INDIAN INCOME TAX RETURN VERIFICATION FORM
Assessment Year
[Where the data of the Return of Income/Fringe Benefits in Form ITR-1, ITR-2, ITR-3,
ITR-V
ITR-4, ITR-5, ITR-6 & ITR-8 transmitted electronically without digital signature]
2 0 0 9 - 10
(Please see Rule 12 of the Income-tax Rules, 1962)
Name SHYAM SINGH
PAN AXJPS6305C
Flat/Door/Block No 331
Name Of Premises/Building/Village
Road/Street/Post Office
Area/Locality CHATTARPUR VILLAGE
Town/City/District NEW DELHI
State
Form No. which has been electronically transmitted (fill the code) Status (fill the code)
Pin
DELHI
110074
Individual
Original or Revised
Designation of AO (Ward / Circle) ITO WARD 24(3) E-filing Acknowledgement Number
ITR-4
80237990300709
Date(DD/MM/YYYY)
ORIGINAL 30-07-2009
1
Gross total income
1
264330
2 3
Deductions under Chapter-VI-A Total Income a Current Year loss, if any Net tax payable Interest payable
2 3 3a 4 5
108466 155864 0 604
Total tax and interest payable Taxes Paid a Advance Tax
6
4
5 6 7
7a
0
b c
TDS TCS
7b 7c
0
d
Self Assessment Tax
7d
0 604
8
e Total Taxes Paid (7a+7b+7c +7d) Tax Payable (6-7d)
9
Refund (7e-6)
10 11
Value of Fringe Benefits Total fringe benefit tax liability
10
12
Total interest payable
12
13
Total tax and interest payable
13
14
Taxes Paid a Advance Tax
15 16
7e
604
8 9
0 0
11
14a
b
Self Assessment Tax
c
Total Taxes Paid (14a+14b)
14b
14c
Tax Payable (13-14c) Refund
15 16 VERIFICATION , son/ daughter of
I, SHYAM SINGH
0 604
,
MANGAL SINGH
AXJPS6305C holding permanent account number solemnly declare to the best of my knowledge and belief, the information given in the return and the schedules thereto which have been transmitted electronically by me vide acknowledgement number mentioned above is correct and complete and that the amount of total income/ fringe benefits 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 and fringe benefits chargeable to income-tax for the previous year relevant to the assessment year 2009-10. I further declare that I am making this return in my capacity as and I am also competent to make this return and verify it. Date Place NEW DELHI Sign here 30-07-2009
If the return has been prepared by a Tax Return Preparer (TRP) give further details as below: Identification No. of TRP Name of TRP
For Office Use Only Receipt No
Filed from IP address
Counter Signature of TRP
59.178.173.35
Date Seal and signature of receiving official
AXJPS6305C04802379903007094B37FA53903195D324CA623E4C67B3F33F9CA12A
Please furnish Form ITR-V to “Income Tax Department - CPC, Post Bag No - 1, Electronic City Post Office, Bangalore - 560100, Karnataka”, by ORDINARY POST OR SPEED POST ONLY, on or before the 31st March, 2010 or within 120 days, whichever is later, from date of transmitting the data electronically. Form ITR-V shall not be received in any other office of the Income-tax Department or in any other manner. The receipt of this ITR-V at ITD-CPC will be sent to you at this e-mail address
[email protected]
