Personal Information

A1. First Name A2.Middle Name
A3.Last Name * A4.PAN *
A5.Sex* A6.Date of Birth (DD/MM/YYYY)*
A7.Income Tax Ward / Circle Status *
Address
A8.Flat / Door / Building * Name Of Premises / Building / Village
A9.Road / Street A10.Area / Locality *
A11.Town / City / District * A12.State *
A13.Country * A14.Pincode *
A15.Email Address * A16.Mobile Number 1 *
A17.Mobile Number 2 Residential/Office Phone no.with STD code
(Do not prefix STD code with '0')
-

(STD)(Landline)

Filing Status

A18.Employer Category
(if in employment) *
A19.Tax Status *
A20.Residential Status *
A21.Return filed under section
(Please see Form Instruction) *
A22.Whether Person governed by Portuguese Civil Code under section 5A*
A23. If A22 is applicable, PAN of the Spouse
Whether original or revised return? *
A24.If under section: 139(5) - revised return:
Original Acknowledgement Number
Date of filing of Original Return(DD/MM/YYYY)
If under section: 139(9) - return in response to defective return notice:
Original Acknowledgement Number
Date of filing of Original Return (DD/MM/YYYY)
Notice Number
A25.If filed in response to notice u/s 139(9)/142(1)/148/153A/153C, enter the date of such notice
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