 for a share of profit /losses in firm @

i) Share of Profit -
ii) Interest on Capital -
iii) Remuneration received -
-
Less: Exemption U/s 10(2A) -
-
Less: Expenses -
Net Income from Firm No. 1 -

IV. INCOME FROM CAPITAL GAINS :

a. Long Term Capital Gain :
Income from Long Term Capital Gains -
b. Short Term Capital Gains :
Short Term Capital gains chargeable at special rates -
Short Term Capital gains chargeable at normal rates -

V. INCOME FROM OTHER SOURCE :

A. Income other than from owning race horse(s):-
a. Dividends -
Less: Exemption U/s 10(33) -
-
### Interest
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
-
c. Rental Income from Machinery -
d. Other Income
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
#VALUE! -
 #VALUE! -
#VALUE! -
#VALUE! -
-
-
Less: Deduction u/s 54
a. Expenses -
b. Depreciation -
c. Other Expenses -
-
-
B. Winnings from lotteries, crossword puzzles, races, etc., -

C. Income from owning and maintaining race horses

Receipts -

Deductions under section 57 -

-

Gross Total Income Gross Total Income

Less: Deduction under chapter VIA :
Gross Amount Qlfy. Amount
a) Deduction U/s 80C
1) Life Insurance Premium -
2) Housing Loan Repayment -
3) Contribution to PF -
4) Purchase of NSC -
5) Investment in MF -
6) Investment in Pension Plan -
7) Children Tuition Fee -
8) Registration Fee of Res. House -
9) Other Savings -
- -

b) Deduction U/s 80D - -

c) Deduction U/s 80G -

d) Deduction U/s 80GG -

e) Other Deductions -

Taxable Income
Rounded to 39,690
Agriculture Income
Tax on Income returned
Income Chargeable Income Tax
At special Rates (@ 20%) -
Less: Short fall of Basic exeption if any -
- - -
240000
At special Rates (i.e. @ 15%) -
Less: Short fall of Basic exemption if any 240,000
240,000 - -

At Normal Rates - -
Tax on Income returned
Add: Education Cess
Total Tax Payable
Less: Tax Deducted At Source
Refund Receivable
Less: Advance Tax
BSR Code Date Amount in Rs.
#VALUE! -
#VALUE! -
#VALUE! - -

-
-
-
- -
 FEMALE

2010-11
2009-10

31-Mar-10

UTATION OF TOTAL INCOME

AMOUNT
RS.

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-

-
-

-
-
-
-
 INDIAN INCOME TAX RETURN Assessment Year
FORM [For Individuals/HUFs being partners in firms and not carrying out business
ITR - 3 or profession under any proprietorship]
(Please see Rule 12 of the Income - tax Rules, 1962) 20 1 0 - 11
(Also see attached Instructions)

Part A - GEN GENERAL

First Name Middle Name Last Name PAN
#VALUE!
PERSONAL INFORMATION

Flat / Door / Block No. Name of Premises / Building /Villege Status (Tick)

#VALUE! ###
Individual ### HUF

Road /Street /Post Office Area / Locality Date Of Birth (DD/MM/YYYY)

(in case of individual)

30-Dec-99
Town / City / District State Pincode Sex (in case of individual) (Tick)

VISAKHAPATNAM ANDHRA PRADESH Male Female

Email Address (STD CODE) - Phone number Employer Category (if in
employment (Tick)
#VALUE! ### ###
Govt ###
PSU Others

Designation of the Assessing Officer (Ward / Circle) Return Filed Under Section
[Please see instruction number 9(i)]
FA
TR
Whether original or Revised Return ? (Tick) Original LS Revised
UE
E
FILING STATUS

If revised, then enter Receipt No and Date of

filing original return (DD/MM/YYYY)

Residential Status (Tick)

### Resident ### Non-Resident ### Resident but Not Ordinarily Resident

Whether this return is being filed by a representative assessee?

###(Tick)Yes ### No
If yes, please furnish following information -
(a) Name of the representative
(b) Address of the representative
(c) Permanent Account Number (PAN) of the representative
#VALUE!
PART - B
Part B - TI Computation of total income
1 Salaries (6 of Schedule S) 1 -
2 Income from house property (3c of Schedule HP) (enter nil if loss) 2 -
Profits and gains from business or profession (6vi of Schedule BP) (enter nil if
3 loss) (A4 of schedule CG)
TOTAL INCOME

3 -
4 Capital gains
a Short term
i Short-term (u/s 111A) (A5 of Schedule CG) 4ai -
ii Short-term (others) (A6 of Schedule CG) 4aii -
iii Total short-term (3ai + 3aii) (enter nil if loss) 4aiii -
b Long-term (B5 of ScheduleCG) (enter nil if loss) 4b -
c Total capital gains (3aiii + 3b) 4c -
5 Income from other sources
a from sources other than from owning race horses (3 of
5a -
Schedule OS) (enter nil if loss)
b from owning race horses (4c of Schedule OS) (enter nil if loss)5b -
c Total (5a + 5b) 5c -
6 Total (1+2+3+4c+5c) 6 -
Do not write or stamp in this area (Space for bar code) For Office Use only

Receipt No.

Date
 Seal and signature of receiveing official

7 Losses of current year set off against 6 (total of 2vii,3vii and 4vii of Schedule CYLA) 7 -
8 Balance after set off current year losses (6-7) (also total of column 5 of Schedule CYLA) 8 -
9 Brought forward losses set off against 8 (2vii of Schedule BFLA) 9 -
###Gross Total income (8-9)(also 3viii of Schedule BFLA) 10 -
###Deductions under Chapter VI-A (o of Schedule VIA) 11 -
###Total income 12 -
###Net agricultural income/ any other income for rate purpose (4 of Schedule EI) 13 -
###Aggregate income (12+13) 14 -
###Losses of current year to be carried forward (xi of Schedule CFL) 15 -

Part B - TI Computation of tax liability on total income

1 Tax payable on total income
a Tax at normal rates 1a -

b Tax at special rates (11 of Schedule SI) 1 -

b 1c
c Tax Payable on Total Income (1a + 1b) -
COMPUTATION OF TAX LIABILITY

2 Education Cess, including secondary and higher education cess on 1c 2 -

3 Gross tax liability (1c+ 2 ) 3 -
4 Tax relief
a Section 89 4a -

b Section 90 4 -
b
c Section 91 4c -
d Total (4a + 4b+4c) 4d -
5 Net tax liability (3 4d) 5 -
6 Interest payable
a For default in furnishing the return (section 234A) 6a -
b For default in payment of advance tax (section 234B) 6 -
c For deferment of advance tax (section 234C) b
6c -
d Total Interest Payable (6a+6b+6c) 6d -
7 Aggregate liability (5 + 6d) 7 -
8 Taxes Paid
a Advance Tax (from Schedule-IT) 8a -
TAXES PAID

b TDS (total of column 7 of Schedule-TDS1 and column 7 8 -

of Schedule-TDS2) b

c Self Assessment Tax(from Schedule-IT) 8c -

d Total Taxes Paid (8a+8b+8c) 8d -
9 Amount payable (Enter if 7 is greater than 8d, else enter 0) 9 -
### Refund (If 8d is greater than 7, also give Bank Account details below) 10 -
REFUND

### Enter your bank account number (mandatory in case of refund) #VALUE!
### Do you want your refund by cheque, or deposited directly into your bank account? (tick as applicable )
In case of direct deposit to your bank account give
###
additional details
#VALUE!
Type of Account (tick as
MICR Code - MICR - Savings Current
applicable )

V E R I F I C A T I O N

I, #VALUE! Daughter of #VALUE! holding PAN

solemnly declare that to the best of my knowledge and belief, the information given in the return and schedules 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 2010-2011

Place VISAKHAPATNAM Date 14-Jun-2010 Sign Here

 14 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

15
If TRP is entitled for any reimbursement from the Government, amount thereof

Schedule S Details of Income from Salary

Name of Employer PAN of Employer (optional)
#VALUE!
Address of employer Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH
SALARIES

