Indian Income Tax Return Verification Form Page 2
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1
2Government of India
INCOME-TAX DEPARTMENT
ACKNOWLEDGEMENT
Received with thanks from _______________________________________________________________ a return of income in
Form No. ITR … for assessment year 2010-11, having the following particulars.
Name
PAN
Flat/Door/Block No
Name Of Premises/Building/Village
Road/Street/Post Office
Area/Locality
Town/City/District
State
Status (fill the
code)
Designation of Assessing Officer (Ward/ Circle)
Original or Revised
Gross total income
1
1
Deductions under Chapter-VI-A
2
2
Total Income
3
3
3a
Current Year loss (if any)
3a
4
Net tax payable
4
5
Interest payable
5
6
Total tax and interest payable
6
7 Taxes Paid
a
Advance Tax
7a
b
TDS
7b
c
TCS
7c
d
Self Assessment Tax
7d
e
Total Taxes Paid (7a+7b+7c +7d)
7e
Tax Payable (6-7e)
8
8
Refund (7e-6)
9
9
R
R
e
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e
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p
t
t
N
N
o
o
S
S
e
e
a
a
l
l
a
a
n
n
d
d
S
S
i
i
g
g
n
n
a
a
t
t
u
u
r
r
e
e
o
o
f
f
r
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e
e
c
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i
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v
v
i
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g
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a
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D
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D
a
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e
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