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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: ABDUL ASIF PHANIBAND EMP_ID: F011548

Division: PROCARE CV Region: MUMBAI H. Q.: MUMBAI-1

Date of Joining:27 NOV 2007 Contact:9892550002 Male

Permanent Account Number: ___BBVPP2271D______________________[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._____10,000________ (Per month)

Address of the property: _____B.D.D BLOCK 39,ROOM NO 18,WORLI MUMBAI-

400018____________________________________________________________________________________

___________________________________________________________________________________________

City: MUMBAI State: MAHARASHTRA Pincode:____400018_________________________ 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 Deduction Maximum Limit Amount

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/ 60,000

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/ 100000

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*New 1,50,000/-

2

Proof Required: Xerox copy of passbook/challan copy with seal on it.

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/-

4Medical 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 AMOUNT1 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