1

INVESTMENT DECLARATION / PROOF SUBMISSION FORM FOR THE F. Y. 2015-16

NOTE: PLEASE FILL UP THE FORM & SUBMIT THIS IMMEDIATELY ACCORDING TO GUIDELINES

EMP_NAME: EMP_ID:

Division: Region: H. Q.:

Date of Joining: Contact: Male Female

Permanent Account Number: _________________________[If PAN no is not stated, the employee may be liable for a penalty u/s 139A for Rs. 10,000/-]

A

EXEMPTION IN RESPECT OF HRA u/s 10(13A) House Rent:

1. From April 2015 To March 2016 Rs._____________ (Per month)

Address of the property:

_________________________________________________________________________________________

___________________________________________________________________________________________

City: State: Pincode:_____________________________ Proof Required: Monthly or quarterly receiptsRent receipt should include - 1. Complete address of house property with Pin-code, 2. Name & address of Landlord, 3. Amount & period of rent paid, 4. Receipts should be duly signed by the landloard on Rs. 1/- revenue stamp, 5. Rent Rs.1 lacs & above – PAN of Landlord required

BThe Maximum amount deductible u/s 80C, 80CCC & 80CCD cannot exceed Rs. 1.5 Lacs. [Items from 1 to 12]

Deduction u/s 24(b) is available for housing loan Interest upto Rs. 2,00,000/-. (Principal – Rs. 150,000/- u/s 80C)

* Investments Qualifying For DeductionMaximum

LimitAmount

1Contribution to Public Provident Fund (PPF) u/s 80CProof Required: X-rox copy of Pass book OR Challan with date & seal of bank on it.Note: Please do not mention the Provident fund deducted through salary.

1,50,000/-

2

Life Insurance Premium paid u/s 80CProof Required: Premium paid receipts or Premium paid certificate for F. Y. 2015-16 Note: 1. Date, amount & name should be clear on x-rox,

2. Do not send deposit receipts or acknowledgement receipt. 3. Amount of late fees would not be considered.

150,000/

3 Contribution to Pension Fund u/s 80CCCProof Required: Premium paid receipts or premium paid certificate for F. Y. 2015-16

150,000/

4 Purchase of NSC VIII u/s 80CProof Required: X-rox of Certificate of investment made in current year

150,000/

5

Payment of Tuition Fees (Education Expenditure) to any School / College / University in India for full time education of children (Excluding any paymenttowards Development fee or donation at the time of admission or thereafter)

No of Children studying: __________

Note: Allowed to maximum of 2 childeren

150,000/

6 Fixed Deposit for Term 5 years or more with a Scheduled BankProof Required: Certificate copy with Income Tax rebate stamp from bank.

150,000/

7ULIP / Mutual Fund u/s 80CProof required: Payment receipts copy or Certificate of premium for F. Y. 2015-16Note: Please mention Tax-Saver Mutual fund only

150,000/

8 Deposit in Post Office Tax Saving Scheme u/s 80CProof Required: Payment receipts or certificate copy for payment made in F. Y. 2015-16.

150,000/-

9 Equity Linked Saving SchemeProof Required: Receipt or Certificate copy for payment made in F. Y. 2015-16

150,000/-

11 Sukanya Samriddhi Account Scheme*NewProof Required: Xerox copy of passbook/challan copy with seal on it.

1,50,000/-

2

10

Housing Loan Principal Amount repaid or payable u/s 80C in F. Y. 15-16

Date of Loan Taken: _________________ Date of possession: __________________ Note: Only if possession of property received before 31/03/2016.

Self Occupied Property Let-out Property150,000/-

Address of House Property: ________________________________________________________

_______________________________________________________________________________

City: State: Pincode :

C

Interest amount of Housing Loan repaid or repayable in F. Y. 2015-16Proof Required: Provisional Certificate from the Bank with break-up of principal & interest only.Note: Do not send Loan sanction letter or account statement

A) Rs. 30,000/-

B) Rs. 2,00,000/-

Interest Limit for deduction:A) If loan taken before 01/04/1999B) If loan taken after 01/04/1999

D OTHER DEDUCTION UNDER SECTION 80 MAXIMUM LIMIT

AMOUNT

1 Investment in Rajiv Gandhi Equity saving Scheme(Limit Rs. 25000/- whose gross income is upto Rs. 12 lacs)

25000/-

2Deduction in respect of Interest of Housing loan u/s 80EE(Loan amount does not exceed Rs. 25lacs,Value of Property Rs.40lacs & deduction of additional interest Rs. 100000/)

100000/-

3Mediclaim Policy u/s 80D for Self, Spouse & Dependent children/ Parents(Addl. Rebate of Rs. 30,000/- in case of dependent parents above 60 years)Proof Required: Certificate of payment made for F. Y. 2015-16 stating deduction u/s 80D

25,000/-

4

Medical Treatment of Specified Diseases for self or dependent u/s 80DDB(Ceiling limit Rs 60,000/- in case of dependent parents above 60 years & very senior citizen Rs. 80000/-)Proof Required: Certificate copy from competent prescribed authority

40,000/-

5Medical Treatment of Handicapped Dependent u/s 80DDProof Required: Certificate copy from competent prescribed authority(Maximum limit Rs. 1,25,000/- if person with severe disability - over 80 percent)

75,000/-

6Deduction in case of permanent disability u/s 80UProof Required: Certificate copy issued by medical authority(Maximum limit Rs. 1,25,000/- if person with severe disability – over 80 percent)

75,000/-

7Interest on Education Loan taken for Higher Education u/s 80E Loan Taken Date: ________________Proof Required: Certificate copy issued by bank giving break up of Interest paid for F. Y. 2015-16

Full amt eligible for deduction

E PREVIOUS EMPLOYERS INCOME DETAILS AMOUNT

1 Salary paid by Previous Employer after Section 10 exemptions2 Professional Tax deducted by Previous Employer3 Provident fund deducted by Previous Employer4 Income Tax Deducted by Previous Employer

Proof Required: Form 16 or Signed copy of Tax computation sheet from the Previous Employer along with Form 12B

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 the loss / liability that may arise in the event of the above information

being incorrect.Note:

1. Tax once deducted from your salary will be deposited in the bank & company will not give refund. You will receive Form 16 for the Tax deducted from your salary.

2. All the x-rox copies of supporting evidences of investments should be submitted on or before 15tT FEB. 2016.DATE:

PLACE: SIGNATURE