1 1

2 2
3 3
4 4
5
6 6
7 7
8 Tax payable on Total Income 8
9 Rebate u/s 87A 9
10 Tax payable after Rebate (8-9) 10
11 Surcharge if Taxable Total Income (7) exceeds 1 crore 11
12 Education Cess, including secondary and higher secondary cess on 10+11 12
13 Total Tax,Surcharge and Education Cess (Payable) (10+11+12) 13
14
15 15
16a
16b
16c
17 Total Interest u/s 234A 234B 234C 17
18 Total Tax and Interest Payable (15 + 17) 18
0
Name of premises / building / village Flat / Door / Building
Enter PAN of
Spouse if
applicable
Date of birth
0
Income from Other Sources (Ensure to fill Sch TDS2)
Income from one House Property
0
80 D
0
0
(Select)
0
80 DD
80 TTA
i
f
(Std code)
0 p
o 80 QQB
80 CCD (Employees / Self Employed Contribution)
If filed, in response
to a notice u/s
139(9)/142(1)/148/1
53A/153C enter
date of such notice
Date of Filing
Original Return
0
0
0
Income from Salary / Pension (Ensure to fill Sch TDS1)
0
0
If revised, defective, Modified then Enter
Receipt No
State Country (Select)
Phone No
(Select)
Pin Code
Whether original or
revised return?
Mobile no 2
Return filed under section
(Select)
(Select)
EmployerCategor
Residential Status
c
a
0 b
System Calculated
5l
5m
5n
5r
0
0
80 CCG
Gross Total Income (1+2+3)
Deductions under Chapter VI A (Section)
0
0
5c
(Select)
[For Individuals having Income from Salary / Pension / Income from One House Property
(excluding loss brought forward from previous years) /
Income from Other Sources (Excluding Winning from Lottery and Income from Race Horses)]
Last Name
(Please see rule 12 of the Income-tax Rules,1962) (Also see attached instructions)
00/00/0000
Sex
Assessment
Year
2 0 1 4 - 1 5
PAN
(Select)
F
O
R
M
SAHAJ
First Name Middle Name
Email Address
Town/City/District
INDIAN INCOME TAX RETURN
ITR-1
Road / Street
Status
I - Individual
(Select)
Area / Locality
5b
80 C
80 CCC
0
(Select)
Notice No (Where the original return filed
was defective and a notice is issued to the
assessee to file a fresh return Sec 139(9)
F
I
L
I
N
G

S
T
A
T
U
S
Are you Governed by Portugese Civil Code under Section 5A?
Income Tax Ward / Circle
(Select)
P
E
R
S
O
N
A
L

I
N
F
O
R
M
A
T
I
O
N
Mobile no 1
e
I
N
C
O
M
E

&

D
E
D
U
C
T
I
O
N
S
80 DDB
5g
5p
0
5a
0
5h
5i
0
5f
5e 0
0
0
m
n
80 U
0
k
0
80 RRB
0 0
Deductions (Total of 5a to 5r)
l 80 GG 0
0
r
q
80 E
80 GGA
0
0
0
0 0
5k 80 G 0
0
0 16 a Interest payable u/s 234 A
0 b
0
0
0
c Interest payable u/s 234 C
0
T
A
X

