FORM ITR-5 INDIAN INCOME TAX RETURN
[For firms, AOPs and BOIs]
(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 Name PAN
Is there any change in the name? If yes, please furnish the old name
Flat/Door/Block No Name Of Premises/Building/Village Date of formation (DD/MM/YYYY)
/ /
Road/Street/Post Office Area/Locality Status (firm-1, local authority-2,cooperative bank-3, other cooperative society-4, LLP-5, any other AOP/BOI artificial juridical person-6, ) ?
Town/City/District State Pin code Income Tax Ward/Circle
Residential/Office Phone Number with STD code
Mobile No.
Email Address
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
In the case of non-resident, is there a permanent establishment (PE) in India (Tick) ? ? Yes ? No
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
PARTNERS/ MEMBERS INFORMATION A. Whether there was any change during the previous year in the partners/members of the firm/AOP/BOI/LLP (Tick) ? ? Yes ? No
(Income of societies and cooperative banks give details of Managing Committee)
B. Particulars of persons who were partners/ members in the firm/AOP/BOI on 31st day of March, 2011
S.No. Name and Address Percentage of share (if determinate) PAN
NATYURE 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.9(ii)] Description
(i)
(ii)
(iii)
Part A-BS BALANCE SHEET AS ON 31ST DAY OF MARCH, 2011 (fill items 1 to 5 in a case where regular books of accounts are maintained, otherwise fill item 6)
SOURCES OF FUNDS 1 Partners / members fund
a Partners / members 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 partners/ members 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
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 supera
