Indian Income Tax Return: (Refer Instructions For Eligibility)
Indian Income Tax Return: (Refer Instructions For Eligibility)
(A1) PAN (A2) First Name (A2a) Middle (A3) Last Name (A4) Date of Birth (A5) Aadhaar Number (12 digits)
DPPPS7614K Name SATTIASSILY 20-Dec-1967 /Aadhaar Enrolment Id (28 digits) (If
eligible for Aadhaar No.)
3xxx xxxx 8789
(A6) Mobile No. (A7) Email Address (A8) Flat/Door/Block (A9) Name of Premises (A10) Road/Street/Post
+ 91 9036466830 rafeekmekgce@gmail.com No. /Building/Village Office, Area/Locality
43,sivavishnu nagar keerapalayam Mudaliyarpet ,
PONDICHERRY
(A15) Filed u/s ✔ 139(1)-On or before due date (A16) Nature of employment-
(Tick) [Please see 139(4)-Belated 139(5)-Revised Central Govt. State Govt. Public Sector
instruction] 119(2)(b)- After Condonation of delay Undertaking CG - Pensioners SG -
Pensioners PSU - Pensioners Other
(A17) Or Filed in 139(9) 142(1) 148 Pensioners ✔ Others Not Applicable (e.g.
response to notice Family Pension etc.)
u/s
(A18) If revised/defective, then enter Receipt No. and Date of filing original
return (DD/MM/YYYY)
(A19) If filed in response to notice u/s 139(9)/142(1)/148 or order u/s 119(2)(b)- enter Unique
Number/Document Identification Number (DIN) & Date of such Notice or Order
(A20) Are you opting for new tax regime u/s 115BAC? Yes ✔ No
(A21) Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? - (Tick)
Yes ✔ No
If yes, please furnish following information
[Note: To be filled only if a person is not required to furnish a return of income under section 139(1) but filing return of income due to fulfilling
one or more conditions mentioned in the seventh proviso to section 139(1)]
(i) Have you deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more 0
current account during the previous year?
Yes ✔ No
(ii) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for 0
travel to a foreign country for yourself or for any other person?
Yes ✔ No
(iii) Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on 0
consumption of electricity during the previous year?
Yes ✔ No
(iv) Are you required to file a return as per other conditions prescribed under clause (iv) of seventh proviso to section 139(1)) (If yes, please
select the relevant condition from the drop down menu) Yes ✔ No
S.No Amount
iia Less : Income claimed for relief from taxation u/s 89A iia 0
vii Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put B2 0
the figure in negative)
Note: - Maximum Loss from House property that can be set-off in computing
income of this year is INR 2,00,000. To avail the benefit of carry forward and set
off of loss, please use ITR-2
Quarterly breakup of Dividend Income Quarterly breakup of Income from retirement benefit account
maintained in a notified country u/s 89A (taxable portion)
i Up to 15-Jun-2021 0 i Up to 15-Jun-2021 0
B4 Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) B4 1,76,449
Note: To avail the benefit of carry forward and set off of loss, please use ITR-2
D10 Fee u/s 0 D11 Total Tax, Fee and Interest (D5 + D7 + D8 + D9 + D10 - 0
234F D6)
Sl. IFS Code of the Bank Name of the Bank Account Number Select Account for Refund
Credit
Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior citizen? Not claiming for Self/Family
(iii) Medical Expenditure (This deduction to be claimed on which health insurance is not 0
claimed at (i) above)
2 Whether any one of your parents is a senior citizen Not claiming for parents
(a) Parents 0
(iii) Medical Expenditure (This deduction can be claimed on which health insurance is not 0
claimed at (i) above)
Schedule 80G: Details of donations entitled for deduction under section 80G
A. Donations entitled for 100% deduction without qualifying limit, (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Address City or State Pin code PAN of Amount of donation Eligible Amount of
- 0 0 0 0
Total A 0 0 0 0
B. Donations entitled for 50% deduction without qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Address City or State Pin code PAN of Amount of donation Eligible Amount of
- 0 0 0 0
Total B 0 0 0 0
C. Donations entitled for 100% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Address City or State Pin code PAN of Amount of donation Eligible Amount of
- 0 0 0 0
Total C 0 0 0 0
D. Donations entitled for 50% deduction subject to qualifying limit (where any row is filled by the user, all the fields in that row should become
mandatory)
S No. Name of the Address City or State Pin code PAN of Amount of donation Eligible Amount of
- 0 0 0 0
Total D 0 0 0 0
S No. Relevant Name of Address City or State Pin code PAN of Amount of donation Eligible
Clause under
the Town or Code the Amount of
which Donation Donation in Total
Donee District Donee Donation
deduction is
in cash other mode Donation
claimed
- 0 0 0 0
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
Total Donation 0 0 0 0
BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Tax paid
Total 0
Schedule TDS1 - Details of Tax Deducted at Source from Salary [As per form 16 issued by Employer(s)]
Sl.No. TAN of the Deductor Name of the Deductor Income chargeable under Total Tax Deducted
salaries
1 2 3 4
Total 0
Schedule TDS2 - Details of Tax Deducted at Source from Income Other than Salary [As per form 16A issued by Deductor(s)]
Sl. TAN of the Name of the Gross receipt which is Year of Tax Deducted TDS Credit out of (5)
No. Deductor Deductor subject to tax deduction tax claimed this year
deduction
1 2 3 4 5 6
Total 54,486
Schedule TDS3 - Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]
Sl. PAN Aadhaar Name of the Gross receipt which is Year of Tax Deducted TDS Credit out of (6)
No. of the Number Tenant subject to tax claimed this year
Tenant of tax deduction deduction
the
Tenant
1 2 3 4 5 6 7
Total 0
Schedule TCS - Details of Tax Collected at Source [As per form 27D issued by the Collector(s)]
Sl. Tax Name of the Gross payment which is Year of Tax Collected TCS Credit out of (5)
No. Collection Collector subject to tax claimed this year
Account tax collection collection
Number of
the
Collector
1 2 3 4 5 6
Total 0
VERIFICATION
I, SATTIASSILY son/ daughter of ANTOUT ANTOINE solemnly declare that to the best of my knowledge and belief, the information
given in the return is correct and complete and is in accordance with the provisions of the Income-tax Act, 1961. I further declare that I am
making this return in my capacity as Self and I am also competent to make this return and verify it. I am holding permanent account
number DPPPS7614K
Place: 165.225.76.100
Date: 31-05-2022
If the return has been prepared by a Tax Return Preparer (TRP) give further details below: