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 sources
ITR-1 (Interest etc.), and agricultural income upto Rs.5 thousand] Assessment Year
SAHAJ [Not for an individual who is either Director in a company or has invested in unlisted 2023 - 24
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 Name (A3) Last Name (A4) Date of Birth (A5) Aadhaar Number (12 digits)/Aadhaar Enrolment
AIIPR8727M THANKAPPAN KUMAR RATHEESH 28-May-1980 Id (28 digits) (If eligible for Aadhaar No.)
3xxx xxxx 5024
(A6) Mobile No. (A7) Email Address (A8) Flat/Door/Block No. (A9) Name of (A10) Road/Street/Post Office,
+ 91 9746243746 ratheesh300@gmail.com SANDHYA BHAVAN,A45 Premises/Building/Village Area/Locality
K.V NAGAR KURISSUMUTTOM,PEYAD PO ,
THIRUVANANTHAPURAM
(A11) Town/City/District (A12) State (A13) Country/Region (A14) PIN Code/ZIP Code
16-Kerala 91-India 695573
(A15) Filed u/s (Tick) 139(1)-On or before due date 139(4)-Belated 139(5)-Revised (A16) Nature of employment-
[Please see instruction] 119(2)(b)- After Condonation of delay Central Govt. State Govt. Public Sector Undertaking
CG - Pensioners SG - Pensioners PSU - Pensioners
(A17) Or Filed in 139(9) 142(1) 148 153C Other Pensioners Others
response to notice u/s Not Applicable (e.g. Family Pension etc.)
(A18) If revised/defective, then enter Receipt No. and Date of filing of original return
(DD/MM/YYYY)
(A19) If filed in response to notice u/s 139(9)/142(1)/148/153C 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 incurred expenditure of an amount or aggregate of amount exceeding Rs. 2 lakhs for travel to a foreign country for yourself or for any other person? Yes No 0
(ii) Have you incurred expenditure of amount or aggregate of amount exceeding Rs. 1 lakh on consumption of electricity during the previous year? Yes No 0
(iii) 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
1 Select 0
PART B GROSS TOTAL INCOME Whole - Rupee only
B1 i Gross Salary (ia + ib + ic + id + ie) i 6,89,000
a Salary as per section 17(1) ia 6,89,000
b Value of perquisites as per section 17(2) ib 0
c Profit in lieu of salary as per section 17(3) ic 0
d Income from retirement benefit account maintained in a notified country u/s 89A id 0
e Income from retirement benefit account maintained in a country other than notified country ie 0
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) )
Sl. Nature of Exempt Allowance Description ( If Amount
No. Any Other
selected)
a Sec 10(5)-Leave Travel concession/assistance 0
b Sec 10(10)-Death-cum-retirement gratuity received 0
c Sec 10(10A)-Commuted value of pension received 0
d Sec 10(13A)-Allowance to meet expenditure incurred on house rent 0
iia Less : Income claimed for relief from taxation u/s 89A iia 0
iii Net Salary (i - ii - iia) iii 6,89,000
iv Deductions u/s 16 (iva + ivb + ivc) iv 52,500
a Standard deduction u/s 16(ia) iva 50,000
b Entertainment allowance u/s 16(ii) ivb 0
c Professional tax u/s 16(iii) ivc 2,500
v Income chargeable under the head 'Salaries' (iii - iv) B1 6,36,500
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 during the year less 30% vi 0
vii Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put the figure in negative) B2 0
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 565
S.No Nature of Income Description ( If Any Other Total Amount
selected)
1 Interest from Income Tax Refund 565
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- 2022 0 i Up to 15-Jun- 2022 0
ii From 16-Jun- 2022 to 15-Sep- 2022 0 ii From 16-Jun- 2022 to 15-Sep- 2022 0
iii From 16-Sep- 2022 to 15-Dec- 2022 0 iii From 16-Sep- 2022 to 15-Dec- 2022 0
iv From 16-Dec- 2022 to 15-Mar- 2023 0 iv From 16-Dec- 2022 to 15-Mar- 2023 0
v From 16-Mar- 2023 to 31-Mar- 2023 0 v From 16-Mar- 2023 to 31-Mar- 2023 0
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 6,37,065
Note: To avail the benefit of carry forward and set of loss, please use ITR-2
Part C - Deductions and Taxable Total Income
S.No. Section Amount System Calculated
a 80C - Life insurance premia, deferred annuity, contributions to provident fund, subscription to certain 5a 62,288 62,288
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 Government 5c 0 0
d 80CCD(1B) - Contribution to pension scheme of Central Government 5d 0 0
e 80CCD(2) - Contribution to pension scheme of Central Government by employer 5e 0 0
f 80D Deduction in respect of Health Insurance premia (Please fill 80D Schedule. This field is auto- 5f 22,100 22,100
populated from schedule 80D.)
