Acknowledgement Number:670523210140622 Date of filing:14-06-2022

INDIAN INCOME TAX RETURN ACKNOWLEDGEMENT

[Where the data of the Return of Income in Form ITR-1 (SAHAJ), ITR-2, ITR-3, ITR-4(SUGAM), ITR-5, ITR-6, ITR-7
Assessment Year
filed and verified] 2022-23
(Please see Rule 12 of the Income-tax Rules, 1962)

PAN BXUPB2950A

Name SAMUEL CLEMENT PRABHAKAR BANDELA

Address 11-1-78 , ARAVINDA NAGAR , Aravindanagar S.O , Anantapur , ANANTHAPUR , 02-Andhra Pradesh , 91-India , 515001

Status Individual Form Number ITR-1

Filed u/s 139(1) Return filed on or before due date e-Filing Acknowledgement Number 670523210140622

Current Year business loss, if any 1 0

Total Income 4,73,250

Book Profit under MAT, where applicable 2 0

Adjusted Total Income under AMT, where applicable 3 0

Net tax payable 4 0

Interest and Fee Payable 5 0

Total tax, interest and Fee payable 6 0

Taxes Paid 7 34,345

(+) Tax Payable /(-) Refundable (6-7) 8 (-) 34,350

Accreted Income as per section 115TD 9 0

Additional Tax payable u/s 115TD 10 0

Interest payable u/s 115TE 11 0

Additional Tax and interest payable 12 0

Tax and interest paid 13 0

(+) Tax Payable /(-) Refundable (12-13) 14 0

Income Tax Return submitted electronically on 14-06-2022 18:26:41 from IP address 157.48.219.71 and verified by SAMUEL CLEMENT
PRABHAKAR BANDELA having PAN BXUPB2950A on 01-07-2022 12:10:26 using paper ITR-Verification Form /Electronic Verification
Code XUF7PI86DY generated through Bank Account Prevalidation mode

System Generated

Barcode/QR Code
BXUPB2950A016705232101406224D8970DBBC401C9124B002E2369C696781284BE5

DO NOT SEND THIS ACKNOWLEDGEMENT TO CPC, BENGALURU