1. SALARY INCOME:
2. INCOME FROM HOUSE PROPERTY:
3. INCOME FROM BUSINESS OR PROFESSION:
4 (a) INCOME FROM LONG-TERM CAPITAL GAINS:
   (b) INCOME FROM SHORT-TERM CAPITAL GAINS:
5. INCOME FROM OTHER SOURCES:
6. GROSS TOTAL INCOME (TOTAL OF 1 TO 5)
7. LESS DEDUCTION UNDER CHAPTER VI-A
OF THE INCOME TAX ACT, 1961:
8. TAXABLE TOTAL INCOME (6-7):
9. AMOUNT OF REBATE CLAIMED:
10. TOTAL TAX PAYABLE:
11. DETAILS OF PRE-PAID TAXES:
    (a) ADVANCE TAX
    (b) TAX DEDUCTION AT SOURCE
    (c) SELF-ASSESSMENT TAX
    TOTAL:
12. BALANCE TAX PAYABLE/REFUNDABLE:

I, _{_____________________} (name in full and block letters), son/daughter of ____________________ solemnly declare that to the best of my knowledge and belief, the information given in this return and the annexures and statements accompanying it are correct, complete and truly stated and in accordance with the provisions of Income-tax Act, 1961, in respect of income chargeable to income-tax for the previous year relevant to the assessment year 1998 to 1999.

DATE:
PLACE:

SIGNATURE

(SERIAL NUMBERS CORRESPOND TO THOSE GIVEN ABOVE)

1. Pension is taxable as salary. The taxable salary is after you avail of the standard deduction.
2. Income from House Property - Please give address of the property and how you have arrived at this income.
3. Income from business or profession - What is the line of business? Please attach trading, proof and loss account, balance sheet and all enclosures required under the Income tax Act, 1961. What is the profession? Please attach income and expenditure statement and all enclosures required under the Income tax Act, 1961.
4. Please state the year of acquisition of the capital asset disposed off. Please give the computation of capital gains.
5. Please give details of income from other sources such as interest, etc.
6. Chapter VI-A of the Income-tax Act, 1961 allows deduction for donations, medical claim, etc. Please cross check with the provisions of Chapter VI-A while making the claim. Please annex statement of claims under each provision separately.
7. Please note that if you have agricultural income, you must add such income to the total income computed at pre--page for finding out the rate of tax applicable to you. If you are claiming exemption under section 11 of the Act as a Charitable Trust please give a separate Annexure explaining how you have complied with the provisions of law in order to be entitled for exemption.
8. Rebates are allowed for contribution such as LIP, GPF, PPF, etc. These are available u/s 88 of the Income-tax Act, 1961. If you are an individual who is aged 65 years or more a further rebate of a maximum of Rs. 10,000 is given from income-tax. Please give details or rebate claimed.
9. Total tax payable should include interests under section 234A (for late filing of return), 234B (shortfall in payment of advance tax) and 234C (defermant of instalment of advance tax), if due.
10. Please attach proof of payment of taxes including tax deducted at source along with a statement of the tax payment.