SAHAJ INDIVIDUAL INCOME TAX RETURN Assessment

Year
FORM ITR-1 (For Individuals having Income from Salaries, One House Property, Other Sources 2 0 15 - 1 6
(Interest etc.). Refer to Instructions for eligibililty.)

First Name Middle Name Last Name PAN

SHYAMSUNDAR KRISHNAMOORTHY BJFPS7838R

PERSONAL INFORMATION

Flat / Door / Building Name of Premises / Building / Village Status

OLD NO 10-1, NEW NO- I - Individual
RADHA ILLAM
21
Road / Street Area / Locality Date of birth Sex
GK SUNDARAM STREET SAIBABA COLONY, KK PUDUR PO 26/07/1986 M-Male
Town/ City/ District State Country Pincode

COIMBATORE 29-TAMILNADU 91-INDIA 641038

Email Address Mobile No. 1 (STD Code) Phone No Mobile No. 2 Employer Category

shyamsundar.krishnamoorthy@tcs.com 7708893714 OTH

Income Tax Ward / Circle Return filed under section

12 - After DueDt 139(4)

Whether Person governed by Portuguese Civil Code under section 5A ? Enter PAN of Spouse
No if applicable

Whether Original or
FILING STATUS

Revised return? Original Tax Status Tax Refundable

If Revised/Defective, then Enter Receipt Date of Filing

Number of Original Return Original Return

If filed in response to
Notice No (Where the Original Return filed a notice u/s
was defective and a notice is issued to the 139(9)/142(1)/148/15
assessee to file a fresh return Sec 139(9) 3A/153C enter date
of such notice
Residential Status
RES-Resident
 Whether you have Aadhaar Number? (Select) If Yes, Please provide Aadhaar Number

1 Income from Salary / Pension (Ensure to fill Sch TDS1) 1 815624

2 Income from One House Property (Select) 2 0

3 Income from Other Sources (Ensure to fill Sch TDS2) 3 0

4 Gross Total Income (1+2+3) 4 815624
5 Deductions under Chapter VI A (Section) System Calculated
a 80 C 5a 105772 105772
b 80 CCC 5b 0
80 CCD (Employees / Self Employed
c 5c 0
Contribution)
INCOME & DEDUCTIONS

d 80 CCD (Employers Contribution) 5d 0

e 80 CCG 5e 0
f 80 D 5f 3596 3596
g 80 DD 5g 0
h 80 DDB 5h 0
i 80 E 5i 0
j 80 EE 5j 0
k 80 G 5k 1000 1000
l 80 GG 5l 0
m 80 GGA 5m 0
n 80 GGC 5n 0
o 80 QQB 5o 0
p 80 RRB 5p 0
q 80 TTA 5q 0
r 80 U 5r 0
6 Total Deductions (Total of 5a to 5r) 6 110368 6 110368
###
7 Taxable Total Income (4 - 6) 7 705260
###
8 Tax Payable on Total Income 8 66052
9 Rebate u/s 87A 9 ###
0
10 Tax Payable After Rebate (8-9) 10 66052
###
11 Surcharge if Taxable Total Income (7) exceeds 1 crore 11 0
12 Education Cess, including secondary and higher education cess on 10+11 12 1982
###
13 Total Tax,Surcharge and Education Cess (Payable) (10+11+12) 13 68034
###
14 Relief under Section 89 14
15 Balance Tax after Relief (13-14) 15 68034
###
a Interest payable u/s 234 A 16a ###
0
16 b Interest payable u/s 234 B 16b ###
0
c Interest payable u/s 234 C 16c ###
0
17 Total Interest u/s 234A 234B 234C 17 ###
0
18 Total Tax and Interest Payable (15 + 17) 18 68034
###
 19 Details of Tax Deducted at Source from SALARY [As per FORM 16 issued by Employer(s)]
TDS1
Tax Deduction
Account Number Income under
SI.No Name of the Employer Tax Deducted
(TAN) of the salary
Employer

(1) (2) (3) (4)

MUMT11446B TATA CONSULTANCY 802145 68034
1
SERVICES LIMITED
2
3
4
Total 802145 68034
(Do Not Delete Blank Rows)

20 Details of Tax Deducted at Source on Income OTHER THAN SALARY [As per FORM 16 A issued by Deductor(s)]
TDS2
SI.No If covered by
Tax Deduction
Portuguese Civil
Account Number Unique TDS Amount out of (5)
Name of the Deductor Deducted Year Tax Deducted Code, Amount
(TAN) of the Certificate No. claimed this year
claimed in the
Deductor
hands of spouse

