Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

INDIAN INCOME TAX UPDATED RETURN

FORM [For persons to update income within twenty-four months from the end of the relevant assesment year] Assessment Year
ITR-U (Refer instructions for eligibility) 2024-25
(Please see rule 12AC of the Income-tax Rules, 1962)

PART A GENERAL INFORMATION - 139(8A)

(A3) Aadhaar Number (Please enter Aadhaar
(A1) PAN (A2) Name
Number. Applicable to Individual only)
BQMPB6568D PRABHAT BURNWAL
9xxx xxxx 5487
(A5) Whether return previously filed for this
(A4) Assessment Year
assessment year? (A6) If Yes, Whether U/s
2024-25
No
(A7) If applicable, enter from filed,
acknowledgement no. or Receipt no. and
ITR Type Acknowledgement Number Date of Filing of Original Return
date of filing original return
(DD/MM/YYYY)
Are you eligible for filing an updated return as per the conditions laid out in first, second and
(A8) Yes No
third provisos to section 139(8A)?
Please choose the ITR form for updating your income (ITRs 1-7 to be selected from drop-down
(A9) ITR4
and filled as per the details made available by e-filing utility– see instruction)

(A10) Reasons for updating your income:

Sl No. Reason for Updating Income

1 2

1 Return previously not filed

2 Income not reported correctly

Up to 12 months from the end of

(A11) Are you filing the updated return during the period
Relevant Assessment Year
(a) Are you filing the updated return to reduce carried forward loss or unabsorbed depreciation
(A12) Yes No
or tax credit?
(b) If Yes , please specify the assessment years where carried forward loss or unabsorbed
depreciation or tax credit is being affected because of the updated return
Whether return has been filed after
Sl No. Assesment Year Return filed, if yes is selected
giving effect of Sl. No. 12a above

1 2 3 4

PART B - ATI COMPUTATION OF TOTAL UPDATED INCOME AND TAX PAYABLE

Head of Income under which additional income is being returned as per Updated Return
1 A
Head of income (If yes, Please specify additional income)

a Income from Salary a 0

b Income from house property b 0

c Income from Business or Profession c

4,80,250

d Income from Capital Gains d 0

e Income from Other Sources e 0

f Total additional Income (a + b + c + d + e) f 4,80,250

Total Income as per last valid return (only in cases where the Income Tax Return has been
B B 0
previously filed)

2 Total income as per Part-BTI (Please see instruction) 2 4,80,250

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

Amount payable, if any (To be taken from the “Amount payable” of Part B-TTI of the updated ITR)
3 3 960
(Please see instruction)
Amount refundable, if any (To be taken from “Refund” of Part B-TTI of the updated ITR) (Please see
4 4 0
instruction)

5 Amount payable on the basis of last valid return (only in applicable cases) 5 0

6i Refund claimed as per last valid return, if any (Please see instruction) 6i 0

6ii Total Refund issued as per last valid return, if any ( this amount should include interest u/s 244A 6ii 0
received ) (Please see instruction)

7 Fee for default in furnishing return of income u/s 234F 7 1,000

8 Regular Assessment Tax, if any (in applicable cases) 8 0

9 Aggregate liability on additional income

9i In case refund has been issued [3 + 6ii- (5 + 8 + 4)]) 9i 0

9ii In case refund has not been issued [3 + 6i – (5 + 8 + 4)] 9ii 960

10 Additional income-tax liability on updated income [25% or 50% of (9-7)] 10 0

11 Net amount payable (9+10) 11 960

12 Tax paid u/s 140B 12 960

13 Tax due (11-12) 13 0

14 Tax Payment details (ONLY as per Updated Return)

A Details of Payments of tax on updated return u/s 140B

Sl. Date of Deposit

BSR Code Serial Number of Challan Amount (Rs)
No. (DD/MM/YYYY)

1 2 3 4 5

1 0002271 18/03/2025 32890 960

Total 960

Details of payments of Advance Tax / Self Assessment Tax / Regular Assessment Tax, credit for which has not been claimed in the
B
earlier return (credit for the same is not to be allowed again under section 140B(2) )
Sl. Date of Deposit
BSR Code Serial Number of Challan Amount (Rs)
No. (DD/MM/YYYY)