1 Salary (Excluding all allowances, perquisites & profit in lieu of salary) 1 -

2 Allowances exempt under section 10 2 -
3 Allowances not exempt 3 -
4 Value of perquisites 4 -
5 Profits in lieu of salary 5 -
6 Income chargeable under the Head Salaries (1+3+4+5) 6 -

Schedule HP Details of Income from House Property

1 Address of property 1 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 1a -
year, lower if let out for part of the year)
1
b The amount of rent which cannot be realized -
b
c Tax paid to local authorities 1c -
1
d Total (1b + 1c) -
d
e Balance (1a 1d) 1e -
f 30% of 1e 1f -
1
g Interest payable on borrowed capital -
g
h Total (1f + 1g) 1h -
i Income from house property 1 (1e 1h) 1i -
2 Address of property 2 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 2a -
year, lower if let out for part of the year)
2
b The amount of rent which cannot be realized -
b
c Tax paid to local authorities 2c -
2
d Total (2b + 2c) -
d
e Balance (2a 2d) 2e -

f 30% of 2e -
2f
2
g Interest payable on borrowed capital -
g
h Total (2f + 2g) 2h -
i Income from house property 2 (2e 2h) - 2i
3 Address of property 3 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 3a -
year, lower if let out for part of the year)
3
b The amount of rent which cannot be realized -
b
 c Tax paid to local authorities 3c -
3
d Total (3b + 3c) -
d
e Balance (3a 3d) 3e -

f 30% of 2e -
3f
HOUSE PROPERTY

3
g Interest payable on borrowed capital -
g
h Total (3f + 3g) 3h -
i Income from house property 3 (3e 3h) 3i -
4 Address of property 4 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 4a -
year, lower if let out for part of the year)
4
b The amount of rent which cannot be realized -
b
c Tax paid to local authorities 4c -
4
d Total (4b + 4c) -
d
e Balance (4a 4d) 4e -
f 30% of 4e -
4f
4
g Interest payable on borrowed capital -
g
h Total (4f + 4g) 4h -
i Income from house property 4 (4e 4h) 4i -
5 Address of property 5 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 5a -
year, lower if let out for part of the year)
5
b The amount of rent which cannot be realized -
b
c Tax paid to local authorities 5c -
5
d Total (5b + 5c) -
d
e Balance (5a 5d) 5e -
f 30% of 5e -
5f
5
g Interest payable on borrowed capital -
g
h Total (2f + 2g) 5h -
i Income from house property 5 (5e 5h) 5i -
6 Address of property 6 Town/City State PIN Code
#VALUE! #VALUE! ANDHRA PRADESH #VALUE!

(Tick) if let out ### Name of Tenant PAN of Tenant (optional)

Annual letable value/ rent received or receivable (higher if let out for whole of the
a 6a -
year, lower if let out for part of the year)
6
b The amount of rent which cannot be realized -
b
c Tax paid to local authorities 6c -
6
d Total (6b + 6c) -
d
e Balance (2a 2d) 6e -
f 30% of 6e -
6f
6
g Interest payable on borrowed capital -
g
h Total (6f + 6g) 6h -
i Income from house property 6 (6e 6h) 6i -
3 Income under the head Income from house property
a Rent of earlier years realized under section 25A/AA 3a -
b Arrears of rent received during the year under section 25B after deducting 30% 3b -
 c Total(3a+3b+3c+1i+2i) 3c -
NOTE Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head

Schedule IF Information regarding partnership firms in which you are partner

Number of firms in which you are partner
Name of the Firm PAN of the Firm Percentage Amount of Capital balance
FIRMS IN WHICH PARTNER

Share share on 31st March in

in the profit in the profit the Firm
Firm No of the firm i ii
11 #VALUE! - -
22 #VALUE! - -
33 #VALUE! - -
44 #VALUE! -
55 #VALUE! -