(1) (2) (3) (4) (5) (6) (7)

1
2
3
4
Total 0
(Do Not Delete Blank Rows)
21 IT Details of Advance Tax and Self Assessment Tax Payments
Date of Deposit
BSR Code Challan No Tax Paid
Sl.No (DD/MM/YYYY)
(1) (2) (3) (4)
1 0510308 06/09/2014 40234 25889
2 0510308 10/10/2014 40329 5766
3 0510308 07/11/2014 40323 5766
4 0510308 07/12/2014 40101 7129
5 0510308 07/01/2015 32019 4301
6 0510308 07/02/2015 40164 4409
7 0510308 07/03/2015 40113 7716
8 0510308 30/03/2015 40149 7058
Total 68034
(Do Not Delete Blank Rows)
 Taxes Paid
22 PLEASE NOTE THAT CALCULATED FIELDS (IN WHITE) ARE PICKED 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.
TAXES PAID

a Total Advance Tax Paid (from item 21) 68034

b Total TDS Claimed (Total from item 19 + item 20) 68034

c Total Self Assessment Tax Paid (from item 21) 0

23 Total Taxes Paid (22a+22b+22c) 136068

24 Tax Payable (18-23) (if 18 is greater than 23) 0
25 Refund (23-18) (if 23 is greater than 18) 68030
26 Exempt Income only for Reporting Purpose (If agricultural income is more than Rs. 5000/-, use ITR-2 or 2A)
Details of all Bank Accounts (excluding dormant accounts) held in India at any time during the previous year (Mandatory irrespective of refund due
27
or not)
Total number of savings and current bank accounts held by you at any time during the previous year (excluding dormant
1
accounts).
Bank Account in which refund, if any, shall be credited

Account Number
Sl.No IFS Code of the Bank Name of the Bank (the number should be 9 digits or Type of Account
more as per CBS system of the
bank)

1 HDFC0000323 HDFC BANK LTD 03231610046774 Savings

Other Bank account details

Account Number
Sl.No IFS Code of the Bank Name of the Bank (the number should be 9 digits or Type of Account
more as per CBS system of the
bank)

2 (Select)
3 (Select)
4 (Select)

(Do Not Delete Blank Rows)

 (Do Not Delete Blank Rows)

VERIFICATION
I, SHYAMSUNDAR KRISHNAMOORTHY son/daughter of KRISHNAMOORTHY

solemnly declare that to the best of my knowledge and belief, the information given in the return 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 2015-16

Place COIMBATORE Date 15/04/2017

PAN BJFPS7838R

28 If the return has been prepared by a Tax Return Preparer (TRP) give further details as below:

Identification No of TRP Name of TRP

29 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)
Donations entitled for 100% deduction without qualifying limit
A
If no entry is made in Name of Donee, then for such rows, any value entered in other columns will be ignored from 80GA to 80GD
City or Town or Eligible Amount
Name of donee Address State Code Pincode PAN of Donee Amount of donation
District of Donation
Tata Relief 6c road (west) Jamshedpur 35- 831011 AAATT1309F 1000 1000
1
Committee northern town JHARKHAND
2 (Select) 0
3 (Select) 0
4 (Select) 0

Total 80GA 1000 1000

(Do Not Delete Blank Rows)

B Donations entitled for 50% deduction without qualifying limit

City or Town or Eligible Amount

Name of donee Address State Code Pincode PAN of Donee Amount of donation
District of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0

Total 80GB : 0 0

(Do Not Delete Blank Rows)

C Donations entitled for 100% deduction subject to qualifying limit

 City Or Town Eligible Amount
Name of donee Address State Code Pincode PAN of Donee Amount of donation
Or District of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0

Total 80GC : 0 0

(Do Not Delete Blank Rows)

D Donations entitled for 50% deduction subject to qualifying limit

City Or Town Eligible Amount
Name of donee Address State Code Pincode PAN of Donee Amount of donation
Or District of Donation
1 (Select) 0
2 (Select) 0
3 (Select) 0
4 (Select) 0

Total 80GD 0 0

(Do Not Delete Blank Rows)

E Donations (A + B + C + D) 1000 1000

NOTE : IN CASE OF DONEE FUNDS SETUP BY GOVERNMENT AS DESCRIBED IN SECTION 80G(2),

PLEASE USE PAN AS "GGGGG0000G".