1 2 3 4 5

Total 0

Relief u/s 89 which is not claimed in earlier return [relief for the same is not to be allowed under
15 15 0
section 140B(2)]

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

INDIAN INCOME TAX RETURN

FORM [For Individuals, HUFs and Firms (other than LLP) being a resident having total income upto Rs.50 lakh and
Assessment
having income from business and profession which is computed under sections 44AD, 44ADA or 44AE] [Not
ITR4 Year
for an individual who is either Director in a company or has invested in unlisted equity shares or if income-
SUGAM 2024-25
tax is deferred on ESOP or has agricultural income more than Rs.5000] (Please refer instructions for
eligibility)

PART A GENERAL INFORMATION

(A1) First Name (A3) Last Name (A4) Permanent Account Number
(A2) Middle Name
PRABHAT BURNWAL BQMPB6568D
(A5) Date of Birth/Formation (DD/MM/YYYY) (A6) Flat/Door/Block No.
03/07/1989 KRISH STORE
(A7) Name of Premises/Building/Village (A8) Road/Street/Post Office (A9) Area/Locality
POLICE LINE NEAR BHART PETROL PUMP Dabar Gram B.O Kunjisar
(A10) Town/City/District (A11) State (A12) Country/Region (A13) PIN Code/ZIP Code
DEOGHAR 35-Jharkhand 91- INDIA 814142
(A14) Aadhaar Number(12 digits)/Aadhaar Enrolment Id(28 digits) (if eligible for Aadhaar No.) (A15) Status
9xxx xxxx 5487 Individual
(A16) Residential/Office Phone Number with STD/ISD Code /Mobile No.1
(A17) Mobile No.2
/ 91 7739520508
(A18) Email Address-1(Self)
Email Address-2 (A19) Nature of employment Others
[email protected]
(A20)(a) Filed u/s (Tick)[Please see instruction] (b) Or Filed in response to
139(8A)-Updated return
notice u/s"
(A21) If revised/defective then enter Receipt No. and Date of filing of
original return (DD/MM/YYYY)
(A22) 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
(A23) Have you exercised the option u/s 115BAC(6) of Opting out of new tax regime? (default is “No”) No Yes, within the due date Yes, but
beyond the due date ( If option other than ‘No’ is selected, please furnish date of filing and Acknowledgement number of form 10-IEA) Note-For
Opting out, option should be exercised on or before the due date for filing return u/s 139(1)
No Yes, within due date Yes, but beyond due date
If option other than ‘No’ is selected, please furnish date of filing and Acknowledgement
number of form 10-IEA Note-For Opting out, option should be exercised on or before the
due date for filing return u/s 139(1)
(A24) Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? (Not applicable
in case of firm) - (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 deposited amount or aggregate of amounts exceeding Rs. 1 Crore in one or more current account
during the previous year? 0
Yes No
(ii) 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? 0
Yes No
(iii) Have you incurred expenditure of an amount or aggregate of amount exceeding Rs. 1 lakh on consumption
of electricity during the previous year? 0
Yes No
(iv) 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
(A25) Whether this return is being filed by a representative assessee?
Yes No
If yes, please furnish following information -

(1) Name of the representative

(2) Capacity of the representative

(3) Address of the representative

Permanent Account Number (PAN)/ Aadhaar

(4)
No. of the representative

PART B GROSS TOTAL INCOME

B1 Income from Business & Profession B1 4,80,246

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

B2 i Gross Salary (ia + ib + ic + id + ie) i 0

a Salary as per section 17(1) ia 0

b Value of perquisites as per section 17(2) ib 0

c Profit in lieu of salary as per section 17(3) ic 0

Income from retirement benefit account maintained in a notified country u/s

d id 0
89A

Income from retirement benefit account maintained in a country other than

e ie 0
notified country u/s 89A
Less allowances to the extent exempt u/s 10 [Ensure that it is included in salary income u/s
ii ii 0
17(1)/17(2)/17(3)]
Sl.
Nature of Exempt Allowance Description ( If Any Other selected) Amount
No.

(1) (2) (3) (4)

iia Less : Income claimed for relief from taxation u/s 89A iia 0

iii Net Salary (i - ii - iia) iii 0

iv Deductions u/s 16 (iva + ivb + ivc) iv 0

a Standard deduction u/s 16(ia) iva 0

b Entertainment allowance u/s 16(ii) ivb 0

c Professional tax u/s 16(iii) ivc 0

v Income chargeable under the head 'Salaries' (iii - iv) B2 0

B3 Type Of House Property B3

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/Unrealized Rent received during the year Less 30% vi 0

Income chargeable under the head 'House Property' (iii - iv - v) + vi (If loss, put the figure in
negative) Note:- Maximum loss from house property that can be set-off in computing income
vii B3 0
of this year is INR 2, 00,000. To avail the benefit of carry forward and set of loss, please use
ITR -3/5.

B4 Income from Other Sources B4 0

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

Sl.
Nature of Income Description ( If Any Other selected) Amount
No.

(1) (2) (3) (4)

1 Dividend 0

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-2023 0 (i) Up to 15-Jun-2023 0

From 16-Jun-2023 to From 16-Jun-2023 to 15-

(ii) 0 (ii) 0
15-Sep-2023 Sep-2023
From 16-Sep-2023 to From 16-Sep-2023 to
(iii) 0 (iii) 0
15-Dec-2023 15-Dec-2023
From 16-Dec-2023 to From 16-Dec-2023 to
(iv) 0 (iv) 0
15-Mar-2024 15-Mar-2024
From 16-Mar-2024 to From 16-Mar-2024 to
(v) 0 (v) 0
31-Mar-2024 31-Mar-2024

Less: Deduction u/s 57(iia) (in case of family pension only)

0

Less: Income claimed for relief from taxation u/s 89A 0

Gross Total Income (B1+B2+B3+B4) To avail the benefit of carry forward and set off of loss,
B5 B5 4,80,246
please use ITR-3/5.

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

PART C - DEDUCTIONS AND TAXABLE TOTAL INCOME

Sl.No. Section Amount System Calculated

80C - Life insurance premium, deferred annuity, contributions to 0

C1 0
provident fund, subscription to certain equity shares or debentures, etc.

C2 80CCC - Payment in respect Pension Fund 0 0

C3 80CCD(1) - Contribution to pension scheme of Central Government 0 0

C4 80CCD(1B) -Contribution to pension scheme of Central Government 0 0

80CCD(2) - Contribution to pension scheme of Central Government by 0

C5 0
employer

C6 80D - Deduction in respect of health insurance premia 0 0

80DD - Maintenance including medical treatment of a dependent who is a

C7 0 0
person with disability

80DDB - Medical treatment of

C8 0 0
specified disease

C9 80E - Interest on loan taken for higher education 0 0

C10 80EE - Interest on loan taken for residential house property 0 0

80EEA - Deduction in respect of interest on loan taken for certain house 0

C11 0
property

C12 80EEB - Deduction in respect of purchase of electric vehicle 0 0

C13 80G - Donations to certain funds, charitable institutions, etc. 0 0

C14 80GG - Rent paid 0 0

C15 80GGC - Contribution to Political party 0 0

C16 80TTA - Interest on savings bank account 0 0

C17 80TTB - Interest on deposits 0 0

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

C18 80U - In case of a person with disability 0 0

C19 80CCH - Contribution to Agnipath Scheme 0 0

C20 Total deductions (Add items C1 to C19) 0 0

C21 Taxable Total Income (B5 - C20) 4,80,250

PART D - TAX COMPUTATIONS AND TAX STATUS

D1 Tax payable on total income D1 9,013

D2 Rebate on 87A D2 9,013

D3 Tax payable after Rebate (D1-D2) D3 0

D4 Health and Education Cess @ 4% on (D3) D4 0

D5 Total Tax & Cess (D3 + D4) D5 0

D6 Relief u/s 89 (Please ensure to submit Form 10E to claim this relief) D6 0

D7 Balance Tax after Relief (D5 – D6) D7 0

D8 Total Interest u/s 234A D8 0

D9 Total Interest u/s 234B D9 0

D10 Total Interest u/s 234C D10 0

D11 Fee u/s 234F D11 1,000

D12 Total Tax, Fee and Interest (D7 + D8 + D9 + D10 + D11) D12 1,000

D13 Total Advance Tax Paid D13 0

D14 Total Self-Assessment Tax Paid D14 0

D15 Total TDS Claimed ( total of column 4 of Schedule-TDS1 and column 6 of Schedule- D15 37
TDS2(i) and TDS 2(ii) )

D16 Total TCS Collected ( total of column (5) of Schedule-TCS ) D16 0

D17 Total Taxes Paid (D13 + D14 + D15 +D16) D17 37

D18 Amount payable (D12 - D17, If D12 > D17) D18 960

D19 Refund (D17 - D12, If D17 > D12) D19 0

PART E - OTHER INFORMATION DETAILS OF ALL BANK ACCOUNTS HELD IN INDIA AT ANY TIME DURING THE PREVIOUS YEAR
(EXCLUDING DORMANT ACCOUNTS)
Sl.
No. IFS Code of the Bank Name of the Bank Account Number Type of account

(1) (2) (3) (4) (5)

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

1 CBIN0284873 CENTRAL BANK OF INDIA 3946351714 Savings Account

EXEMPT INCOME ONLY FOR REPORTING PURPOSES (IF AGRICULTURAL INCOME IS MORE THAN RS.5,000/-, USE ITR 3/5)
Sl.
Nature of Income Description (If 'Any Other' is selected) Amount
No.

(1) (2) (3) (4)

Total 0

SCHEDULE BP - DETAILS OF INCOME FROM BUSINESS OR PROFESSION

COMPUTATION OF PRESUMPTIVE BUSINESS INCOME UNDER SECTION 44AD

Sl.
Name of Business Business code Description
No.

(1) (2) (3) (4)

1 Prabhat Burnwal 09023-Retail sale in non-specialized stores Krish General Store

Gross Turnover or Gross Receipts (E1 limited to Rs.2 Crores, however if E1b is less
E1 i 14,56,246
than or equal to 5% of E1 then the limit under E1 is extended to Rs.3 Crores.)
Through a/c payee cheque or a/c payee bank draft or bank electronic clearing
a E1a 0
system or prescribed electronic modes received before specified date

b Receipts in Cash E1b 14,56,246

c Any mode other than a and b E1c 0

E2 Presumptive Income under section 44AD ii

a 6% of E1a or the amount claimed to have been earned, whichever is higher E2a 0

b 8% of (E1b+E1c) or the amount claimed to have been earned, whichever is higher E2b 4,80,246

c Total (a + b) E2c 4,80,246

COMPUTATION OF PRESUMPTIVE INCOME FROM PROFESSIONS UNDER SECTION 44ADA

Sl.
Name of Business Business code Description
No.

(1) (2) (3) (4)

Gross Receipts (E3 limited to Rs.50 Lakhs, however if E3b is less than or equal to 5% of
E3 E3 0
E3 then limit under E3 is extended to Rs.75 Lakhs.)
Through a/c payee cheque or a/c payee bank draft or bank electronic clearing
a E3a 0
system or prescribed electronic modes received before specified date

b Receipts in Cash E3b 0

c Any mode other than a and b E3c 0

Presumptive Income under section 44ADA (50% of E3) or the amount claimed to have
been earned, whichever is higher NOTE- If Income is less than 50% of Gross Receipts,
E4 E4 0
it is mandatory to have a tax audit under 44AB & other ITR as applicable has to be
filed
COMPUTATION OF PRESUMPTIVE INCOME FROM GOODS CARRIAGES UNDER SECTION 44AE
Sl.
Name of Business Business code Description
No.

