/ MAHARASHTRA STATE ELECTRICITY DISTRIBUTION CO. LTD.

Corporate Office, Prakashgad, Mumbai - 400 OSl.

Actual Investment ~ecla~ation Form F.Y. 2017 to 2011 [Pay Bill Nc.: 2J~)

D,~IGNATIDN 2. CPF NO.

01:, ,r./SECTION
ADDRESS (For the purpose or HRA}

I ur.d~nJl~ to m3~e Ihe following investment under incomc ta. act 1961 during the financial vcar 2017·2013 as pc- cC!Jils
given below. The Oocument~ry Proof is enclosed herewith.

I.
II Actual Investment/ Savings
I'
I
Document
Attached
Sr.
No. Description I (Amt. In Rs) I (Strike Out)
A.
!INV£SHI.£NT uis so ( & wO ccc I I
I I I :Vc,/II.=i
!~_!:!iC :t~:\'i::tn; ;:":nd (j:';:f) I 1
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r- ~II~ns~v~ra~~~ct~?r~t~m~iu~n~,~P.~i~d~(C~I~rt~c~t!~y)~
~ : +i ~

3. ::I;,:,c",! Sa-'lnK ecniii<a:c I:I;SC) i :"cs:'" 0:

.•. ; :"C's.':o...::
:.\ccruc:! in:t'tst on NSC I\':cr~ir.g S~cc: "'lIJchedl I
s.

6 iEcuc2t:on Es~ns~s (Onlv Tuition Fees)

7.
IHCVSi~&tean- Principal Payment
8.
Iso eee .lIC·Pension Fund
9.
t--
Olhtrs (with specific S.cc:.:::-ti,:.on-::-'-o:-:II:'-.T::-.-::-A-':ct"':)-:-::-::--,- I
+-
:Vcs/II.~~
-----i
: TOTAlINV£!TMENT U/S 80 e& 80 CCG I
a, .1
. 'InEDucnoNS U'liDER CHAPTER VI A
t--r-'
I.
-- --.-----::---,-----------l'----,---.,---l

I
2.
Rejiv G3ndhi
So-D
Rs.2S,OOO/·)
Medl.:)~im

80 DO incurred
tre31mcnt
.quity Saving Scheme
Insurance

by expenditure
including nursing,
80 CCG
Premium

jar the
=
medica)
training &
6000! I

rehabilitation of Dependent being 3 person with

dis~bilily (Upto Rs. 75,000/·)
80 U Permanent Physical Disability (Self) [Ves/No/
s. Olt.;~ ; .. :::: -r-':::' 'xtion of I.T.Act) [YeS/No/
c. tnterest P.yment for Lo.n on Self· Occupied House
[ycs!r:oJ

D.
(uplO Rs.2 Lakhs] I
,qent P3id pcr Monlh House Rent Paid will be exempted upto (enclose Rent Receipt & Copy of IIgreement)
[jJI$IC 0.11. RENT PIIID _
1. 50% OF Salary (llasic+DII)
2. IICtual H.RA Received
3. Rent Paid - (10% of llasic+DA)
, 4. Whichever in lower

1,10 hereby dC'(tarr that what j\ stared above is true to the best of my ~,:cw!r:dr.c and bncf r~nh~(e. in CJ\C of .loy (hJnr.c III H'ot aoo / Ilt

OCCupJIIon of the above ptemises I would rcvis c the dcci;Jratioll p~ Inform Immcdi<:udy.
 <)o;rr ~fMt<m trig ~ 'lJTTf ~ fi'l!l5cWl'Clllf{q;Z;Jlqlqo<l QIt1UIl4;f
,m qd ,ot,-,-tL)

--_. __ ._-------

LT. PAN No. Poy Bill No.

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I
VERifICATION
I do hereby declare that what is stated above is true to the best of my Knowledge and
belief. Further, in case of any change in investment, I would revise the declaration & inform
immediately to Salary & Claims Section. If in the later stage if found the amount to be invested, during
January- March is notinvested, the Salary & Claims Section will not be held liable for that.

Date

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