8/7/2019 Tax Declaration Form for Tax Relief Form - Ye 31.03.2012

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TAX DECLARATION FORM FOR INCOME TAX RELIEF - Y.E. 31.03.2012

NAME OF COMPANY: LOCATION:

EMPLOYEE CODE NO. PAN:

(As appears on the Pay Slip)

NAME OF EMPLOYEE:

Rs. (No paise)

1

2

3

4

5 80E - EDUCATION LOAN INTEREST (Only Interest Component)

6

7

8

9 FIXED DEPOSIT WITH SCHEDULE BANK MORE THAN 5 YEARS.

10

11

12

13

14

15

16 (As perRules

17

18

I hereby declare that the information given above is correct and true in all respects and I request the company to allow me

the appropriate Income-tax exemption / relief.

I undertake to produce to the company, LATEST BY JANUARY 1, 2012, OR prior to leaving the company, appropriate

documentary evidence in respect of payments mentioned above. Failing this, I agree that the company wil be free to cancel

the exemption allowed and to recover from me the additional Income-tax arising there from.

Signature of Employee: Date:

NAME OF EMPLOYEE: (in block letters)

ACCRUED INTEREST ON NSC VIII

TUITION FEES PAID TO UNIVERSITY, COLLEGE, SCHOOL

80CCF - New Long Term Infrastructure Bonds (Rs.20,000 Max)

INFRASTRUCTURE BONDS (As per old Scheme)

SEC.80D - MEDICLAIM PREMIUM (Max. Rs.35,000)

LOSS UNDER THE HEAD "INCOME FROM HOUSE PROPERTY"

INTEREST PAID IN RESPECT OF SELF-OCCUPIED PROPERTYInterest on Loans taken after 01.04.1999 (Max. Rs.1,50,000)

Sec.80DD Handicapped or Sec.80U Disability

HOUSING LOAN REPAYMENT - PRINCIPAL AMOUNT

NATIONAL SAVINGS CERTIFICATE VIII SERIES - NSC VIII

SEC. 80CCC - JEEVAN SURAKSHA / OTHER PENSION SCHEMES

UNITS OF MUTUAL FUND [ Section 10(23D) ]

LIFE INSURANCE PREMIA (by LIC or any other Insurer) - LIP

ULIP / DHANRAKSHA

PUBLIC PROVIDENT FUND - PPF (Max. Rs.70,000)

RENT PAID BY EMPLOYEE ( FOR HRA COMPUTATION PURPOSE ) Foremployees who have joined during the year, the rent amount should only be from date of

joining the company till the year end. For Others it should be for the full year.