ITR-4 Income Tax Return Form AY2011-2012 Assessment Year

FORM ITR-4 INDIAN INCOME TAX RETURN
( For individuals and HUFs having income from a proprietory business or profession)
(Please see rule 12 of the Income-tax Rules,1962)
(Also see attached instructions) Assessment Year
2 0 1 1 - 1 2
________________________________________
Part A-GEN GENERAL
PERSONAL INFORMATION First name Middle name Last name PAN

Flat/Door/Block No Name Of Premises/Building/Village Status (Tick) ?
? Individual ? HUF
Road/Street/Post Office Area/locality Date of Birth (DD/MM/YYYY)
( in case of individual)
/ /
Town/City/District State Pin code Sex (in case of individual) (Tick) ?
? Male ? Female
Residential/Office Phone Number with STD code Mobile No. Employer Category (if in employment) (Tick) ?
? Govt. ? PSU ? Others
Email Address Income Tax Ward/Circle

FILING STATUS Return filed (Tick)[Please see instruction number-7] ?Before due date -139(1) ? After due date -139(4) ? Revised Return- 139(5)

OR In response to notice ? 142(1) ? 148 ? 153A/153C
If revised, then enter Receipt No and Date of filing original return (DD/MM/YYYY) / /

Residential Status (Tick) ? ? Resident ? Non-Resident ? Resident but Not Ordinarily Resident
Whether this return is being filed by a representative assessee? (Tick) ? ? Yes ? No
If yes, please furnish following information -
(a) Name of the representative
(b) Address of the representative
( c) Permanent Account Number (PAN) of the representative
AUDIT INFORMATION Are you liable to maintain accounts as per section 44AA? (Tick) ? ? Yes ? No
Are you liable for audit under section 44AB? (Tick) ? ? Yes ? No, If yes, furnish following information-
(a) Name of the auditor signing the tax audit report
(b) Membership no. of the auditor
(c) Name of the auditor (proprietorship/ firm)
(d) Permanent Account Number (PAN) of the proprietorship/ firm
(e) Date of audit report.
For Office Use Only

For Office Use Only

Receipt No

Date

Seal and Signature of receiving official

NATURE OF BUSINESS NATURE OF BUSINESS OR PROFESSION, IF MORE THAN ONE BUSINESS OR PROFESSION INDICATE THE THREE MAIN ACTIVITIES/ PRODUCTS
S.No. Code
[Please see instruction No.7(i)] Trade name of the proprietorship, if any Description
(i)

(ii)

(iii)

Part A-BS BALANCE SHEET AS ON 31ST DAY OF MARCH, 2011 OF THE PROPRIETORY BUSINESS
(fill items 1 to 5 in a case where regular books of accounts are maintained, otherwise fill item 6)
SOURCES OF FUNDS 1 Proprietor fund
a Proprietor capital a
b Reserves and Surplus
i Revaluation Reserve bi
ii Capital Reserve bii
iii Statutory Reserve biii
iv Any other Reserve biv
v Total (bi + bii + biii + biv) bv
c Total proprietor fund (a + bv) 1c
2 Loan funds
a Secured loans
i Foreign Currency Loans ai
ii Rupee Loans
A From Banks iiA
B From others iiB
C Total ( iiA + iiB) iiC
iii Total (ai + iiC) aiii
b Unsecured loans (including deposits)
i From Banks bi
ii From others bii
iii Total (bi + bii) biii
c Total Loan Funds (aiii + biii) 2c
3 Deferred tax liability 3
4 Sources of funds (1c + 2c +3) 4
APPLICATION OF FUNDS 1 Fixed assets
a Gross: Block 1a
b Depreciation 1b
c Net Block (a b) 1c
d Capital work-in-progress 1d
e Total (1c + 1d) 1e
2 Investments

a Long-term investments
i Government and other Securities - Quoted ai
ii Government and other Securities Unquoted aii
iii Total (ai + aii) aiii
b Short-term investments

i Equity Shares, including share application money bi
ii Preference Shares bii
iii Debentures biii
iv Total (bi + bii + biii) biv
c Total investments (aiii + biv) 2c
3 Current assets, loans and advances
a Current assets
i Inventories
A Stores/consumables including packing material iA
B Raw materials iB
C Stock-in-process iC
D Finished Goods/Traded Goods iD
E Total (iA + iB + iC + iD) iE
ii Sundry Debtors aii
iii Cash and Bank Balances
A Cash-in-hand iiiA
B Balance with banks iiiB
C Total (iiiA + iiiB) iiiC
iv Other Current Assets aiv
v Total current assets (iE + aii + iiiC + aiv) av
b Loans and advances
i Advances recoverable in cash or in kind or for value to be received bi
ii Deposits, loans and advances to corporates and others bii
iii Balance with Revenue Authorities biii
iv Total (bi + bii + biii ) biv
c Total of current assets, loans and advances (av + biv) 3c
d Current liabilities and provisions
i Current liabilities
A Sundry Creditors iA
B Liability for Leased Assets iB
C Interest Accrued on above iC
D Interest accrued but not due on loans iD
E Total (iA + iB + iC + iD) iE
ii Provisions
A Provision for Income Tax iiA
B Provision for Wealth Tax iiB
C Provision for Leave encashment/Superannuation/Gratuity iiC
D Other Provisions iiD
E Total (iiA + iiB + iiC + iiD ) iiE
iii Total (iE + iiE) diii
e Net current assets (3c diii) 3e
4 a Miscellaneous expenditure not written off or adjusted 4a
b Deferred tax asset 4b
c Profit and loss account/ Accumulated balance 4c
d Total (4a + 4b + 4c) 4d
5 Total, application of funds (1e + 2c + 3e +4d) 5
NO ACCOUNT CASE 6 In a case where regular books of account of business or profession are not maintained - (furnish the following information as on 31st day of March, 2011, in respect of business or profession)
a Amount of total sundry debtors 6a
b Amount of total sundry creditors 6b
c Amount of total stock-in-trade 6c
d Amount of the cash balance 6d