Total - -

Schedule BP Income under the head 'Profits and Gains from Business or Profession' (Income from firms in which you are partne
Firm No. Salary,bonus, Interest received Total Expenses in Net Income
SI. (From commission or from the firm on the ii + iii relation iv-v
No.Schedule-IF)remuneration received capital to iv
INCOME FROM FIRMS

from the firm

i ii iii iv v vi
1 1 - - - - -
2 2 - - - - -
3 3 - - - - -
4 4 - - - - -
5 5 - - - - -

Total - - - - -
NOTE Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head

Schedule CG Capital Gains

A Short-term capital gain
1 From assets in case of non-resident to which first proviso to section 48 applicable1 -
2 From other assets
a Full value of consideration 2a -
b Deductions under section 48
i Cost of acquisition bi -
ii Cost of Improvement bii -
iii Expenditure on transfer biii -
iv Total
Total ((ii +
+ ii
ii +iii)
+ ii) biv -
c Balance (2a biv) 2c -
d Loss, if any, to be ignored under section 94(7) or
94(8) (enter positive vlaues only) 2d -

e Exemption under section 54/54B/54D/54EC/54F 2e -

f Short-term capital gain (2c 2d 2e) 2f -
3 Amount deemed to be short term capital gains under sections 54/54B/54D/54EC/54ED/54F
3 -
4 Total short term capital gain (1 + 2f +3 +4) 4 -
5 Short term capital gain under section 111A included in 4 A5 -
6 Short term capital gain other than referred to in section 111A (4 5) A6 -
B Long term capital gain
1 Asset in case of non-resident to which first proviso to section 48 applicable 1 -
2 Other assets where proviso to section 112(1) not applicable
a Full value of consideration 2a -
b Deductions under section 48
i Cost of acquisition after indexation bi -
ii Cost of improvement after indexation bii -
 iii Expenditure on transfer biii -
iv Total (bi + bii +biii) biv -
c Balance (2a biv) 2c -
Deduction under sections 54/54B/54D/54EC /
d 2d -
54F
e Net balance (2c 2d) 2e -
3 Other assets where proviso to section 112(1) is applicable
a Full value of consideration 3a -
CAPITAL GAINS

b Deductions under section 48

i Cost of acquisition without indexation bi -
ii Cost of improvement without indexation bii -

iii Expenditure on transfer biii -

iv Total (bi + bii +biii) biv -

c Balance (3a biv) 3c -

d Deduction under sections 54/54B/54D/54EC/54F 3d -
e Net balance (3c-3d) 3e -
###Amount deemed to be long term capital gains under sections 54/54B/54D/54EC/54ED/54F 4 -
###Total long term capital gain (1 + 2e [(enter 2e as nil if loss) + 3e (einter 3e as nil if
B5loss)+ 4)] -
C Income chargeable under the head CAPITAL GAINS (A6 + B5) C -
D Information about accrual/receipt of capital gain
Upto 15/9 16/9 to 15/12 16/12 to 15/3 16/3 to 31/3
Date
(I) (ii) (iii) (iv)
1 Long-term where provisio under section
112(1) is applicable (Whiout
Indexisation) -
Code in SI schedule is
22, Tax Rate is 10% :
Enter only positive value from Item
B3e of Schedule CG AFTER loss adjustment
under this category in Schedule CYLA and
2 Long-term
BFLA, if any where provisio under section
112(1) is NOT applicable (Whiout
Indexisation) -
Code in SI schedule is - - - -
21, Tax Rate is 20% :
Enter only positive value from Item
(B5-B3e) of Schedule CG AFTER loss
adjustment under this category in Schedule
3 Short-term
CYLA and BFLA,under 111A -
if any
Code in
SI schedule is 1A, Tax Rate is 15% :
Enter only positive - - - -
value from Item A7 of Schedule CG AFTER
loss adjustment under this category in
Schedule CYLA and BFLA, if any
4 Short-term OTHERS-

Enter only positive value

- - - -
from Item A8 of Schedule CG AFTER loss
adjustment under this category in Schedule
CYLA and BFLA, if any
NOTE Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head

