HEMARUS INDUSTRIES LTD.

INCOME TAX DECLARATION FORM - F.Y. 2014-15

(To be used to declare investment that will be made during the period from 01/04/2014 to 31/03/2015 for Income Tax purpose)

Company Name Employee Name

Hemarus Industries Limited SHASHIDHAR NAGANUR

Emp ID PAN of Employee (compulsory)

45 AJFPN9446F

As per section 206AA, in case PAN is not submitted, TDS will be deducted at flat rate of 20% ITEMS DEDUCTION U/S 10 I am staying in a rented house and I agree to submit Leave & Licence A'ment when required.The Rent Paid is (Rs. 5000 X 12 months) & the house is located in a METRO / NON METRO (Tick whichever is applicable) Sec 80D - Medical Insurance Premium (If the policy covers a senior citizen then exemption is Rs.20,000/-) Sec 80DD - Handicapped Dependent Sec 80E - Repayment of Loan for higher education (only Interest) Sec 80GG - Rent Paid DEDUCTION UNDER CHAPTER - VI A Sec 80U - Handicapped Sec 80CCG - Rajeev Gandhi Equity Saving Scheme (Investment max upto Rs.50,000, would get a deduction of 50% on the amount invested) Sec 80TTA - Interest on saving a/c Sec 80EE - additional deduction of Rs. 1Lac on home loan interest (applicable only for FY2013-14) Any other Deduction (Please specify) Contribution to Pension Fund (Jeevan Suraksha) Life Insurance Premium on life of self/spouse/child only Deferred Annuity Public Provident Fund in own name/spouse/child only ULIP of UTI/LIC in own name or spouse and child only Repayment of Housing Loan (Only principal) DEDUCTION U/S 80C Contribution to Pension Fund or UTI or Notified Mutual Fund Investment in ELSS made in units of Notified Mutual Fund Children Tuition Fee: Restricted to a max of 2 Children Deposit in home loan account scheme of NHB/HDFC 5 yrs. Term deposit in a Sch.Bank Others (please specify) Others (please specify) DEDUCTION U/S 80CCC Annuity/Pension Plan DEDUCTION U/S 80CCD Notified Pension Scheme 1,00,000.00 1,00,000.00 1,00,000.00 Max Limit DEDUCTION U/S 24 Interest on Housing Loan on fully constructed accomodation only Interest if the loan is taken before 01/04/99 on fully constructed accomodation only 150,000.00 30,000.00 Declared Amount PARTICULARS MAXIMUM LIMIT DECLARED AMOUNT

HOUSE RENT

NON METRO

60,000.00

Max Limit -

Declared Amount

25,000.00 10,000.00 100,000.00 Max Limit 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 1,00,000.00 Declared Amount 46,676.00

Aggregate Deduction U/S 80C, 80CCC & 80CCD cannot exceed Rs. 100000/-

DECLARATIONS:
1. I hereby declare that the information given above is correct and true in all respects. I am also aware that the company will be considering the above details in utmost good faith based on the details provided by me and that I am personally liable for any consequences arising out of errors, if any, in the above information. 2. I am also aware that any person making a false statement / declaration in the above form shall be liable to be fined and prosecution u/s 277 of the Income Tax Act, 1961 3. The proof of payment / Supportings for claim, will be provided latest by -------15 March 2015

Note -

Date : Place:

19.04.2014 Rajgoli, Kolhapur

SHASHIDHAR NAGANUR SIGNATURE OF THE EMPLOYEE

Investment details: 1) LIC JEEVAN ANAND - 636137269 2) MAX LIFE INSURANCE - 816441695 3) PNB METLIFE - 20333587 TOTAL

Amount 11,574.00 10,102.00 25,000.00 46,676.00

Provident Fund House Rent -5000 X 12months

As per Deduction 60,000.00

Form 12c PARTICULARS OF INCOME U/S 192 (2B) FORM NO. 12C [See rule 26B] Form for sending particulars of income under section 192 (2B) for the year ending 31st March, 2015 1 2 3 4 Name and address of the employee Permanent Account Number Residential Status Particulars of income under any head of income other than "salaries" (not being a loss under any such head other than the loss under the head "Income from house property") received in the financial year. (I) Income from house property (in case of loss, enclose computation thereof) (ii) Profits and gains of business or profession (iii) Capital gains (iv) Income from other sources Rs. (a) Dividends _____________ (b) Interest _____________ (c) Other incomes (specify) _____________ Total Aggregate of sub-items (I) to [(iv)] of item 4 Tax deducted at source [enclose certificate(s) issued under section 203] Place _____________ Date _____________ Rs. _____________ _____________ _____________ FORM 12-C

_____________

5 6

_______________________ Signature of the employee

1 2

______________________________ Inserted by the IT (Eighth Amdt.) Rules, 1987. Substituted by the IT (Fourteenth Amdt.) Rules, 1998, w.e.f. 14-9-1998. Prior to its substitution, item 4, as inserted by the IT(Eighth Amdt.) Rules, 1987, read as under: "4. Particulars of income (not being loss) under any head other than "Salaries" received in the financial year (I) "Interest on securities" Rs. _____________ (ii) Income from house property Rs. _____________ (iii) Profits and gains of business or profession Rs. _____________ (iv) Capital gains Rs. _____________ (v) Income from other sources Rs. _____________ (a) Dividends Rs. _____________ (b) Interest Rs. _____________ (c) Other incomes Rs. _____________ (specify) Total Rs. _____________ Substituted for "(v)" by the IT (Fourteenth Amdt.) Rules, 1998. w.e.f. 14-9-1998

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Form 12c Form 12C INCOME-TAX RULES, 1962 Verification I,_________________________,do hereby declare that what is stated above is true to the best of my knowledger and belief. Verified today, the ____________________day of ___________________20. Place _____________ Date _____________ _______________________ Signature of the employee _____________________ ACTION POINTS 1 This form is to be used by an assesse-employee when he desires that his income from sources other than "salaries" may also be taken into account by the employer for purposes of deduction of tax of source. This form may be submitted by the assessee employee to his employer. Once the Form is submitted by the assessee employees, the employer has to take into account the other income disclosed by the assesse and the tax deducted at source thereon while computing the tax deductible at source from the assessee's salary. From the assessment year 1999-2000, the assessee is permitted to furnish particulars in respect of any loss under the head 'Income from house property' to his employer. The Form has consequently been enlarged, so as to enable the assessee-employee to furnish particulars of such loss. Employees having loss under the head 'Income from house property' will find it to their advantage to furnish such loss (if any) to the employer, since the tax deductible at source will get corresponsdingly reduced. This apart, such employees will also be saved from the botheration of filing a return of income just for the purpose of obtaining tax refund. 4 The assessee-employee cannot however furnish particulars of loss (if any) under any head of income other than 'Income from house property'. _____________________ 1.428

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