g 80DD - Maintenance including medical treatment of a dependent who is a person with disability 5g 0 0
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 certain house property 5k 0 0
l 80EEB - Deduction in respect of purchase of electric vehicle 5l 0 0
m 80G - Donations to certain funds, charitable institutions, etc. (Please fill 80G Schedule. This field is 5m 0 0
auto-populated from schedule.)
n 80GG - Rent paid (Please submit form 10BA to claim deduction) 5n 96,000 60,000
o 80GGA - Certain donations for scientific research or rural development (Please fill 80GGA Schedule. This field is 5o 0 0
auto-populated from schedule.)
p 80GGC - Donation to Political party 5p 0 0
q 80TTA - Interest on savings bank account 5q 0 0
r 80TTB- Interest on deposits 5r 0 0
s 80U-In case of a person with disability 5s 0 0
t 80CCH - Contribution to Agnipath Scheme 5t 0 0
Total Deductions (Add items 5a to 5t) 1,80,388 1,44,388
Note: Total deductions under chapter VI A cannot exceed GTI.
Total Income 4,92,680
Exempt income (For reporting purpose)
S.No Nature of Exempt Income Description ( If Any Other Total Amount
selected)
Total Exempt Income 0
PART D - COMPUTATION OF TAX PAYABLE
D1 Tax payable on total income 12,134 D2 Rebate u/s 87A 12,134 D3 Tax payable after rebate 0
D4 Health and education Cess 0 D5 Total Tax and Cess 0 D6 Relief u/s 89 (Please 0
@4% on D3 ensure to submit Form 10E
to claim this relief)
D7 Interest u/s 234A 0 D8 Interest u/s 234B 0 D9 Interest u/s 234C 0
D10 Fee u/s 234F 1,000 D11 Total Tax, Fee and Interest (D5 + D7 + D8 + D9 + D10 - D6) 1,000
D12 Total Taxes Paid 41,400 D13 Amount 0 D14 Refund 40,400
payable(D11-D12) (D12-D11) (if D12>D11)
(if 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 DLXB0000260 DHANLAXMI BANK LTD 026001100000241
2 DLXB0000260 DHANLAXMI BANK LTD 026001100000241
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? No
(a) Self & Family 22,100
(i) Health Insurance 22,100
(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 can be claimed on which health insurance is not claimed at (i) above) 0
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
(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 claimed at (i) above) 0
3 Eligible Amount of Deduction 22,100
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 Name of Address City or State Pin code PAN of Amount of donation Eligible Amount of
No. the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total Donation
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 Name of Address City or State Pin code PAN of Amount of donation Eligible Amount of
No. the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total Donation
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 Name of Address City or State Pin code PAN of Amount of donation Eligible Amount of
No. the Town Code the Donation
Donee or Donee
District Donation in cash Donation in other Total Donation
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 Name of ARN (Donation Address City or State Pin code PAN of Amount of donation Eligible Amount
No. the Reference Town Code the of Donation
Donee Number) or Donee
District Donation in Donation in Total Donation
cash other 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 Relevant Name Address City or State Pin code PAN Amount of donation Eligible Amount of
No. Clause of the Town Code of the Donation
under Donee or Donee
which District Donation in cash Donation in other Total Donation
deduction mode
is claimed
- 0 0 0 0
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 salaries Total Tax Deducted
1 2 3 4
1 TVDA03179B AMRITA VISHWA VIDYAPEETHAM 1,18,000 41,400
Total 41,400
Schedule TDS2 - Details of Tax Deducted at Source from Income Other than Salary [As per form 16A issued by Deductor(s)]
Sl. No. TAN of the Name of the Gross receipt which is Year of tax deduction Tax Deducted TDS Credit out of (5)
Deductor Deductor subject to claimed this year
tax deduction
1 2 3 4 5 6
Total 0
Schedule TDS3 - Details of Tax Deducted at Source [As per Form 16C furnished by the Payer(s)]
Sl. PAN of the Aadhaar Number Name of the Gross receipt which is subject Year of Tax TDS Credit out of
No. Tenant of Tenant to tax Deducted (6)
the Tenant tax deduction deduction claimed this year
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 Collection Account Number Name of the Gross payment which is subject Year of Tax TCS Credit out of (5)
No. of Collector to tax Collected claimed this year
the Collector tax collection collection
1 2 3 4 5 6
Total 0
VERIFICATION
I, THANKAPPAN KUMAR RATHEESH son/ daughter of THANKAPPAN NAIR KRISHNAPILLA 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 AIIPR8727M
Place: TRIVANDRUM
Date: 03-Jan-2024
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
If TRP is entitled for any reimbursement from the Government, amount thereof 0