Schedule OS Income from other sources

1 Income other than from owning race horse(s):-
a Dividends, Gross 1a -
b Interest, Gross 1b -
c Rental income from machinery, plants, buildings, 1c -
d Others, Gross 1d -
e Total (1a + 1b + 1c + 1d) 1e -
f Deductions under section 57:-
OTHER SOURCES

i Expenses fi -
ii Depreciation fii -
iii Total fii -
g Balance (1e fiii) 1g -
2 Winnings from lotteries, crossword puzzles, races, etc. 2 -
OTHER 3 Income from other sources (other than from owning race horses) (1g + 2) (enter 1g as 3
nil if loss) -
4 Income from owning and maintaining race horses
a Receipts 4a -
b Deductions under section 57 in relation to (4) 4b -
c Balance (4a 4b) 4c -
Income chargeable under the head Income from other sources (3+4c)(enter 4c
5 as nil, if loss and take 4c loss figure to schedule CYLA) 5 -

NOTE Please include the income of the specified persons referred to in Schedule SPI while computing the income under this head.

Schedule CYLA Details of Income after Set off of current year losses
Sl. Head/ Source Income of House property loss Business loss Other sources loss (other Current years
No of Income current year of the current year set than loss from race income
(Fill this column off horses) of the current remaining after
only if income is Total loss Total loss Totalset
year loss
off set off
(3c of Schedule HP) (6vi of (3 of
zero or positive) Schedule-BP) Schedule-OS)

1 2 3 4 5=1-2-3-4
CURRENT YEAR LOSS ADJUSTMENT

Loss to be adjusted

i Salaries - - - -
ii House property
- - - -
iii Business or
profession - - -
-
iv Short-term
- - - -
capital gain -
v Long term
- - - -
capital gain -
vi Other
sources (incl
profit from
owning race
- - -
horses but
excluding
winning from
lottery) -
vii Total loss set off - - -
viii Loss remaining after set-off - - -

Schedule BFLA Details of Income

Income after
after Set
set off
off,of
if Brought
any, of Forward Losses of earlier years
Sl. Head/ Source of current years losses as per 4 of Brought forward loss set off Current years income
No Income Schedule
1 CYLA 2 remaining after
3 set off
i Salaries - - -
ii House property
BROUGHT FORWARD LOSS ADJUSTMENT

- - -
Business or
iii - - -
profession
Short-term capital
iv - - -
gain
v Long-term capital
- - -
gain
vi Other sources
(including profit
from owning race
- - -
horses but
excluding winning
from lottery)
vii Total of brought forward loss set off -
viii Current years income remaining after set off Total (i3 + ii3 + iii3 + iv3 + v3 + vi3) -

Schedule CFL Details of Losses to be carried forward to future years

Assessment Year Date of Filing House Business Short- Long-term Other sources loss ( from owning
SI. (DD/MM/YYY property or term Capital race horses)
No Y) loss profession capital loss
loss
i 2002-03 - - - - -
OF LOSS
 -
CARRY FORWARD OF LOSS ii 2003-04 - - - -
iii 2004-05 - - - -
iv 2005-06 - - -
v 2006-07 - - - - -
vi 2007-08 - - - - -
vii 2008-09 - - - - -
viii 2009-10 - - - - -
ix Total of earlier year - - - - -
losses
x Adjustment of above - - - - -
losses in Schedule BFLA
xi 2010-11 (Current year - - - - -
xii Total losslosses)
Carried - - - - -
Forward to
future years

Schedule VIA Deductions under Chapter VI-A (Section)

a 80C - h 80G -
TOTAL DEDUCTIONS

b 80CCC - i 80GG -
c 80CCD - j 80GGA -
d 80D - k 80GGC -
e 80DD - l 80RRB -
f 80DDB - m 80U -
g 80E - n
o Total deductions (total of a to n) o -

Schedule SPI Income of specified persons (spouse, minor child etc) includable in income of the assessee
Sl No Name of person PAN of person (optional) Relationship Nature of Income Amount (Rs.)
1
2

Schedule SI Income chargeable to Income tax at special rates IB [Please see instruction Number-9(iii) for section code and rate of tax]
Special Sl
Sl Section Income Tax thereon Section Special Income Tax thereon
rate N
No code i ii code rate (%) i ii
SPECIAL RATE

