File Content -
PLEASE NOTE:» PAN & Address are mandatory. Please do not fail to furnish the same.» Please indicate details of your investments in appropriate columns only.
(1) Full Name:Mr. /Mrs./Ms. ______________________________________________
Department __________________Designation ___________________
Contact No. __________________ Male / Female ________________
Email Id __ ________________________________________________
Date of Birth __________________Date of Joining _________________
(2) Income Tax Permanent A/c. (PAN) No. : _________________(MANDATORY) Please provide Xerox of PAN Card.
Deduction available from salary income under chapter VI A:Sr. No.Description of InvestmentDocuments RequiredMaximum Limit (Rs.)Amount in Rs.1House Rent paid to the LandlordOriginal Rent Receipts every month (with Revenue Stamp above Rs. 4999/-) or Rent Agreement. Receipt should contain PAN of Landlord if Rent for the year exceeds one Lakh.Nil
2New Pension Plan-80CCD(1)Copy of Payment Receipt / Passbook150,000/- or 10% of Basic Pay + D.A3New Pension Plan-80CCD(1B)Copy of Payment Receipt / Passbook50,000/-4Mediclaim – 80D (Self, Family & Parents)Mediclaim Policy Copy or Premium Certificate25,000/-5Mediclaim – 80D (Self, Family & Parents Sen. Citizen)Mediclaim Policy Copy or Premium Certificate30,000/-6Preventive Health Check-up for Himsefl & Family & parents (Senior Citizen or Not)-80DOriginal Medical Bills5,000/-
7Medical Expenditure for Himself, Family, Parents (Sen. Citizen or not) (not having Mediclaim Policy) -80DOriginal Medical Bills30,000/-
6Interest on Housing Loan (Loan taken prior to 01/04/99)Certificate from Bank / Financial Institution30,000/-7Interest on Housing Loan (Loan taken after 01/04/99)Certificate from Bank / Financial Institution2,00,000/-8Expenditure on Maintainence or Medical treatment being Dependant with – Disability Rs. 75,000 – Several Disability Rs. 1,25,000-80DD
Certificate from Prescribed Authority in Rule 11A Form No. 10-IA Sec. 80 DD75,000/- or 1,25,000/-
9Expense on Dependent for Specified Disease [Very Sen. Citizen ie., (80 years) Rs 80,000 for others Rs 40,000]-80DDBPrescription from Prescribed Authority in Rule 11DD Sec. 80 DDB40,000 or 80,000/-
10Himself with – Disability Rs. 75,000 – Several Disability Rs. 1,25,000-80UCertificate from Prescribed Authority as per Rule 11A Form No. 10-IA75,000/- or 1,25,000/-
11Medical Bill ReimbursementOriginal Medical Bills (including Parents, Wife/Husband, Children)1250/- every month12Donations -Section 80 GPrime Minister Relief Fund Receipt ( Employer can Consider only this donation for tax computation purpose of Employee)Donation Amount
Sr. No.Description of InvestmentDocuments RequiredMaximum Limit (Rs.)Amount in Rs.1Public Provident FundCopy of Payment Receipt / Passbook2Life Insurance Premium:- Pension Plan & ULIPCopy of Premium Payment Receipt3Repayment of Housing Loan PrincipalCertificate from Bank / Financial Institution4Mutual Fund (Equity) (Sec. 10(23D))Statement of Holding5NSC Purchased during the yearCopy of NSC Certificate/s6Interest on NSC PurchasedStatement regarding date of purchase & amount7Tuition Fees (Up to Two Children)Copy of Payment Receipt from School8National Saving SchemeCopy of NSS Certificate/s9Bank Fixed Deposit (More than 5 Years)Copy of FD Receipt10Sukanya Samriddhi AccountCopy of Deposit Receipt
Please Note:-1.Deduction under section 80C+80CCC+80CCD(1) can’t excedds Rs 150,000/- ( Section 80CCE)2. Deduction of Rs. 50,000/- under section 80CCD(1B) is over & above deductuon under section 80CCD(1). Thus Section 80CCE in point 1. above will not applicable to this deduction. 3. Provided No Deduction under section 80CCD(1B) shall be allowed in respect of the amount on which a deduction has been claimed and allowed u/s 80CCD(1)4. Deduction u/s 80D shall be allowed only if the payment is made by any mode other than cash. Exception is only for amount paid for Preventive health check up.5. Maximum Deduction u/s 80D shall be allowed only upto RS 30,000/- in case point 5 & 7 AND RS 25,000/- in any other case.6. For Inerest on housing loan:- provided such acquisition or construction is completed within [three] years from the end of the financial year in which capital was borrowed.
I further undertake to provide all documentary proofs of payment made by me before 15th Febuary 2017 and if I fail to do so, the company can make fulldeduction of income tax dues from Febuary 2017 & March 2017 salary.
Date : ___________________________ ______________________________Sign. of the Employee
Deduction u/s 80C
I, declare that the above statement is true to the best of my knowledge and belief. In the event of any change that may occur during the year pertaining to the informationgiven in the form, I undertake to inform the same to the company. Income Tax liability arising due to failure, if any, for not making / not intimating payment / investmentmade or proposed to be made by me and / or any wrong declaration would be my responsibility.
Declaration Format for Claiming Deduction from Salary for F.Y. 2016-17 (A.Y 2017-18)
For Any Queries Suggestions Please Conatct:-Sahil Sachdeva(Management Accountant)(+91) 7876073737