PCI LTD 11/5B, PUSA ROAD, New Delhi 110 005 Income Tax declaration for the Financial

Year April2011 to March 2012 mplo!ee Detail" Laxman Ya"h%ant &te'ar -#".and" /Father" Ya"h%ant
F#ll $ame $ame 2e"idential Addre""

A.

De"i(nation
Date of

)r. *ffice exec#ti+e, M,1

0oini n(

1 1

, 0 1

, 200 0

3himna(r4 3/-. )ar+oda!a -o"pital4 Adhar"h Colan!4 5iran )e+a mandal4 6hat'opar 789M#m.ai,:00;< AA&P&=0;<> Total Income for,,,,,,,,,,,,,,?

Permanent Acco#nt $#m.er

In the case of an Emplo ee !oinin" the compan #$%in" the %ele&ant 'inancial (ea%, cop of )e%tificate of sala% %ecei&e# an# income ta* #e#$cte# at so$%ce + the p%e&io$s Emplo e% sho$l# +e f$%nishe#, Policy N u m be r Policy Number Policy Number Policy Number Policy Number &LIP nil C#m#lati+e Time Depo"it -Details. NS) / Deposits 0a#e/to +e ma#e nil nil nil nil 2".1000 x 12B<04000/, ;@1A<A;1= ;;A@A@=00 Premium Amount Premium Amount Premium Amount Premium Amount 1A1</, -YL 1021/, Monthl! ;@2@002;< Premium Amount 121@/, -YL

3. LIC

P#.lic Pro+ident F#nd , Deposits 0a#e/to +e ma#e $ational )a+in( )cheme , Deposits 0a#e/to +e ma#e Act$al /Estimate# -o#"e 2ent Pai#/to +e pai# f%om

Ap%il12011 to 0a%ch12012 -Attach Photocop of Rent Receipt. An othe% #eposits/In&estment eli"i+le fo% #e#$ction $n#e% )hapte% 3I A of income 4a* act11561 -0e#iclaim etc, . C. An Othe% %ele&ant info%mation (o$ wo$l# li7e to +e inco%po%ate# nil

I, he%e+ #ecla%e that the a+o&e info%mation is t%$e to the +est of m 7nowle#"e an# +elief an# I shall +e lia+le to in#emnif P)I 8imite# fo% the loss, if an , s$staine# + the compan if #ecla%ation "i&en he%ein a+o&e p%o&es to +e #efecti&e, DatedC )i(nat#re of mplo!ee

$oteC 1. )ompan will not +e lia+le fo% hi"he% #e#$ction of Income 4a* at so$%ce in case #ecla%ation fo%m is not s$+mitte# in time 2, In case an chan"e is #esi%e# %e"a%#in" info%mation f$%nishe#, please info%m the Acco$nts Depa%tment imme#iatel ,