KRISHI RASAYAN EXPORTS PRIVATE LIMITED

DECLARATION FOR CLAIMING EXEMPTION/DEDUCTION/REBATE UNDER I.TAX ACT, FOR CALCULATION OF INCOME TAX TO BE DEDUCTED AT SOURCE FROM
SALARIES
DETAILS REQUIRED, WHOSE ANNUAL GROSS INCOME IS MORE THAN RS.2,50,000/- FOR FY 2014-15 (A/Y 2015-16).
NAME OF EMPLOYEE : Sanjay Kumar

DOB: 22-04-1966

DESIGNATION : Sale Supervisor

PAN : ALKPK1837G

FATHER'S NAME : Late Sh. Roshan Lal

RESIDENTIAL ADDRESS : c/o P.N. Bansal, H. No. 20235A, Guru Teg Bahadur Nagar, Bibi Wala Road, Bathinda
DETAILS OF RENT PAID : (RECEIPT TO BE ENCLOSED IF RENT IS MORE THAN Rs.3000/- PM). Also Copy of PAN no. of House Owner is
required
1 incase Rent paid more than Rs.100000/MONTHLY RENT PAID OF
Bahadur

:Rs. 3500.00

NAME & ADDRESS OF LAND LOARD : P.N. Bansal, H. No. 20235A, Guru Teg

ANNUAL RENT

:Rs. 42000.00

Nagar, Bibi Wala Road, Bathinda

2 PENSION FUND U/S 80 CCC :

NAME OF INSURED

AMOUNT

DATE

POLICY NO.

RELATIONSHIP

NAME OF ORGANISATION

3 DETAILS OF INVESTMENT TO BE CLAIMED AS REBATE U/S 80C (MAX. 150000/- for 80C, 80CCC & 80CCD) UNDER I.TAX ACT.:a) PPF DEPOSIT RECEIPT
A/C HOLDER'S NAME

AMOUNT

DATE

A/C NO.

RELATIONSHIP

AMOUNT

DATE

A/C NO.

RECEIPT NO.

A/C NO.

RECEIPT NO.

b) NSC PUCRHASES - RECEIPT

A/C HOLDER'S NAME

c) DETAILS OF ACCREUED INTEREST ON NSC/OTHER INCOME

A/C HOLDER'S NAME

AMOUNT

DATE

RECEIPT AMOUNT

d) TUTION FEES OF CHILDREN (Only tution fees up to 2 children and no other charges like development, etc. to be allowable)
NAME OF CHILD

AMOUNT

Abhi

28200.00

NO. OF RECT.

ORGANISATION

Gurukul Sen. Sec. School

Dharamshala (H.P.)

e) UNIT LINKED INVESTMENT PLAN (ULIP ) - RECEIPT

NAME OF INSURED

Nil

AMOUNT

DATE

AMOUNT

DATE

POLICY NO.

RELATIONSHIP

NAME OF ORGANISATION

Nil

f) LIFE INSURENACE PREMUIUM

NAME OF INSURED

Sanjay Kumar
Sanjay Kumar
Navneet
Suman Bala

11861.00
3362
6220
8040

POLICY NO.

131808513
131139778
131626519
5006489818

RELATIONSHIP

Self
Self
Son
Wife

NAME OF ORGANISATION

LIC
LIC
LIC
Axis Bharti

g) RECEPT OF INVESTMENT IN MUTUAL FUND (EXEMPTED U/S 80C) OR BONDS ETC.

TYPE OF FUND

AMOUNT

DATE

RECEIPT NO.

NAME OF ORGANISATION

h) HOME LOAN - BANK CERTIFICATE FOR FY 2014-15 ( Intt. on Home Loan up to Rs. 2.00 Lacs)
FINANCER'S NAME

LOAN AMOUNT

DATE

PRINCIPAL

INTEREST

CONSTRUCTION COST

i) FIXED DEPOSIT FOR MORE THAN 5 YRS. - RECEIPT

NAME OF
BANK

AMOUNT

DATE

RECEIPT NO.

PERIOD

RATE OF INT

MEDICLAIM U/S 80D:- Deduction up to Rs 5000 for Preventive health checkup of Self , Spouse , Dependent Children or Parents is
allowed in the
4 existing limit ( ie This is allowed within the limit of Rs 15000 ) For this supporting to be Collected form the Tax Payer
NAME OF INSURED

AMOUNT

DATE

POLICY NO.

RELATIONSHIP

NAME OF ORGANISATION

ANY OTHER INCOME OTHER THAN SALARY FROM KREPL FOR FY

2014-15
80TTA Interest on Deposit in Saving Bank Account with Bank , a Co-operative Bank or a Post office Deduction Allowed up to
Rs 10000 FOR FY 6 2014-15
NAME OF
BANK

AMOUNT

DATE

RECEIPT NO.

PERIOD

RATE OF INT

I DECLARE THAT I HAVE PLANNED MY INVESTMENT AS MENTIONED ABOVE FOR THE FY 2014-15. OUT OF ABOVE SOME INVESTMENT TO BE MADE IN
FUTURE DATE BUT
BEFORE THE END OF FINANCIAL YEAR 2014-15. RECEIPT OF ABOVE INVESTMENT IS ENCLOSED FOR YOUR INFORMATION AND RECORD. YOU MAY
DEDUCT THE TAX IN CASE ANY DEFAULT IS MADE IN SUBMITTING THE RECEIPT BEFORE 31-03-2015.
DATE :
NOTE : IF LIST IS LONG, YOU MAY ATTACH ANNEXURE OR USE BACKSIDE OF THIS FORM.
EMPLOYEE

SIGNATURE OF THE