Acknowledgement Number:642209160310522 Date of filing:31-05-2022
INDIAN INCOME TAX RETURN
[For individuals being a resident (other than not ordinarily resident) having total
income upto Rs.50 lakh, having Income from Salaries, one house property, other Assessment
ITR-1 sources (Interest etc.), and agricultural income upto Rs.5 thousand] Year
SAHAJ [Not for an individual who is either Director in a company or has invested in unlisted 2022 - 23
equity shares or in cases where TDS has been deducted u/s 194N or if income-tax is
deferred on ESOP]
(Refer instructions for eligibility)
PART A GENERAL INFORMATION
(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
(A11) Town/City/District (A12) State (A13) Country (A14) PIN Code/ZIP
Mudaliarpet S.O 25-Pondicherry 91-India Code
605004
(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
PART B GROSS TOTAL INCOME Whole - Rupee only
B1 i Gross Salary (ia + ib + ic + id + ie) i 0
a Salary as per section 17(1) ia 0
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
b Value of perquisites as per ib 0
section 17(2)
c Profit in lieu of salary as per ic 0
section 17(3)
d Income from retirement benefit id 0
account maintained in a
notified country u/s 89A
e Income from retirement benefit ie 0
account maintained in a
country other than notified
country u/s 89A
ii Less allowances to the extent exempt u/s 10 ii 0
(Ensure that it is included in salary income u/s 17(1)/17(2)/17(3) )
iia Less : Income claimed for relief from taxation u/s 89A iia 0
iii Net Salary (i - ii - iia) iii 0
iv Deductions u/s 16 (iva + ivb + ivc) iv 0
a Standard deduction u/s 16(ia) iva 0
b Entertainment allowance u/s 16 ivb 0
(ii)
c Professional tax u/s 16(iii) ivc 0
v Income chargeable under the head 'Salaries' (iii - iv) B1 0
B2 Tick applicable option
Self-Occupied Let Out Deemed Let Out
i Gross rent received/ receivable/ lettable value during the year i 0
ii Tax paid to local authorities ii 0
iii Annual Value (i - ii) iii 0
iv 30% of Annual Value iv 0
v Interest payable on borrowed capital v 0
vi Arrears/Unrealised rent received vi 0
during the year less 30%
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
B3 Income from Other Sources B3 1,76,449
S.No Nature of Income Description ( If Any Other Total Amount
selected)
1 Interest from Income Tax Refund 1,817
2 Interest from Deposit (Bank/Post Office/Cooperative Society) 1,74,632
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
ii From 16-Jun-2021 to 15- 0 ii From 16-Jun-2021 to 15- 0
Sep-2021 Sep-2021
iii From 16-Sep-2021 to 15- 0 iii From 16-Sep-2021 to 15- 0
Dec-2021 Dec-2021
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
iv From 16-Dec-2021 to 15- 0 iv From 16-Dec-2021 to 15- 0
Mar-2022 Mar-2022
v From 16-Mar-2022 to 31- 0 v From 16-Mar-2022 to 31- 0
Mar-2022 Mar-2022
Less: Deduction u/s 57(iia) (in case of family pension only) 0
Less: Income claimed for relief from taxation u/s 89A 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
Part C - Deductions and Taxable Total Income
S. Section Amount System Calculated
No.
a 80C - Life insurance premia, deferred annuity, contributions to 5a 0 0
provident fund, subscription to certain equity shares or
debentures, etc.
b 80CCC - Payment in respect Pension Fund,etc. 5b 0 0
c 80CCD(1) - Contribution to pension scheme of Central 5c 0 0
Government
d 80CCD(1B) - Contribution to pension scheme of Central 5d 0 0
Government
e 80CCD(2) - Contribution to pension scheme of Central 5e 0 0
Government by employer
f 80D Deduction in respect of Health Insurance premia (Please 5f 0 0
fill 80D Schedule. This field is auto-populated from schedule
80D.)
