1. Tota1
number of sheet(s) 986 (in case of more than one assessment
year)
Sheet No. 987
2. Assessment
year
989
3. Previous year
989
4. Residential Status*
5. Whether a return of
income was furnished before the date of search/ requisition
989
Yes No
6. If return was
filed:
i.
Date of filing return
990
ii.
Ward/ Circle/ Special Range where the return was filed
992
iii. Returned total income
993
iv.
Brought forward loss/ unabsorbed depreciation, if any shown adjusted in
the
return/under section
994
v. Amount of loss/ depreciation remaining
unadjusted after computation of
total
income/under section 996 997
vi. Assessed total income
998
vii. Date of assessment
999
COMPUTATION OF
TOTAL INCOME/LOSS
S
No.
Head of Income
Total income including undisclosed income computed u/s 158BB
Return/ Assessed Income as on the date of search/
requisition
1.
Salary
701
2.
Income
from house property
702
3.
Profit
and gains of business or profession
703
4.
Capital gain:
long term
705
short term
704
5.
Income
from other sources
709
6.
Gross
total income
745
7.
Less:
Deduction under chapter VIA
Code*
Section
Amount
Total
747
8.
Total
Income
750
9.
Current year's loss remaining unadjusted after computation of
total income
Total
774
If there is
any difference between the figures of column (2) and that of column (3)
for any row, please explain how it arose.
PART-III STATEMENT OF TAXES
1. Tax
payable on the undisclosed income of the block
period
826
2. Add:
Surcharge
828
3. Total
Tax payable (1+2)
830
4.
Interest payable u/s 158BFA
835
5. Tax and
interest payable
852
6. Tax and
interest paid on undisclosed income before filing the return
(attach challans)
Date
of Payment
Bank Branch with
code
Amount (in
Rs.)
Tax
Interest
Total
853
854
Total
prepaid tax and interest
855
7. Balance
tax and interest payable
882
8.
Assessee's offer for adjustment of seized money against tax
payable (s 158BFA),
Yes
No
(a) If yes, date
of receipt of offer in AO's
office
884
-
-
(b) Amount of seized
money offered for adjustment
885
9. Balance
amount of tax and interest
990
10. NO. OF
DOCUMENTS/ STATEMENTS ATTACHED
Description
In Figures
In words
Challans
Description
In Figures
In words
Others
VERIFICATION*
I,. . . . . . . . . . .
. (full name in block letters), son/ daughter of. . . . . . . . . (Name of
the father) solemnly declare that to the best of my knowledge and belief,
the information given in this return and the annexures and statements
accompanying is correct and complete and that the amount of total income
including the undisclosed income and other particulars shown therein are
fully and truly stated and relate to the previous years falling in the
block period from . . . . . . .to. . . . . . . in accordance with the
provisions of the Income-tax Act, 1961.
I further declare that I
am making this return in my capacity as . . . . . . . .and I am competent
to make this return and verify it.
Date . . . . . . . .
.
Assessee's Signature". Place. . . . . .Any person making a
false statement in the return or the accompanying schedules shall be
liable to be prosecutes under that section with rigorous imprisonment and
with fine
Sd/
- (Batsala
Jha Yadav) Under Secretary to the Government of
India