(1) (2) (3) (4)

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

Presumptive income
u/s 44AE for the goods
carriage "Computed
at a minimum of Rs
Number of months for
1000 per ton per
which goods carriage
Sl. Registration No. of Whether owned/ Tonnage capacity of month in case
was owned
No. goods carriage leased/hired goods carriage(in MT) tonnage exceeds
/leased/hired by
12MT, or at a
assessee
minimum of Rs 7500
per month if the
tonnage is less than
or equal to 12MT"

(1) (2) (3) (4) (5) (6)

Presumptive Income from Goods Carriage under section 44AE [total of column (5)]
E5 NOTE- If the profits are lower than prescribed under S.44AE or the number of Vehicles E5 0
owned at any time exceed 10 then the other ITR, as applicable, has to be filed

E6 Salary and interest paid to the partners NOTE - This is to be filled up only by firms E6 0

E7 Presumptive Income u/s 44AE (E5-E6) E7 0

E8 Income chargeable under Business or Profession (E2c+E4+E7) E8 4,80,246

Information regarding turnover/gross receipt reported for GST Note – Please furnish the
E9
information below for each GSTIN No. separately
Sl. Annual Value of Outward Supplies as per the GST Return
GSTIN No.(s)
No. Filed

(1) (2) (3)

E10 Total of value of Outward Supplies as per the GST return filed E10 0

FINANCIAL PARTICULARS OF THE BUSINESS NOTE- FOR E11 TO E25 FURNISH THE INFORMATION AS ON 31ST DAY OF MARCH, 2024

E11 Partners/ Members own capital E11 8,45,247

E12 Secured loans E12 0

E13 Unsecured loans E13 1,20,542

E14 Advances E14 86,486

E15 Sundry creditors E15 12,452

E16 Other liabilities E16 15,240

E17 Total capital and liabilities (E11+E12+E13+E14+E15+E16) E17 10,79,967

E18 Fixed assets E18 5,54,364

E19 Inventories E19 2,45,624

E20 Sundry debtors E20 8,642

E21 Balance with banks E21 26,458

E22 Cash-in-hand E22 1,12,542

E23 Loans and advances E23 65,428

E24 Other assets E24 65,428

E25 Total assets (E18+E19+E20+E21+E22+E23+E24) E25 10,78,486

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

SCHEDULE IT - ADVANCE TAX AND SELF ASSESSMENT TAX PAYMENTS

Sl.
BSR Code Date of Deposit (DD/MM/YYYY) Challan No. Tax paid
No.

(1) (2) (3) (4)

Total 0

SCHEDULE TCS - DETAILS OF TAX COLLECTED AT SOURCE [AS PER FORM 27D ISSUED BY THE COLLECTOR(S)]
Details of amount paid
Sl. Tax Collection Account Amount out of (4) being
Name of the Collector as mentioned in Form Tax Collected
No. Number of the Collector claimed
26AS

(1) (2) (3) (4) (5)

Total 0

SCHEDULE TDS1 - DETAILS OF TAX DEDUCTED AT SOURCE FROM SALARY

[AS PER FORM 16 ISSUED BY EMPLOYER(S)]
Sl. Tax Deduction Account
Name of the Employer Income under Salary Tax deducted
No. Number (TAN)

(1) (2) (3) (4)

Total 0

SCHEDULE TDS2(I) - DETAILS OF TAX DEDUCTED AT SOURCE ON INCOME OTHER THAN SALARY [AS PER FORM 16 A ISSUED BY
DEDUCTOR(S)]
TDS credit
being claimed
Unclaimed TDS brought this Year (only
TDS of the Corresponding Receipt /
forward (b/f) if
current Fin. withdrawals offered
corresponding
Year (TDS
Tax Deduction receipt is
deducted
Account being offered TDS credit
Sl. during the FY
Number (TAN) for tax this being carried
No. 2023-24)
of the year not forward
Deductor applicable if
Fin. Year in TDS is
which TDS is TDS b/f deducted u/s Gross Amount Head of
deducted 194N) Income
TDS Deducted
TDS Claimed

(1) (2) (3) (4) (5) (6) (7) (8) (9)

OS-Income from
1 MUMR19954E 0 37 37 726 0
Other Source

Total 37

SCH TDS 2(II) DETAILS OF TAX DEDUCTED AT SOURCE [AS PER FORM 16C / 16D FURNISHED BY PAYER(S)]
TDS credit
being
Unclaimed TDS brought TDS of the claimed this Corresponding Receipt
forward (b/f) current Year (only if offered
Financial correspondin TDS Credit
PAN of the Aadhaar No Year g receipt is
Sl. being
Tenant / of the tenant being
No. carried
Deductor / Deductor offered for
Fin. Year in forward
tax this
which TDS b/f Gross Head of
TDS year) Amount Income
deducted
Deducted
TDS Claimed

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

Total 0

SCHEDULE 80D
If you are individual, whether you or any of your family member(excluding parents) is a senior
1
citizen? If you are HUF, whether any member of HUF is a senior citizen?