(%) o
1 1A 15 0 6
2 22 10 7
3 21 20 0 8
4 5BB 30 9
5 ###
11 Total (1ii to 10 ii)

Schedule EI Details of Exempt Income (Income not to be included in Total Income)

1 Interest income 1
EXEMPT INCOME

2 Dividend income 2 -
3 Long-term capital gains on which Securities Transaction Tax is paid 3
4 Net Agriculture income /any other income for rate purpose 4 -
5 Share in the profit of firm / AOP etc. 5 -
6 Others 6
7 Total (1+2+3+4+5+6) 7

Other Information (Information relation to Annual Information Return) [Please see instruction number - 9(ii) for
Schedule AIR
code]
Sl Code of Amount (Rs) Sl Code of Amount (Rs)
1 Transaction
001 - 5 Transaction
005 -
2 002 - 6 006 -
3 003 - 7 007 -
4 004 - 8 008 -

Schedule IT Details of Advance Tax and Self Assessment Tax Payments of Income-tax
Name of Bank & Branch BSR Code Date of Serial Number Amount (Rs)
Sl
Deposit of
No
TAX PAYMENTS

(DD/MM/YYYY) Challan
TAX PAYMENTS i #VALUE! #VALUE! -
ii #VALUE! -
iii #VALUE! -
iv #VALUE! #VALUE! -
v #VALUE! #VALUE! -
NOTE Enter the totals of Advance tax and Self Assessment tax in Sl No. 9a & 9c of PartB-TTI

Schedule TDS1 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 Income Deduction Tax Payable Total tax Tax
No Number (TAN) of the Employer chargeab under (incl. surch. deposited payable/
TDS ON SALARY

Employer le under Chapter and edn. refunda

Salaries VI-A cess) ble
(1) (2) (3) (4) (5) (6) (7) (8)
i #VALUE! #VALUE! - - - - -
ii #VALUE! #VALUE! - - - - -
iii
iv

Schedule TDS2 Details of Tax Deducted at Source on Income [As per Form 16A issued by Deductor(s)]
Sl Tax Deduction Account Name and address of the Date of Total tax Amount out
TDS ON OTHER INCOME

No Number (TAN) of the Deductor Amount Payment/ deposited of (6)

Deductor paid Credit claimed for
this year
(1) (2) (3) (4) (5) (6) (7)
i #VALUE! - - -
ii #VALUE! - - -
iii #VALUE! - - -
iv #VALUE! - - -
v #VALUE! - - -
vi #VALUE! - - -
NOTE Please enter total of column 7 of Schedule-TDS1 and column 7 of Schedule-TDS2 in 9(b) of PartB-TTI
 Single copy ( to be sent to the ZAO)

Tax Applicable (Tick One) Assessment

Year
CHALLAN NO./ (0020) INCOME - TAX ON (0021) INCOME TAX
ITNS 280 COMPANIES (OTHER THAN COMPANIES) 2010-11
(CORPORATION TAX)

Parmenent Account Number

Full Name
#VALUE!

Complete Address with City & State

#VALUE!
VISAKHAPATNAM

Type of Payment (Tick One)

Advance Tax (100) Surtax (102)
Self Assessment Tax (300) Tax on Distributed Profits of Domestic Companies(106)
Tax on Regular Assessment (400) Tax on Distributed Income to Unit Holders (107)

DETAILS OF PAYMENTS FOR USE IN RECEIVING BANK

Income Tax - Debit to A/c / Cheque credited on
Surcharge
Education Cess DD MM YY
Interest
Penalty SPACE FOR BANK SEAL
Others
Total -
Total (in words)

Crores Lacs Thousands Hundreds Tens Units

Zero Zero Zero Zero

Paid in Cash/Debit to A/c/Cheque Dated

Drawn on
Name of the Bank and Branch)
Rs. -
Date 14-Jun-2010 Signature of person making payment

Taxpayers' Counterfoil (To be filled up by tax payer) SPACE FOR BANK SEAL

PAN
Received from #VALUE!
(Name)

