INCOME DECLARATION FORM FOR 2010-2011

(To be used to declare investment for income Tax that will be made during the period 2010-2011)
Note:The form is based on the changes proposed in the Finance bill 2010, which might change once the bill finally passed
Company Name ABHAY INDUCTION TECH PVT LTD Employee ID
Employee Name
DOJ
PAN Number
Item Particulars Max. Limit Declared Amount

Deduction Under Section 10

I am staying in a house and I egree to submit rent receipts when required.
The Rent paid is (Rs. _____ Per Month) & the house is located in Non-Metro
House Rent
0
I will produce the Medical Bills to the Satisfacton of the company for my
Medical eligibility of Rs. 15000/- as per Income Tax Act of else the company can 15000 0
consider the amount paid as taxable
** If you have opted for the medical reimbursements ( being Medical expenses part of your CTC)

Max. Limit Declared Amount

Sec.80CCF - Long Term Infrastructure Bonds
20,000 0
Sec.80D - Medical Insurance Premium (If the policy covers a senior Citizen
then additional deduction of Rs.5000/- is available) 15,000 0

Sec. 80DD - Medical treatment/insurance of Handicapped Dependant

A higher deduction of Rs. 100,00 is available, where such dependent is with
Deduction Under severe disability of > 80% 50,000 0
Chapter VI A
Sec 80DDB - Medical treatment (specified diseases only)
(medical treatment in respect of a senior Citizen then additional deduction of
Rs.20,000/- is available) 40,000 0

Sec 80E - Repayment of Loan for higher education (only interest) 0

Sec 80U - Handicapped 50,000 0

Max. Limit Declared Amount

Sec 80CCC - Contribution to Pension Fund (Jeevan Suraksha) 100,000 0

Life Insurance Premium 100,000 0

Defferred Annuity 100,000 0

Public Provident Fund 70,000 0

Deposit in Post Office Sevings Scheme 100,000 0

ULIP of UTI/LIC 100,000 0

Deduction Under
Section 80C Principal Loan (Housing Loan) Repayment 100,000 0

Mutual Funds 100,000 0

Investment in infrastructure Bonds 100,000 0

Children- Tution Fee restricted to max.of 2 children 100,000 0

Deposit in NHB 100,000 0

Deposit In NSC 100,000 0

Others (please specify) Employee Provident Fund 100,000 0

Max.Limit Declared Amount

If yes, Form 16 from previous employer or Form 12 B with tax computation
statement 0
Previous Salary paid by the Previous Employer after Sec.10 Exemption 0
Employment Salary
(Salary PROFESSIOAL TAX deducted by the Previous Employer 0
earened from
01/04/06 till date of PROVIDENT FUND deducted by the Previous Employer 0
joining)
INCOME TAX deducted by the Previous Employer 0

Income other then If yes, then Form 12C detailing other income is attached
Salary Income
 Max.Limit Declared Amount

Deduction under Interest on Housing Loan 1,50,000.00 0

Section 24
Interest if the loan is taken before 01/04/99 30,000.00 0

Note: Form 12C along with the calculation of loss on house property heeds to be attached for considering the above
Declaration:
1) I hereby declare that the information given above is correct and true in all respects.

2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information being incorrect.
Date:
Place:
Please remember the following points while filling up the form

1 Do not forget to mention you Employee Id , Name & Pan #

2 Only Delcared Amount needs to be filled. Donot change the figures mentioned in Max. limit Column
In col J 12 please mention the Annual rent expected to be paid for the Finnacial Year 2006-07. Also
3 mention the monthly rent paid on the left side description.

In row 13 against Col Declared amount for Medical Expenses, mention the amount only if the
4 folowing 2 conditions are staisfied:
a Medical Expenses of Rs 15,000 are part of your CTC
b You wish to opt for the reimbursement against the monthly allowance

In case of Housing Loan Interest, only mention the interest component of the Housing Loan in
Column J 47. Make sure you mention the amount only if the Loan has already commenced and you
5 have taken the posession of the house.