COSMIC STRUCTURES LTD.

"TAX DECLARATION FORM"

F.Y.2013-14 (April 2013 to March 2014)
NAME & FATHERS NAME:
EMPLOYEE ID :
DATE OF BIRTH:
DATE OF JOINING :
DESIGNATION :
LOCATION :
DEPTT. :
EXTN. NO. :
PAN No. :
E-MAIL ADDRESS :(OFFICIAL)
RESIDENTIAL ADDRESS :

All above details are mandatory

PART A: - TO BE FILLED BY EMPLOYEES WHO HAVE JOINED AFTER 1ST APRIL 2013
INCOME EARNED FROM PREVIOUS EMPLOYER. Taxable salary income from 01.04.2013 to the date of
joining Cosmic): attach Form 12B / Form 16 issued by previous organization.
Previous Employers Name & Address :
Income after section 10
Professional tax deducted
PF deducted
Tax deducted
INVESTMENT PLAN FOR THE YEAR
I here by declare that my Investment plan for the current financial year is as follows:
Investments proposal under Section 80 C:
S.NO.

TYPE OF INVESTMENTS
Life Insurance Premium Paid for
self/spouse/children
Public Provident Fund subscriptions
for self/spouse/children
NSC (Only in name of self)
NSC Accrued Interest Please mention
the NSC purchased date and the
amount by a separate note.
ULIP

Principal repayment on Housing Loan

1
2
3
4

7
8
9

Equity Linked Saving Scheme (ELSS) /

Mutual Funds
Education Expense (Please mention
number of children going to
school/college)
Any other (under sec 80C)
TOTAL

AMOUNT

PROOF REQUIRED LATER

Copy of Premium Receipt
Deposit Receipt for PPF Account
Copy of NSC certificate
Copy of NSC certificate
Copy of Premium Receipt
Certificate of Principal repayment from the
Financial Institution
Proof of investment made
Proof of expenses incurred (only the school
fees, excluding donations/building fund)
Acknowledgement copy of payment

COSMIC STRUCTURES LTD.

Section

PARTICULARS

REMARKS

AMOUNT

Section
80CCC

Pension Plan (Section

80 CCC)

Investments made in
pension plan.

PROOF
Copy of premium
paid receipt

Mediclaim Insurance
Premium

Copy of premium
paid receipt

Section 80D

Any others

S.NO

PARTICULARS

REMARKS

HRA Rebate u/s 10 (13A)

Rent paid per month

Rent receipts for each

month/quarter.Duly
stamped

Mention whether the

property is (self occupied /
let out)

Certificate from
Lender

AMOUNT

PROOF REQUIRED

Name & Address of the

rented house
Name of the owner
To rent paid

Interest on Housing Loan

(Section 24)

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 _______________________________.

Place:
Date:

Signature of the Employee