DECLARATION FORM FOR INVESTMENTS TO BE MADE BY AN EMPLOYEE IN TAX SAVING SCHEMES FOR THE FINANCIAL YEAR 2011-12
To:
I wish to declare that I shall invest the following amounts in tax saving schemes during the financial year 2011-12 in addition to the Provident Fund deduction being made by the company for the purpose of computation and deduction of tax at source from my salary.
(Amount in Rs.)
Whether you will be claiming Deduction for HRA YES
IF Yes Give the amount of Monthly Rent payable during various month
of the year.
U/S 80D ______
Premium to be paid for Medical Insurance
(Deduction allowed up to maximum of Rs. 15,000/-)
U/S 80DD ______
Expenditures incurred for permanent physical disability
(Deduction allowed up to maximum of Rs. 1,00,000/-)
U/S 80 E ______
Repayment of Education Loan
(Deduction allowed up to maximum of Rs. 40,000/-)
U/S 80G ______
Donations
U/S 80C
1. LIC Premium ______
2. Deposit in 10/15 yrs. P.O. Saving Bank (CTD) ______
3. Deposits in Public Provident Fund ______
4. Contribution to UTI in ULIP Scheme ______
5. Deposit in National Saving Schemes ______
6. Deposit in National Savings Certificate ______
7. Interest on National Saving Certificate ______
(Attach photocopy of NSC purchased)
8. Contribution to ULIP scheme of LIC ______
9. Contribution to ELSS Scheme of UTI ______
10. Payment made for construction/purchase of House/ ______
Repayment of housing loan
11. Others (Please Specify) ______
(Deduction allowed 80C and 80CCC up to maximum of Rs. 100,000/- incl. PF Ded.) ______
Name of the Employee
Signature ______
Date ______
PAN No. ______
(Please attach self attested photocopies of all the certificates)
DECLARATION FORM FOR RENT PAYMENT BY AN EMPLOYEE
FOR THE FINANCIAL YEAR – 2011-12
To:
This is to inform you that, I am paying a rent of Rs. ______per month from my salary.
My residential address is ______
______
______
You are requested to consider this rent payment when you calculate tax on my salary income.
I declare that I shall immediately inform the company about any change in my address or the amount of rent paid.
I further declare that, I shall submit the proof of payment of the rent at the end of every quarter.
I undertake that the above statement is correct and any Income tax liability arising due to my failure in submitting the rent receipts or due to any misdeclaration will be my responsibility and the company will be authorized to deduct tax on my income as if I am not paying any rent.
Name of the employee ______
Signature ______
Date ______
PAN ______
(Please attach self attested photocopies of Rent receipts)
DECLARATION IN FORM NO. 12 C (VOLUNTARY)
[See rule 26B]
Form for sending particulars of income under section 192(2B) for the year ending 31st March, 2012
1. Name and address of the employee ______
______
______
______
2. Permanent Account Number ______
3. Residential status ______
4. Particulars of income under any head of
income other than “salaries” (not being a
loss under any such head other than the
the loss under the head “ Income from
house property”) received in the F.Y
(i) Income from house property ______
(In case of loss, enclose computation thereof)
(ii) Profits and gain of business or profession ______
(iii) Capital gains ______
(iv) Income from other sources
(a) Dividends ______
(b) Interest ______
(c) Others (specify) ______
5. Aggregate of sub-items (i) to (iv) of item 4 ______
6. Tax deducted at source
[enclose certificate(s) issued under section 203]
Place ______
Date ______ Signature of the employee
Verification
I, ______do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the ______day of ______20___
Place ______
Date ______