Intrasoft Technologies Limited Individual Declaration For Income Tax Calculation For the Financial Year 2011-12

01. Name (IN BLOCK LETTERS ) 02. Employee Number 03. Department 04. Date of Birth 05. Date of joining: 06. Residential Address : : : : : : STORES 3 June 1986 23 June 2011 MAHADEV PATIL SRA CHS, B WING ROOM NO 410, NR. CONVENT VIEW SOCIETY, GHATLA VILLAGE ROAD,CHEMBUR MUMBAI 400071 07. Permanent Account No. ( PAN) Mandatory : A W B P K 1 6 1 5 J AMIT SHRIKRISHNA KHOT 2080

DESCRIPTION 08. PARTICULARS OF INCOME FROM SOURCES OTHER THAN SALARY FROM INTRASOFT TECHNOLOGIES LTD a. b. c. Previous Employment Salary ( attach payslips/salary certificate/ Form 16) Income / (Loss) from House Property during 2011-12 ( Attach Annexure 1 incase relevant) Income from other sources i. ii. iii. d. e. Interest ( Attach Proof) Taxable Dividends Others (please specify) Nil Nil Amount (Rs.) Nil Nil Nil

Profits and gains of business or profession Capital Gains (will be taxed at normal slab rate)

Aggregate Of (a to e) above

Amount of Tax deducted at source on above income (enclose certificates issued U/s 203) DEDUCTIONS UNDER CHAPTER VI - A 09.
INVESTMENTS FOR DEDUCTION UNDER U/S 80C TO 80CCF:(Capped at Rs.1 lac u/s.80C to 80CCD & Rs.20000/- for 80CCF)
[Attach Proof]

Amount (Rs.) Nil Nil

a. b.

Contribution to Pension Plans Insurance Premium (LIC) deposited during 2011-12:- (For self, Spouse & Children) (Max 20% of sum assured) Sl No. i ii iii iv Policy No. Date of Payment of premium Amount of Premium paid

c. d. e.

Deposit in Public Provident Fund ( For self, Spouce & Children) Investment in U.L.I.P./U.T.I./E.L.S.S. Investment in N.S.C/ N.S.S

Nil Nil Nil

Page 1 of 3

f. g.

Housing Loan Principal Repayment for the FY 2011-12 Tuition Fees paid during 2011-12: (Please attach copies of receipts for tuition fees paid during F Y : 2011-12) i. ii. For 1st Child For 2nd Child Rs._____________________ Rs._____________________

Nil

h. i. j.

Fixed Deposit for a minimum period of five years in a Scheduled Bank made during F.Y.2011-12 Long-term Infrastructure Bonds under section 80CCF for F.Y 2011-12 (Capped at Rs.20000/- p.a) others (Please specify)

Nil Nil Nil

Total Investments u/s.80C to 80CCF (Limited to Rs.1.2 lakhs includes Rs.20,000/- for 80CCF investments) Nil 10 INVESTMENTS FOR DEDUCTION UNDER U/S 80D to 80U a. 80D - Medical Insurance Premium Subject to maximum deduction of Rs.15,000/- for self, spouse and dependent children plus Rs.15,000/- p.a. for parents whether dependent or not. Additional Rs.5,000/- in case of senior citizen Name of insured Relationship Amount Nill Amount (Rs.)

b. c. d. e. f. g.

80DD - Medical Treatment of Dependent suffering from Permanent Disability 80DDB - Expenditure on Medical Treatment for Specified disease 80E- Repayment of Interest against Higher Educational Loan 80U - Permanent Physical Disability

Nil Nil Nil Nil

Medical Expenses (Exempted upto Rs.15,000/- on producing bills) - the medical bills are for self, spouse, children, & Dependant parents, brothers & sisters. Nil others (Please specify) Total Eligible Deductions u/s.80D to 80U Nil Nil Amount (Rs.)

* For the above declared investments, Please attach copies of the proof of investment/payments. 11 HOUSE RENT ALLOWANCE If residing in rented House, the rent paid for the house during the period from 01.04.2011 TO 31.03.2012 :From i. ii. Amount of of rent per month Note : Furnish Original rent receipts and PAN of Landlord To Amount Total Amount

Nil

I ___________________________________hereby declare that all the information provided above are true and correct. I also declare that all documents produced by me as proof are true & orignal and have not been used previously by any person in any form whatsoever. I undertake to notify you immediately of any change in the above facts. I shall indemnify the company for all the cost and consequences arising on account of any incorrect information/documents furnished in this declaration.

(Signature of the Employee) Date : 24th February 2012 Place : Mumbai Name in BLOCK Letters: Mobile No. Email ID: Page 2 of 3 AMIT SHRIKRISHNA KHOT 9833329039 amitkhot11@gmail.com

Annexure 1 STATEMENT SHOWING LOSS FROM HOUSE PROPERTY To Intrasoft Technologies Ltd. Kolkata From Name : Employee No : Department:

Please find attached the computation of my income from house property for the period from 1st April 2011 to 31st March 2012 Particulars Period for which the property was let out (in months) Period for which the property remained vacant ( in months) Actual Rent Received for let out period (attach proof) Gross Annual Value Less: Municipal Tax Paid (attach proof) Net Annual Value (NAV) ----------------- (1) Less: Deductions u/s 24 (a) Standard deduction (30% of NAV) (b) Total interest payable on borrowed capital (attach proof) (i) Interest on post-contruction period (ii) 1/5th of total interest for pre-contruction period
(Note : Interest on pre-contruction period allowed in 5 equal installments. Maximum interest allowed in case of self occupied property is Rs.1,50,000/-. In case of let out property there is no cap)

Let Out/Deemed to be let out

Self Occupied

Total Deduction -------------------------- (2) Net Income / (-) Loss from House Property [1-2]

Date:

Signature of employee In case the house is unoccupied but treated as self occupied under IT Act, then please furnish the following confirmation : I hereby confirm that (i)my residential house could not be occupied owing to my employment and that I am residing at some other place in a building not belonging to me. (ii) my residential house is not let out, and (iii) no other benefit therefrom is derived by me Signature of employee

(put tick)

Note : Any other information relevant for computation of income from house property, please specify.