Cash/Debit to A/c/Chq. No. For Rs. -

Rs.(in words) Only
Drawn on
(Name of the Bank and Branch)

on account of INCOME TAX OTHER THAN COMPANIES

Type of Payment SELF ASSESSMENT TAX Rs. -
Assesment Year 2010-11
 INDEXED COST OF ACQUISITION

FIN.YEAR INDEX NO. Number

1 1981-82 100 1
2 1982-83 109 2
3 1983-84 116 3
4 1984-85 125 4
5 1985-86 133 5
6 1986-87 140 6
7 1987-88 150 7
8 1988-89 161 8
9 1989-90 172 9
10 1990-91 182 10
11 1991-92 199 11
12 1992-93 223 12
13 1993-94 244 13
14 1994-95 259 14
15 1995-96 281 15
16 1996-97 305 16
17 1997-98 331 17
18 1998-99 351 18
19 1999-00 389 19
20 2000-01 406 20
21 2001-02 426 21
22 2002-03 447 22
23 2003-04 463 23
24 2004-05 480 24
25 2005-06 497 25
26 2006-07 519 26
27 2007-08 551 27
28 2008-09 582 28
29 2009-10 632 29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
 79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
0

1-Apr-2009 15-Sep-2009 15-Dec-2009 15-Mar-2010 31-Mar-2010

Long Term Capital Gain
164 254 344 360
16-Mar-2010 (Long Term)
345 4
30-Oct-2009 (Short Term normal rates)
209
2
30-Aug-2009 (Short Term special rates)
149
1

Long Term Capital Gains :

Income - - - -
Tax - - - -
Surcharge - - - -
Edu. Cess - - - -
Total Tax - - - -

Short Term Capital Gains (At special rates)

Income - - - -
Tax - - - -
Surcharge - - - -
Edu. Cess - - - -
Total Tax - - - -

Short Term Capital Gains (At normal rates)

Income - - - -
Tax #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Surcharge - - - -
Edu. Cess #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Total Tax #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Chargeable at Normal Rates

Income - - - -
Tax - - - -
Surcharge
Edu. Cess - - - -
Total Tax

Tax #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Surcharge - - - -
Edu. Cess #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Total Tax #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Interest u/s 234C

Total Tax Payable #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Qtr. Installment #DIV/0! #DIV/0! #DIV/0! #DIV/0!
 Less: Ad.tax - - - -
Less: TDS - - - -
Short Fall #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Interest #DIV/0! #DIV/0! #DIV/0!
Total Interest #DIV/0!
In words
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Sixteen
Seventeen
Eighteen
Ninteen
Twenty
Twenty one
Twenty Two
Twenty Three
Twenty Four
Twenty Five
Twenty Six
Twenty Seven
Twenty Eight
Twenty Nine
Thirty
Thirty One
Thirty Two
Thirty Three
Thirty Four
Thirty Five
Thirty Six
Thirty Seven
Thirty Eight
Thirty Nine
Forty
Forty One
Forty Two
Forty Three
Forty Four
Forty Five
Forty Six
Forty Seven
Forty Eight
Forty Nine
Fifty
Fifty One
Fifty Two
Fifty Three
Fifty Four
Fifty Five
Fifty Six
Fifty Seven
Fifty Eight
Fifty Nine
Sixty
Sixty One
Sixty Two
Sixty Three
Sixty Four
Sixty Five
Sixty Six
Sixty Seven
Sixty Eight
Sixty Nine
Seventy
Seventy One
Seventy Two
Seventy Three
Seventy Four
Seventy Five
Seventy Six
Seventy Seven
Seventy Eight
Seventy Nine
Eighty
Eighty One
Eighty Two
Eighty Three
Eighty Four
Eighty Five
Eighty Six
Eighty Seven
Eighty Eight
Eighty Nine
Ninty
Ninty One
Ninty Two
Ninty Three
Ninty Four
Ninty Five
Ninty Six
Ninty Seven
Ninty Eight
Ninty Nine
Zero
#DIV/0!