Acknowledgement Number : 595365240050724 Date of Filing : 05-Jul-2024*

INDIAN INCOME TAX RETURN

FORM [For individuals being a resident (other than not ordinarily resident) having total income upto Rs.50 lakh,
Assessment
having Income from Salaries, one house property, other sources (Interest etc.), and agricultural income upto
ITR1 Year
Rs.5 thousand] [Not for an individual who is either Director in a company or has invested in unlisted equity
SAHAJ 2024-25
shares or in cases where TDS has been deducted u/s 194N or if income-tax is deferred on ESOP] (Refer
instructions for eligibility)

PART A GENERAL INFORMATION

(A1) PAN (A2) First Name (A2a) Middle Name (A3) Last Name
HCXPS1630A MARIA VIVEK SIMON
(A5) Aadhaar Number(12 digits)/Aadhaar Enrolment Id(28 digits) (if
(A4) Date of Birth (A6) Mobile No
eligible for Aadhaar No.)
19/12/1994 +91 9731666677
4xxx xxxx 7452
(A9) Name of
(A10) Road/Street/Post Office,
(A7) Email Address (A8) Flat/Door/Block No. Premises/Building/Village
Area/Locality
[email protected] 560, 15th cross sidhartha school karamachand
Bangalore North BANGALORE
layout Lingarajapuram
(A11) Town/City/District (A12) State (A13) Country/Region (A14) PIN Code/ZIP Code
St. Thomas Town S.O 15-Karnataka 91-INDIA 560084

(A17) Nature of employment Others

(A15)(a) Filed u/s (Tick)[Please see instruction] 139(1)-On or before due date

(A16) Or Filed in response to notice u/s

(A18) If revised/defective then enter Receipt No. and Date of filing of

original return (DD/MM/YYYY)
(A19) 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
(A20) Do you wish to exercise the option u/s 115BAC(6) of Opting out of new tax regime ? (default is “No”)
Yes No
(A21) Are you filing return of income under Seventh proviso to section 139(1) but otherwise not required to furnish return of income? - (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 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
(ii) Have you incurred expenditure of 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

Sl No. Nature Amount

(1) (2) (3)

PART B GROSS TOTAL INCOME

B1 i Gross Salary (ia + ib + ic + id + ie) i 10,29,992

a Salary as per section 17(1) ia 10,29,992

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

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

d Income from retirement benefit account maintained in a notified country u/s id 0

89A

Income from retirement benefit account maintained in a country other than

e ie 0
notified country u/s 89A

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

Less allowances to the extent exempt u/s 10 [Ensure that it is included in salary income u/s
ii ii 2,35,198
17(1)/17(2)/17(3)]
Sl.
Nature of Exempt Allowances Description ( If Any Other selected) Total Amount
No.

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

Sec 10(13A)-Allowance to meet

1 235198
expenditure incurred on house rent

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

iii Net Salary (i - ii - iia) iii 7,94,794

iv Deductions u/s 16 (iva + ivb + ivc) iv 52,400

a Standard deduction u/s 16(ia) iva 50,000

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

c Professional tax u/s 16(iii) ivc 2,400

v Income chargeable under the head 'Salaries' (iii - iv) B1 7,42,394

B2 Type Of House Property B2 Self-Occupied

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 30,000

vi Arrears/Unrealised 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
vii B2 -30,000
negative)

B3 Income from Other Sources B3 799

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

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

1 Interest from Income Tax Refund 414

2 Interest from Saving Account 385

Quarterly breakup of Dividend Income Quarterly breakup of Income from retirement benefit
account maintained in a notified country u/s 89A
(taxable portion)

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

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

Less: Deduction u/s 57(iia) (in case of family pension only) 0

Gross Total Income (B1+B2+B3) (If loss, put the figure in negative) Note: To avail the benefit
B4 B4 7,13,193
of carry forward and set off of loss, please use ITR-2

PART C - DEDUCTIONS AND TAXABLE TOTAL INCOME

Sl.No. Section Amount System Calculated

80C - Life insurance premia, deferred annuity, contributions to provident 1,50,000

C1 1,58,000
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 65,100 65,100

80DD - Maintenance including medical treatment of a dependent who is a 0

C7 0
person with disability

C8 80DDB - Medical treatment of specified disease - 0 0

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

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

80G - Donations to certain funds, charitable institutions, etc (Please fill

C13 0 0
80G schedule.This field is auto-populated from schedule 80G.)

C14 80GG - Rent paid (Please submit form 10BA to claim deduction) 0 0

80GGA - Certain donations for scientific research or rural development

C15 0 0
(Please fill 80GGA Schedule. This field is autopopulated from schedule.)

