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INDIAN INCOME TAX RETURNITR-4 (For individuals and HUFs having income from a proprietory business or profession)(please see rule 12 ofthe Income-tax Rules,1962)(Also see attached instructions)Assessment Year

PartA-GENFirst name Middle name Last name PAN

I I I I I I I I I~ FlatJDoorlBlock No Name Of PremisesIBuildingIViUage Status (Tick) 0E = o Individual o HUF~ Road/Street/Post Office Area/locality Date of Birth (DD/MM/YYYY)0. . . ( in case of individual)i! S I I~ TownlCitylDistrict State Pin code Sex (in case of individual)Tick) 00~ I I I I I o Male o Femalef i: Email Address (STD code)-Phone Number Employer Category (if inemployment) (Tick) 0( ) DGovt Dpsu o Others

Designation of Assessing Officer (Ward/Circle) I Return filed under Section I IT][Please see instruction number9(i}}Whether original or Revised return? (Tick) 0 0 Original o Revised

rIl If' revised, then enter Receipt No and Date ofJiling originalI I I I I I I I I I I I I I I I I I:l return (DD/MM/YYYY). . .-

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Nature of business or profession, if more than one business or profession indicate the three main activities! productsv.l Code Trade name of the.l S.No. Description~ [Please see instructionNo.9(ii)} proprietorship, if anyv.l; ; ; J (i)=. .0~ (ii)! ; ; ;:z ; (iii)

__ BALANCE SHEET AS ON 31sT DAY OF MARCH, 2009 OF THE PROPRIETORY BUSINESS(fill items 1to 5 in a case where regular books oft are otherwisefill item 6)1 .up""'U' ~ fund

a c. up "w. ~capital arIJ.~ b .....,~.,.,.,~and Surplus. . . i Revaluation Reserve bi. . .0 ii Capital Reserve biirIJ.f ; o ; l iii ':1 Reserve bili~;;J iv Any other Reserve biv0rIJ.

V Total (bi + bii + biii + biv) bvc Total proprietor's fund (a + bv) Ie2 !Loanfunds

a .~~_.~_ loansi Foreign Currency Loans aiii Rupee Loans

A !FromBanks iiAB !From others iiBC ITotal( iiA+ iiB) iiC

iii Total (ai + iiC) ailib TT . red loans (including deposits)i From Banks bi

ii From others biiiii Total (bi + bii) bili

c Total Loan Funds (aiii + biii) 2e3 ~efel"l"eutax liability 34 ISourcesof funds (Ic + 2c+3) 41 lFixedassets

a Gross: Block lab Ib~I". ~~._ vc Net Block (a - b) Ied Capital work-in-progress Ide Total (Ic + Id) IerIJ.~ 2Z "~;;J a. . ,~ .....,~...,ll.~. . . i Government and other Securities - Quoted al0Z ii Government and other Securities - Unquoted aii0. . . . ailio < iii Total (ai + aii)-

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i nventoriesA Stores/consumables including packing iAmaterialB lRawmaterials iBC Stock-in-process iCD !Finished Goods/Traded Goods illE Total (iA + iB + iC + ill) iE

ii Sundry Debtors aiiiii Cash and Bank Balances

A Cash-in-hand iiiAB lBalancewith banks iiiBC Total (iiiA + iiiB) iiiC

iv Other Current Assets aivv Total current assets (iE + aii + iiiC + aiv) av

b Loans and advancesi Advances recoverable in cash or in kind or for bivalue to be receivedii Deposits, loans and advances to corporates and biiothersiii Balance with Revenue Authorities biiiiv Total (bi + bii + biii ) biv

c Total of current assets, loans and advances (av + biv) 3cd Current liabilities and provisions

i Current liabilitiesA Sundry Creditors iAB !Liability for Leased Assets iBC ~nterest Accrued on above iCD ~nterest accrued but not due on loans illE Total (iA + iB + iC + ill) iE

ii ProvisionsA !provision for Income Tax iiAB IProvision for Wealth Tax iiBC !provision for Leave iiCencashment!SuperannuationlGratuityD Other Provisions iillE Total (iiA + iiB + iiC + iill ) iiE

iii Total (iE + iiE) diiie Net current assets (3c - diii) 3e

4 a Miscellaneous expenditure not written off or adjusted 4ab Deferred tax asset 4bc Profit and loss account! Accumulated balance 4cd Total (4a + 4b + 4c) 4d

5 Total, application of funds [Ie + 2c + 3e +4d) 56 ~na case where regular books of account of business or profession are not maintained -. . .

~~ ( fUrnish thefol lowing information as on 31" day of March, 2009, in respect of business orprofession)a ~mount of total sundry debtors 6aurLl ~mount of total sundry creditors< b 6b

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e ~otal of duties, taxes and cess, received or receivable(2a+2b+2c+2d) 2e~ Other income

a ~ent 3ab Commission 3be ~ividend 3ed ~nterest 3de rrofit on sale of fixed assets 3ef rrofit on sale ofinvestment being securities chargeable 3fo Securities Transaction Tax (STT)g rrofit on sale of other investment 3gh rrofit on account of currency fluctuation 3hi ~griculture income 3ij ~ny other income 3jk [Totalof other income (3a to 3j) 3k

4 Closing Stock 45 [Totalof credits to profit and loss account (1+2e+3k+4) 56 Opening Stock 67 !purchases (net of refunds and duty or tax, if any) 78 ~uties and taxes, paid or payable, in respect of goods and services purchased

a Custom duty 8ab Counter vailing duty 8be Special additional duty 8ed ~nion excise duty 8de Service tax 8ef ~ATI Sales tax 8fg ~ny other tax, paid or payable 8gh Total (8a+8b+8c+8d+8e+8f+8g) 8h

9 !Freight 910 Consumption of stores and spare parts 10

. . . 11 1P0werand fuel 11s 12 ~ents 120u !Repairs to building13 13-