Government of India INCOME-TAX DEPARTMENT ACKNOWLEDGEMENT Received with thanks from _______________________________________________________________ a return of income in Form No. ITR . for assessment year 2010-11, having the following particulars. PAN Name Flat/Door/Block No Name Of Premises/Building/Village Road/Street/Post Office Area/Locality Town/City/District State Status (fill the code) P E R SO N A L IN F O R M A T IO N Designation of Assessing Officer (Ward/ Circle) Original or Revised 1 Gross total income 1 2 Deductions under Chapter-VI-A 2 3 Total Income 3 3a Current Year loss (if any) 3a 4 Net tax payable 4 5 Interest payable 5 6 Total tax and interest payable 6 7 Taxes Paid a Advance Tax 7a b TDS 7b c TCS 7c d Self Assessment Tax 7d e Total Taxes Paid (7a+7b+7c +7d) 7e 8 Tax Payable (6-7e) 8 C O M P U T A T IO N O F I N C O M E A N D T A X T H E R E O N 9 Refund (7e-6) 9 Receipt No Date Seal and Signature of receiving official