(a) Self & Family 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

(b) Self & Family including Senior Citizen 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

Medical Expenditure (This deduction to be claimed on which health insurance is

(iii) 0
not claimed at (i) above)

2 Whether any one of your parents is a senior citizen

(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

Medical Expenditure (This deduction can be claimed on which health insurance is

(iii) 0
not claimed at (i) above)

3 Eligible Amount of Deduction 0

Section 80U Details of deduction in case of a person with disability

Sl. Date of filing of Form Acknowledgement UDID Number (If

Nature of Disability Amount of Deduction
No. 10IA Number available)

(1) (2) (3) (4) (5) (6)

1 0

Details of deduction in respect of maintenance including medical treatment of a dependent who is a person
Section 80DD
with disability.
Sl. Nature of Amount of Type of PAN of the Aadhaar of the Date of filing of Acknowledgeme UDID Number (If
No. Disability Deduction dependent dependent dependent Form 10IA nt number available)

(1) (2) (3) (4) (5) (6) (7) (8) (9)

1 0

SCHEDULE 80G DETAILS OF DONATIONS ENTITLED FOR DEDUCTION UNDER SECTION 80G

A. DONATIONS ENTITLED FOR 100% DEDUCTION WITHOUT QUALIFYING LIMIT

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

Amount of donation
City or Eligible
Sl. Name of PAN of Amount of
Address Town or State code Pin code
No. donee Donee Donation
District Donation in Donation in Total
cash other mode donation

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total A 0 0 0 0

B. DONATIONS ENTITLED FOR 50% DEDUCTION WITHOUT QUALIFYING LIMIT

City or Amount of donation Eligible

Sl. Name of PAN of the
Address Town or State code Pin code Amount of
No. donee donee Donation in Donation in Total
District Donation
cash other mode donation

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total B 0 0 0 0

C. DONATIONS ENTITLED FOR 100% DEDUCTION SUBJECT TO QUALIFYING LIMIT

City or Amount of donation Eligible

Sl. Name of PAN of the
Address Town or State code Pin code Amount of
No. donee donee Donation in Donation in Total
District Donation
cash other mode donation

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Total C 0 0 0 0

D. DONATIONS ENTITLED FOR 50% DEDUCTION SUBJECT TO QUALIFYING LIMIT

ARN Amount of donation

City or Eligible
Sl. Name of PAN of the (Donation
Address Town or State code Pin code Donation Amount of
No. donee donee Reference Donation Total
District in other Donation
Number) in cash donation
mode

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Total D 0 0 0 0

E. Total Amount of Donations (Aix + Bix + Cix + Dix) 0 0 0 0

SCHEDULE 80GGC DETAILS OF CONTRIBUTIONS MADE TO POLITICAL PARTIES

Transaction Reference
Amount of Contribution Eligible number for UPI transfer
Sl. Date of IFSC code of
Amount of / Cheque number / IMPS
No. Contribution Contribution in Contribution in Total Bank
Contribution / NEFT / RTGS reference
Cash other mode Contribution number

(1) (2) (3) (4) (5) (6) (7) (8)

Total 0 0 0 0

VERIFICATION

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”
Acknowledgement Number : 905284540180325 Date of Filing : 18-Mar-2025*

I, PRABHAT BURNWAL son/ daughter of ASHOK PRASAD BURNWAL 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
BQMPB6568D

Place: DEOGHAR

Date: 18-Mar-2025

If the return has been prepared by a Tax Return Preparer (TRP) give further details below:

TRP PIN (10 digit) Name of TRP Counter Signature of TRP

Amount to be paid to TRP 0

*If the return is verified after 30 days of transmission of return data electronically, then date of verification will be considered as date of filing the
return (Notification No.05 of 2022 dated 29-07-2022 issued by the DGIT (Systems), CBDT).”