Part A-P& L Profit and Loss Account for the previous year 2010-11 of the proprietary business
(fill items 1 to 50 in a case where regular books of accounts are maintained, otherwise fill item 51)
CREDITS TO PROFIT AND LOSS ACCOUNT 1 Sales/ Gross receipts of business or profession (Net of returns and refunds and duty or tax, if any) 1
2 Duties, taxes and cess, received or receivable, in respect of goods and services sold or supplied
a Union Excise duties 2a
b Service tax 2b
c VAT/ Sales tax 2c
d Any other duty, tax and cess 2d
e Total of duties, taxes and cess, received or receivable(2a+2b+2c+2d) 2e
3 Other income
a Rent 3a
b Commission 3b
c Dividend 3c
d Interest 3d
e Profit on sale of fixed assets 3e
f Profit on sale of investment being securities chargeable to Securities Transaction Tax (STT) 3f
g Profit on sale of other investment 3g
h Profit on account of currency fluctuation 3h
i Agriculture income 3i
j Any other income 3j
k Total of other income (3a to 3j) 3k
4 Closing Stock 4
5 Total of credits to profit and loss account (1+2e+3k+4) 5
DEBITS TO PROFIT AND LOSS ACCOUNT 6 Opening Stock 6
7 Purchases (net of refunds and duty or tax, if any) 7
8 Duties and taxes, paid or payable, in respect of goods and services purchased
a Custom duty 8a
b Counter vailing duty 8b
c Special additional duty 8c
d Union excise duty 8d
e Service tax 8e
f VAT/ Sales tax 8f
g Any other tax, paid or payable 8g
h Total (8a+8b+8c+8d+8e+8f+8g) 8h
9 Freight 9
10 Consumption of stores and spare parts 10
11 Power and fuel 11
12 Rents 12
13 Repairs to building 13
14 Repairs to machinery 14
15 Compensation to employees
a Salaries and wages 15a
b Bonus 15b
c Reimbursement of medical expenses 15c
d Leave encashment 15d
e Leave travel benefits 15e
f Contribution to approved superannuation fund 15f
g Contribution to recognised provident fund 15g
h Contribution to recognised gratuity fund 15h
i Contribution to any other fund 15i
j Any other benefit to employees in respect of which an expenditure has been incurred 15j
k Total compensation to employees (15a+15b+15c+15d+15e+15f+15g+15h+15i+15j) 15k
16 Insurance
a Medical Insurance 16a
b Life Insurance 16b
c Keyman Insurance 16c
d Other Insurance 16d
e Total expenditure on insurance (16a+16b+16c+16d) 16e
17 Workmen and staff welfare expenses 17
18 Entertainment 18
19 Hospitality 19
20 Conference 20
21 Sales promotion including publicity (other than advertisement) 21
22 Advertisement 22
23 Commission 23
24 Hotel , boarding and Lodging 24
25 Traveling expenses including foreign traveling 25
26 Conveyance expenses 26
27 Telephone expenses 27
28 Guest House expenses 28
29 Club expenses 29
30 Festival celebration expenses 30
31 Scholarship 31
32 Gift 32
33 Donation 33
34 Rates and taxes, paid or payable to Government or any local body (excluding taxes on income)
a Union excise duty 34a
b Service tax 34b
c VAT/ Sales tax 34c
d Cess 34d
e Any other rate, tax, duty or cess incl STT Paid 34e
f Total rates and taxes paid or payable (34a+34b+34c+34d+34e) 34f
35 Audit fee 35
36 Other expenses 36
37 Bad debts 37
38 Provision for bad and doubtful debts 38
39 Other provisions 39
40 Profit before interest, depreciation and taxes
[5 (6 + 7 + 8h + 9 to 14 + 15k + 16e + 17 to 33 + 34f + 35 to 39)] 40
41 Interest 41
42 Depreciation 42
43 Profit before taxes (40-41-42) 43
TAX PROVISIONS AND APPROPRIATIONS 44 Provision for current tax 44
45 Provision for Deferred Tax 45
46 Profit after tax (43 44 45 ) 46
47 Balance brought forward from previous year 47
48 Amount available for appropriation (46 + 47) 48