Investment Declaration Form for FY 2013-14

NAME GENDER DOB S.NO. 1 PARTICULARS Rent Paid / Payable for: April 2013 May 2013 June 2013 July 2013 August 2013 September 2013 October 2013 November 2013 December 2013 January 2014 February 2014 March 2014 TOTAL S.NO. PARTICULARS Interest on Housing Loan u/s 24 (If the house is self occupied and the loan was taken on or after April 1999). Bankers Certificate to be submitted Interest on Housing Loan u/s 24 (Let out/ Deemed to be let out) S.NO. PARTICULARS 3 Medical Allowance MAXIMUM LIMIT (RS.) Max Limit - Rs. 1,50,000/(If Self Occupied) AMOUNT RS. EMP NO PAN D O JOINING Remarks Amount declared by you in the Declaration form AMOUNT RS.

Please enter your Monthly Rent details as per the Rent Receipt / Lease Deed. Note:If the Employee is paying the rent below Rs.3000/per month, he/she need not furnish the Rent Receipts (Circular No:8/2007 Dt: 05.Dec.2007).

- No Limit MAXIMUM LIMIT (RS.) Rs.15,000/- per annum

AMOUNT RS.

Rs. 15,000/- (or) Rs.20,000/Sec 80D (Medi Claim Policy & Preventive health check up)

Rs. 15,000/- (or) Rs.20,000/-

Sec 80DD (Maintenance including Medical Rs. 50,000/- (Rs.1,00,000/treatment of dependant person with for Severe disability) disability) Sec 80DDB (Medical treatment for specified diseases or ailments) - Self / Dependents Rs. 40,000/(Rs. 60,000/- for Senior Citizen )

Sec 80E (Education Loan)

No limit (only Interest Portion) Rs.50,000/- (Rs.1,00,000/for Severe disability) Amount declared by you MAX BENEFIT PERMISSIBLE in the Declaration form (RS.) AMOUNT Rs.

Sec 80U (For person with a disability)

S.NO. 9 10 11 12 13 14 15 16 17 18 19 20 21 22

PARTICULARS Life Insurance Premium Public Provident Fund (PPF) Voluntary Provident Fund (VPF) Pension Fund Contribution National Savings Certificate (NSC) Interest Accrued on NSC (Reinvested) Unit Linked Insurance Policy (ULIP) Equity Linked Savings Schemes (ELSS) Mutual Funds Payment of Tuition fees for Children (Max 2 Children) Principal repayment of Housing Loan Registration charges incurred for Buying House (I year Only) Infrastructure Bonds Bank Fixed Deposit for 5 Years & above Post office Term Deposit for 5years & above TOTAL

Maximum amount eligible for Deduction under section 80C & 80CCC Categories is Rs.1,00,000/-

PARTICULARS AMOUNT

S.NO. 23

a) Interest Income from Savings A.c (Banks & Post office only) b) c) d) PARTICULARS Income From Previous Employer (Joined after 01/04/2013) Income after exemptions Provident Fund (PF) Professional Tax (PT) Tax deducted at source (TDS) AMOUNT

S.NO. 24 a) b) c) d)

Income from house property

a) Date of actual possession of property
[which can be validated by 'Possession Certificate' issued by builder/municipal authorities etc.]

b) Amortisation of pre-construction period interest (if any) incurred [which needs to be considered during Current FY 2013 - 14] c) Information towards the House Property (LET OUT ) - In case of more than 1 Let out House Property % of Owner Ship House Property i) House Property 1 ii) House Property 2 iii) House Property 3 iv) House Property 4
I here by declare that Information as stated above is true and correct . I also authorize the company to recover tax (TDS) from my salary based on the PROOFS Submitted by me. I am personally liable to Income Tax proceedings for any misstatements in the declaration or proofs submitted herewith if they are inconsistent with the requirement of Income Tax Act, 1961.

Rental Income Per Annum

Muncipal Taxes Per Annum

Date: Place: Signature of the Employee

REMARKS

Provisional Certificate issued by the Banker showing the Interest Part

Rental Income for the Period April 2013 - March 2014 Municipal Taxes PAID by the owner (employee) during the financial year REMARKS Medical expenses incurred for family: (Family includes spouse, children and dependent parents, brothers and sisters ) Medical Insurance Premium PAID by Employee: - on the health of employee, spouse, and dependent children. [Rs.20,000/- In case employee is a Senior Citizen] (i.e., 60 years or more). Payment made by an employee for preventive health check-up of self, spouse, dependent children during the financial year is eligible for maximum deduction of Rs 5000. Note: The amount paid is within the overall limits ( Rs. 15000/Rs. 20000). Additional Amount of Rs.15,000/Medical Insurance Premium PAID by Employee on the health of parents (even not dependent on employee) . [Rs.20,000/- In the case parents are Senior Citizen]i.e., 60 years or more payment made by an employee for preventive health check-up of parents during the financial year is eligible for maximum deduction of Rs 5000. Note: The amount paid is within the overall limits ( Rs. 15000/Rs. 20000). Here Employee gets fixed amount of deduction. If employee has incurred any expenditure / deposited in specified policy. (Form 10-IA obtained from Medical Authority has to be submitted) Here Employee gets deduction: Lower of the following: i). Amount incurred or ii). Rs.40,000/- (or Rs.60,000/- if expenses incurred for senior citizen i.e,60 years or more ) (Form 10-I obtained from Medical Authority has to be submitted)

Interest on Loan taken for Higher Education: Amount paid by employee during the financial year on loan taken for higher education of - Employee, spouse or children of employee or students for whom employee is a legal guardian Benefit Period: Current Period + Next 7 years Here Employee gets fixed amount of deduction. (Form 10-IA obtained from Medical Authority has to be submitted)

REMARKS

Self , Spouse & Children only Self , Spouse & Children only will be additionally deducted from salary Self only Self only Self only Self , Spouse & Children only Self only Two children only Self & Joint a/c holder Self only Self only Self only Self only

Form 16 or Tax computation from previous employer should be furnished