g 80DD - Maintenance including medical treatment of a 5g 0 0
dependent who is a person with disability
h 80DDB - Medical treatment of specified disease 5h 0 0
i 80E - Interest on loan taken for higher education 5i 0 0
j 80EE - Interest on loan taken for residential house property 5j 0 0
k 80EEA - Deduction in respect of interest on loan taken for 5k 0 0
certain house property
l 80EEB - Deduction in respect of purchase of electric vehicle 5l 0 0
m 80G - Donations to certain funds, charitable institutions, etc. 5m 0 0
(Please fill 80G Schedule. This field is auto-populated from
schedule 80G)
n 80GG - Rent paid (Please submit form 10BA to claim 5n 0 0
deduction)
o 80GGA - Certain donations for scientific research or rural 5o 0 0
development (Please fill 80GGA Schedule. This field is auto-
populated from schedule.)
p 80GGC - Donation to Political party 5p 0 0
q 80TTA - Interest on deposits in savings Accounts 5q 0 0
r 80TTB- Interest on deposits in case of senior citizens 5r 0 0
s 80U-In case of a person with disability 5s 0 0
Total Deductions (Add items 5a to 5s) 0 0
Note: Total deductions under chapter VI A cannot exceed GTI.
Total Income 1,76,450
Exempt income (For reporting Purposes)
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
S.No Nature of Income Description ( If Any Other selected) Total Amount
Total Exempt Income 0
PART D - COMPUTATION OF TAX PAYABLE
D1 Tax 0 D2 Rebate u 0 D3 Tax after 0
payable /s 87A rebate
on total
income
D4 Health 0 D5 Total Tax 0 D6 Relief u/s 0
and and Cess 89
education (Please
Cess ensure to
@4% on submit
D3 Form 10E
to claim
this relief)
D7 Interest u 0 D8 Interest u 0 D9 Interest u 0
/s 234A /s 234B /s 234C
D10 Fee u/s 0 D11 Total Tax, Fee and Interest (D5 + D7 + D8 + D9 + D10 - 0
234F D6)
D12 Total 54,486 D13 Amount 0 D14 Refund 54,490
Taxes payable (D12-
Paid (D11- D11) (if
D12) (if D12>D11)
D11>D12)
PART E - OTHER INFORMATION
Details of all Bank Accounts held in India at any time during the previous year (excluding dormant accounts)
Sl. IFS Code of the Bank Name of the Bank Account Number Select Account for Refund
Credit
1 SBIN0000900 STATE BANK OF INDIA 10831399924 ✔
1. Minimum one account should be selected for refund credit.
2. In case of Refund, multiple accounts are selected for refund credit, then refund will be credited to one of the account decided by CPC after
processing the return.
Schedule 80D
1 Whether you or any of your family member (excluding parents) is a senior citizen? Not claiming for Self/Family
(a) Self & Family 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(b) Self & Family including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(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
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
(b) Parents including Senior Citizen 0
(i) Health Insurance 0
(ii) Preventive Health Checkup 0
(iii) Medical Expenditure (This deduction can be claimed on which health insurance is not 0
claimed at (i) above)
3 Eligible Amount of Deduction 0
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
Donee Town or Code the Donee Donation
Donation in cash Donation in other Total Donation
District
mode
- 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
Donee Town or Code the Donee Donation
Donation in cash Donation in other Total Donation
District
mode
- 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
Donee Town or Code the Donee Donation
Donation in cash Donation in other Total Donation
District
mode
- 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
Donee Town or Code the Donee Donation
Donation in cash Donation in other Total Donation
District
mode
- 0 0 0 0
Total D 0 0 0 0
E. Total Amount of Donations (A + B + C + D) 0 0 0 0
Schedule 80GGA: Details of donations for scientific research or rural development
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
Schedule-IT Details of Advance Tax and Self-Assessment Tax payments
BSR Code Date of Deposit (DD/MM/YYYY) Serial Number of Challan Tax paid
Col (1) Col (2) Col (3) Col (4)
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
1 MUMS86170A STATE BANK OF INDIA 1,74,632 2021 54,486 54,486
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:
Identification No. of TRP Name of TRP Counter Signature of TRP
Acknowledgement Number:642209160310522 Date of filing:31-05-2022
If TRP is entitled for any reimbursement from the Government, amount thereof 0
