Data Sheet for Income Tax filing for Financial

Year 2014-15

A.

Personal Information:
PAN No:
IT Dept Password (e filing website):

Name of Employee as
in PAN
(First Name, Middle Name, Last
Name)

2
3
4

Date of Birth
Fathers Name
Residential Status in
India

Resident

(Resident/RNOR/Non
Resident)

3
4
5
6

7
8
9

Email
Contact Number
Sex
Communication
address:
House/Door Number
Road/Street
Post office/Area with
PIN
City
State
Bank Account
Number
Bank Branch, MICR
and
IFSC NO.
Mode of refundCheque/ECS

O
Male
/
O
Female
(IT Dept. communicate to this address in case
required)

B. Declaration of Income:

(All amounts to be populated in `)

Please attach Form-16 for the FY 2014-15.

Income from Salary

(In case youve worked in more than one

Company during
the FY-2014-15, all such Form-16s has to be
submitted)

Data Sheet for Income Tax filing for Financial

Year 2014-15

2.
A

Address of the Property 1:

Income /Loss House Property-1

Rental Income received/due during the FY
2014-15
Municipal Tax Paid during FY-2014-15
Interest on Housing Loan

2.
B

Address of the Property 2:

Income /Loss House Property-2

Rental Income received/due during the FY
2014-15
Muncipal Tax Paid during FY-2014-15
Interest on Housing Loan

Income from Business or Please provide income as well as expense

Profession
other
than details in a separate sheet giving complete
details, and attach Form-16A for Tax
salary
Deducted on Business Income

Income from Capital Gain:

Details of Sale

If you have sold shares/MF

please submit the capital
gain statement provided Details of
by the broker.
Purchase
If you have sold any
immoveable
property
during the year, please
submit the purchase and Capital Gain
sale deeds of the property.

Income from Other sources:

1
2
3

Date

Date

Sale Price

Purchase
Price

Interest on savings
Bank
Intererst on Fixed
Deposit
Others (Specify)

Details of Foreign Assets

Si# Type of Asset
Country
Name
1
2

Foreign Bank
Accounts
Financial Interest

Address/Detail Name as per

s of
Bank Nature
Property/Entity of entity

Investment
cost/ Peak bank
balance

Data Sheet for Income Tax filing for Financial

Year 2014-15

3
4
5

in Foreign Entity
Immovable
Property
Any other Asset
Details of
accounts where
the tax payer
has signing
Authority

Declaration
1. I hereby state that the information stated above is true to the best of my
knowledge and belief;
2. I hereby agree that the information requested by the consultants and stated
above contains all information required for filing my Income Tax Return and Ill
be solely responsible for non-statement of any information herein above, and
which assumes significance for declaring in the Income Tax Return.

Place
Bangalore
Date
Signature