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All the proofs have to be uploaded using the scan image option using the link "Upload IPSF Proof Images". Any proofs that are
dropped in the IPSF drop-box will not be accounted. Please ensure to consolidate all the images of your investment proofs; scan
the duly signed IPSF form & annexures (if any); create a ZIP file & upload.
Oracle Solution Services (India) Pvt. Ltd.

IPSF ID : 0017500002

Investment Proofs Submission Form for the Year 2014-2015

Employee ID *

1008

Gender *

Date of Joining

24/07/2006

Name *

Abhinav Yatendra Jain

No. of Children going to School *

PAN *

AGPPJ2245M

No. of Children going to Hostel *

Section A - Rent Paid for claiming HRA exemption (Only Original Rent Receipts will be considered)
From Date

01/04/2014

As Per Last
Declaration

To Date

Address

31/03/2015

F- 304 CEDAR BLOCK,CANOPY APARTM

ENTS,7 CROSS ,NANJAPPA GARDENS ,KR
ISHAN KALY AN NAGAR,BABU SUB PALYA
,BANGALORE -560043,BANGALORE,KARN
ATAKA

Rent Paid Per Month

Rent Paid Per

Year

20000.00

240000.00

Section B - Chapter VI A - Deductions from Total Income

PAN of
Landlord

PANNOTAVBL

Value of Proof Attached.

0 Medical Insurance Premium (U/s 80D)

0.00

0 Medical Insurance Premium (U/s 80D) - Parents not being Senior Citizens

0.00

0 Medical Insurance Premium (U/s 80D) - Parents being Senior Citizens

0.00

0 Medical Treatment/Handicapped Dependent (U/s 80DD) < 80%

0.00

0 Medical Treatment/Handicapped Dependent (U/s 80DD) > 80%

0.00

0 Interest on Educational Loan (U/s 80E)

0.00

0 Permanent Physical Disability (80U) < 80%

0.00

0 Permanent Physical Disability Severe Disabilitty (80U) > 80%

0.00

0 Medical Treatment for Specific Disease (U/s 80DDB)

0.00

0 Additional Housing Loan Interest Benefit (U/s 80EE)

0.00

Section C - Chapter VIA - Section 80C

0 Contribution to Pension Fund ( 80CCC )

0.00

30000 Life Insurance Premium (Jeevan Dhara, Jeevan Akshay) etc

70000 Public Provident Fund (PPF)

108852.00
1000.00

0 National Savings Certificate (NSC)

0.00

0 Infrastructure Bonds

0.00

20000 Children Education Tuition fees

6600.00

0 Equity Linked Savings Scheme (ELSS)

0.00

0 Mutual Funds

0.00

0 Unit Linked Insurance Plan

0.00

0 5 Year Deposit under Senior Citizen Saving Scheme

0.00

0 Cumulative Term Deposits

0.00

0 5 Year Time Deposit in Post Office

0.00

0 Fixed Deposit Scheme (Block Period of 5 yrs)

0.00

0 NSC Interest (Will also be considered as Other Income)

0.00

Section G - Other Income

0 Interest on Deposits in Savings Account (Considered as deduction u/s 80TTA upto Rs.10000)

0.00

Declaration:
1. I hereby declare that I have read and understood the guidelines provided in 'Proofs Option Document' and that, all information,documents provided
above is true and correct in all respects.
2. I also undertake to indemnify the company for any loss/ liability that may arise, in the event of any incorrect information ,documents
provided by me.
Date:
Place:

Signature of Employee * ________________________________

* Indicates mandatory fields as per our database. Please verify the same and if blank, please fill and submit the form.

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Declaration by Landlord in case of PAN not available

(Mandatory if the annual rent amount is more than Rs.1,00,000)

I, ___________________________________________________________ (Landlord Name) hereby declare that,

I receive a monthly rent amount of Rs. ______________________ from Mr./ Ms./ Mrs. __________________
_________________________________________________________________ (Tenant Name) who is residing at
the following address: ________________________________________________________________________
_______________________________________________________

(Address

of

rented

house

from

____________ (mmm-yyyy) to ____________ (mmm-yyyy).

Further, I would like to state that I do not have a Permanent Account Number (PAN).

(Signature of Landlord)

Address of Landlord
_____________________________________

Date:

_____________________________________

Place

_____________________________________
_____________________________________

Reference: As per the section 10(13A), if annual rent paid by the employee exceeds Rs. 1,00,000 per annum
(Rs.8333 p.m), it is mandatory for the employee to report PAN of the landlord to the employer. In case the
landlord does not have a PAN, a declaration to this effect from the landlord along with the name and address of
the landlord should be filed by the employee.

Payroll Deduction
Particulars

Amount

Voluntary Provident Fund

49122.00

Provident Fund

49122.00

Medical Insurance Parents

Payroll Deduction - Total

17871.96
116115.96

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