C
O
M
P
U
T
A
T
I
O
N
0
0
0
0
Relief under Section 89
Interest payable u/s 234 B
0
Balance Tax Payable (13 - 14 )
Taxable Total Income (4 - 6)
d
80 CCD (Employers Contribution)
80 GGC
14 0
h
g
0
0
5d
0
0
j 80 EE 5j 0 0
6 0
5q
5o
19
TDS1
SI.No
Tax Deduction
Account Number
(TAN) of the
Employer
Name of the
Employer
Income charg
eable under the
head Salaries
Total tax
Deducted
(1)
(2)
If no entry is made in
this column, then
columns (3) to (5) will
not be considered for
that row
(3) (4) (5)
1
2
3
(Click + to add more rows to 22) TDS on Salary above. Do not delete blank rows. )
20
TDS2
SI.No
Tax Deduction
Account Number
(TAN) of the
Deductor
Name of the
Deductor
Unique TDS
Certificate No.
Deducted Year
Total tax
Deducted
Amount out of
(6) claimed for
this year
If covered by
Portugese Civil
Code, Amount
claimed in the
hands of spouse
(1)
(2)
If no entry is made in
this column, then
columns (3) to (7) will
not be considered for
that row
(3) (4) (5) (6) (7) (8)
1
2
3
4
(Click + to add more rows ) TDS other than Salary above. Do not delete blank rows. )
21 IT
Details of Tax Deducted at Source on Income OTHER THAN SALARY
[As per FORM 16 A issued by Deductor(s)]
Details of Tax Deducted at Source from SALARY
[As per FORM 16 issued by Employer(s)]
Details of Advance Tax and Self Assessment Tax Payments
(1)
If no entry is
made in this
column, then
columns (2) to
(4) will not be
considered for
that row (2) (3) (4)
BSR Code
Date of Credit into
Govt Account
(DD/MM/YYYY)
Serial
Number of
Challan
Tax Paid (Rs)
1
2
3
4
5
6
(Click '+' to add more rows ) Tax Payments. Do not delete blank rows. )
Sl No
22
a 22a 0
b 22b
0
c 22c 0
23 Total Taxes Paid (22a+22b+22c) 23 0
24 24 0
25 25 0
26
(Select)
29 Exempt income for reporting purposes only (If exempt income more than Rs 5000, use ITR2)
son/daughter of
26 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:
27
T
A
X
E
S

P
A
I
D
VERIFICATION
Advance Tax (from item 21)
Date
Name of TRP
Tax Payable (18-23) (if 18 is greater than 23)
Self Assessment Tax (item 21)
Taxes Paid PLEASE NOTE THAT CALCULATED FI ELDS (I N WHI TE) ARE PI CKED UP FROM OTHER
SCHEDULES AND ARE NOT TO BE ENTERED. For ex : The taxes paid figures below will get filled up when the
Schedules linked to them are filled.
R
E
F
U
N
D
solemnly declare that to the best of my knowledge and belief, the information given in the return 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 2014-15
Sign here -> Place
PAN
I,
TDS (Total from item 19 + item 20)
Refund (23-18) if 23 is greater than 18
Type of Account(As applicable)
Enter your Bank Account number (Refund if
any will directly credited into Bank Account)
IFSC Code
Identification No of TRP
If TRP is entitled for any reimbursement from the Government, amount thereof (to be filled
by TRP)
Schedule 80G Details of donations entitled for deduction under section 80G (PLEASE READ NOTE BELOW)
A
Name of
donee
Address City or Town or
District
State Code PinCode PAN of Donee Amount of
donation
Eligible Amount
of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0
0 0
B Donations entitled for 50% deduction without qualifying limit
Name of
donee
Address City or Town or
District
State Code PinCode PAN of Donee Amount of
donation
Eligible Amount
of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0
0 0
C Donations entitled for 100% deduction subject to qualifying limit
Name of
donee
Address City Or Town Or
District
State Code PinCode PAN of Donee Amount of
donation
Eligible Amount
of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0
0 0
Total 80GA
Total 80GB :
Total 80GC :
Donations entitled for 100% deduction without qualifying limit
If no entry is made in Name of Donee, then for such rows, any value
entered in other columns will be ignored. For 80GA to 80GD
D Donations entitled for 50% deduction subject to qualifying limit
Name of
donee
Address City Or Town Or
District
State Code PinCode PAN of Donee Amount of
donation
Eligible Amount
of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0
0 0
E Donations (A + B + C + D) 0 0
NOTE : (IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2),
PLEASE USE PAN AS "GGGGG0000G".
Total 80GD