C16 80GGC - Donation to Political party 0 0

C17 80TTA - Interest on deposits in saving bank Accounts 385 385

C18 80TTB- Interest on deposits in case of senior citizens. 0 0

C19 80U - In case of a person with disability 0 0

C20 80CCH- Contribution to Agnipath Scheme 0 0

C21 Total deductions (Add items C1 to C18) 2,23,485 2,15,485

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

Total Income 4,97,710

EXEMPT INCOME (FOR REPORTING PURPOSES)

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

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

Total 0

PART D - COMPUTATION OF TAX PAYABLE

D1 Tax payable on total income D1 12,386

D2 Rebate u/s 87A D2 12,386

D3 Tax after rebate D3 0

D4 Health and education Cess @4% on D3 D4 0

D5 Total Tax and Cess D5 0

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

D7 Interest u/s 234A D7 0

D8 Interest u/s 234B D8 0

D9 Interest u/s 234C D9 0

D10 Fee u/s 234F D10 0

D11 Total Tax, Fee and Interest (D5 + D7 + D8 + D9 + D10 - D6) D11 0

D12 Total Taxes Paid D12 44,607

D13 Amount payable (D11-D12) (if D11>D12) D13 0

D14 Refund (D12 - D11) (if D12 > D11) D14 44,610

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

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

1 SBIN0002263 STATE BANK OF INDIA 20360540264 Savings Account

2 HDFC0004178 HDFC BANK 50100415202870 Savings Account

SCHEDULE 80D

1 Whether you or any of your family member (excluding parents) is a senior citizen? No

(a) Self & Family 19,600

(i) Health Insurance 14,600

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

(ii) Preventive Health Checkup 5,000

(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 Yes

(a) Parents 0

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

(b) Parents including Senior Citizen 45,500

(i) Health Insurance 0

(ii) Preventive Health Checkup 0

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

(iii) 45,500
not claimed at (i) above)

3 Eligible Amount of Deduction 65,100

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

Sl. Date of filing of Form Ack. No. of Form 10IA UDID Number (If
Nature of Disability Amount of Deduction
No. 10IA filed 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 with
Schedule 80DD
disability.
Sl. Nature of Amount of Type of PAN of the Aadhaar of the Date of filing of Ack. No. of Form UDID Number (If
No. Disability Deduction dependent dependent dependent Form 10IA 10IA filed 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, (WHERE ANY ROW IS FILLED BY THE USER, ALL THE
FIELDS IN THAT ROW SHOULD BECOME MANDATORY)

City or Amount of donation Eligible

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

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

Total A 0 0 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 : 595365240050724 Date of Filing : 05-Jul-2024*

B. DONATIONS ENTITLED FOR 50% DEDUCTION WITHOUT QUALIFYING LIMIT (WHERE ANY ROW IS FILLED BY THE USER, ALL THE
FIELDS IN THAT ROW SHOULD BECOME MANDATORY)

City or Amount of donation Eligible

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

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

Total B 0 0 0 0

C. DONATIONS ENTITLED FOR 100% DEDUCTION SUBJECT TO QUALIFYING LIMIT (WHERE ANY ROW IS FILLED BY THE USER, ALL THE
FIELDS IN THAT ROW SHOULD BECOME MANDATORY)

City or Amount of donation Eligible

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

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

Total C 0 0 0 0

D. DONATIONS ENTITLED FOR 50% DEDUCTION SUBJECT TO QUALIFYING LIMIT (WHERE ANY ROW IS FILLED BY THE USER, ALL THE
FIELDS IN THAT ROW SHOULD BECOME MANDATORY)

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. the 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 (A + B + C + D) 0 0 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 : 595365240050724 Date of Filing : 05-Jul-2024*

SCHEDULE 80GGA DETAILS OF DONATIONS FOR SCIENTIFIC RESEARCH OR RURAL DEVELOPMENT

Relevant
Clause Amount of Donation
City or Eligible
Sl. under Name of PAN of the
Address Town or State Code Pin code Donation Amount of
No. which the Donee Donee Donation Total
District in other Donation
deduction in Cash Donation
is claimed mode

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

Total 0 0 0 0

SCHEDULE 80GGC DETAILS OF CONTRIBUTION MADE TO POLITICAL PARTIES

Transaction Reference
Amount of Contribution Eligible number for UPI transfer
Sl. IFSC code of
Date Amount of / Cheque number / IMPS
No. 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

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

(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. Income chargeable under
TAN of the Deductor Name of the Deductor Total Tax Deducted
No. salaries

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

1 BLRG07214E GLOBALS ITES PRIVATE LIMITED 10,29,992 44,607

Total 44,607

SCHEDULE TDS2 - DETAILS OF TAX DEDUCTED AT SOURCE FROM INCOME OTHER THAN SALARY [AS PER FORM 16A ISSUED BY
DEDUCTOR(S)]
Gross receipt which
Sl. Name of the Year of tax TDS Credit out of
TAN of the Deductor is subject to tax Tax Deducted
No. Deductor deduction (5)claimed this year
deduction

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

Total 0

SCHEDULE TDS3 DETAILS OF TAX DEDUCTED AT SOURCE (AS PER FORM 16C FURNISHED BY THE PAYER(S))

PAN of the Name of the Gross receipt TDS Credit out

Sl. Aadhaar Number Year of tax
Tenant Tenant which is subject Tax Deducted of (6) claimed
No. of the Tenant deduction
to tax deduction this year

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

Total 0

SCHEDULE TCS

*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 : 595365240050724 Date of Filing : 05-Jul-2024*

Tax Collection Gross payment

Sl. Name of the Year of tax TCS Credit out of (5)
Account Number of which is subject to Tax Collected
No. Collector collection claimed this year
the Collector tax collection

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

Total 0

VERIFICATION

I, MARIA VIVEK SIMON son/ daughter of VICTOR SIMON 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 HCXPS1630A

Place: 157.50.35.25

Date: 05-Jul-2024

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

Identification No. of TRP Name of TRP Counter Signature of TRP

If TRP is entitled for any reimbursement from the Government, amount thereof 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).”