INVESTMENT DECLARATION FORM FOR 2014-2015 (REVISED) Exemption and Deduction u/s 10, 24 & 80 ‘Of Income Tax Act, 1961 be received before 31-Mar-2015 (TA COFFEE LTD Employee ID e Employes | MBALAGANESH Woof Schoo! | No of Hostel Name going | staying children 09, | 18.022008 : children PAN Number | AUZPB4GOSN ‘EPAN snot stated the employee may beable fora pavalty us 139A fr R.A, 000/- ‘sper See 206AA, i PANis not avaiable Tax willbe deducted @ 20% ar actual tax rate whichever is higher, (We..01/04/2010) ‘lave you availed Car / Two Whealer under Company's Vehicle Scherne tres, please mention the cubic cpactyof the engine (Cr otach abstract of RC book) a Particulars 1 | Max Limits - Deduction Under Section 10 Ht Monthly Rent Paid Monthly rent paid/payable for the period 22000 House Ront | From_APR-2014_to_July2014_ s,_5500_pm From__Aug-2014__to__Mar-2015__ Rs__5500__p.m. 44000 {Please specify the months for which the rent is paid/payable during the Financial Year 2014-2015) Zee : a : : el ered Parteulars ‘Max Limits | Deduction | 518 | Interest on Housing Loan (Self occ 2,00,,000 ‘under | 518 | Interest ithe loans taken before 01/04/99 30,000 Section 24 Whether posession of it rocevedoris expected ®® | vac ziyg above. ote : Form 12 C along with the calculation of loss on house property needs to be attached for considering the . Particulars : ~ Max Limits ce __lnvestin “See 800 - Medical insurance Premium (Additional Benefit of, 's, 15000.00 for parents and addtional Rs. 5000.00 in cose parents are Sr. Ckizen) This includes the expense of Preventive Health Check-up ofthe Assessee or his forty ‘and Parent or Parents of the Assessee. 15,000.00, ‘See B0DD - Medical reatment/insurance af handicapped dependant {Certificate under Form 10 from competent prescribed ‘outhority Where such dependent i a person with severe sobilty having ary disabilty over 80 per cent, then the deduction s Rs 100060.00) Deduction under Chapter 50,000.00 ae ‘Sec €0DDB- Medial treatment (specified diseases only) {Certificate under Form 10 {from competent preseribed authority Medical bils, Where the amount spent for a senior citizen obove 65 years of age then the deduction i As {60000.00 ar actual expenditure whichever lower) 40,000.00, NOUMIT “SEC BOE - Deduction in Respect OF Repayment Interest OFB] Education Loan Taken For Higher Education (Full Time Studies For Any Graduate Or Post Graduate Course In Engineering, Medicine, Management Or For Post Graduate Course in Applied Sciences Or Pure Sciences Including [Mathematics And Statistics, adlonal fields of studies (including vocational studes) pursued after passing the ‘Senior Secondary Examination or is equivalent from any ‘school, Board or University recognized bythe Central or ‘State Government will also be covered NOTE: Available for 3 maximum of 7 As. after initial assessment year in which the loan Is taken or interest is paid in full, whichever I eather “See 80U ~ DEDUCTION IN CASE OF PERSON WITH DISABILITY (Oisobty over 80 per cen, then the deduction 50,000.00, Rs 100000.00), ‘See SOCCC- Contribution to Pension Fund See 80. «life msurance Premium “= Public Provident Fund = Deposit in Post Office Savings Scheme (With 5 year lack In peviody/bost Office CTD ‘ULP of uTi/insurance Companies Principal Loan (Mousing Loan) Repayment ‘Children-Tulton Fee - Restricted to a maxof 2 children FIXED Depositin Scheduled Bank 5 yr lock period) 1,50,000.00 Purchase of NSC NSC interest ‘Subscription To Specified Deposit Scheme Or As A CContebutlon To Any Such Pension Fund Set Up By National Housing Bank/UTi{Lock in Period 3 Years) “= Stamp-Duty, Registration Fee And Other Expenses Incurred For Transfer OF Property "> Contribution To Notified Pension Fund Set Up By ‘Approved Mutual Fund. Subscription To Notified Equity Linked Savings Schemes (S5\Lock In Period 3 yrs) Dedaratin: “Fhe teow particulars of vestments and deductions made by me during Fnaclal Year 201415 ae true tothe best of my knowfedge and Toit ran ptvoanare thot the Company wil be consderingthe above deta in utmst good Feith based onthe deta provided by me and {that am personaly fable for any consequences arising out of eror, any, in the above information, | am azo aware that any person make o alse statment / declaration in th above form shal be Hisle to be ined and proseition under section 277 of thencoma Tae Act NAME:M.BALAGANESH DATE:20.08.2014Annexure - 1 Form for sending particulars of ineome u/s 192(28) for the year ending 31" March 2018. 1, Name & Address of the employee 2. PAN 3. Residential status 4, Particulars of income under any head of income other than “salaries “(not being a loss under any such head other than the loss under the head “Income from House Property”) received in the financial year. i) Income from House property : (Complete the computation as per the enclosed format} ii] Income from other sources bj} Interest (interest income from Savings Bank Account Including Co-op banks, post office, is exempt Upto Rs.10,000 pa} ¢) Other Income ( Specify) ‘Total : 5, Aggregate of sub-items (j) to (i) of item + 6, Tax deducted at source (enclose certificate) issued under section 203 Place : Then wae L Date :20.08.2014 Signature ofthe employee Verification 1, - , do hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the ~ day of ~ 2015, Place : Theni Date : 20.08.2014 Signature of the pmployee.Computation of Income from House Property 1) Address of the property: 3) Whether let out/self occupied during the fear 3) Annual Value without deducting taxes paid to the local authorities 4) Taxes paid to local authority 5) Annual Value [3-4] ‘6) 30% of Annual Value 77) Interest on capital borrowed Note: For Self Occupied Property (Interest on Housing Loan if loan taken before 01.04.99 - Max Limit - Rs:30000.00) (interest on Housing Loan if loan taken after 01.04.99 - Max Limit — Rs.2,00,000.00) '8) Income /(Loss} from House Property for Current_Pinancial year [5-6-7] instructions for filling up the above particulars: - y 2 3) 4 5) Furnish the address of the property income/loss from which is to be included in total income; In item 3, in case property is let out, furnish the details of annual rent which is reasonable expected or actual rent received or receivable during the year, whichever is higher; In item 3, furnish the details of tax actually paid during the year levied by the local authorities in respect of house property under question; In item 5, fill ‘NIL’ in case property is occupied by the owner or which cannot actually be occupied by the owner by reason of the fact that owing to employment at any other place, he has to reside at that other place in a building not belonging to him and property has not been let out during the whole or part of the financial year and no other benefit has been derived by the owner. In item 7, calculate the amount of interest as under: - {@) In case property is let out during the year, the actual amount of interest paid during the year; (b) In case property is not let out during the year and property was acquired or constructed with capital borrowed before 1* April 1999, the actual amount of interest not. \ing thirty thousanc () In case property is not let out during the year and property was acquired or constructed with capital borrowed on or after 1% April 1999, and such acquisition or construction was completed within three years from the end of the financial year in which capital was borrowed, the actual amount of interest not excceding one lakh fifty thousand rupees. {@] In addition to interest in (a), or (b} or (c) above, you are entitled to deduction to the extent of one-fifth of the interest paid during the period prior to the year in which property was acquired or constructed in five consecutive years starting from the year in which property was acquired or constructed. (res * Signature of the EmployeeDetails of National Savings Certificates Vil Issue purchased hefore April, 2013 [Date of Purchase. | Certificate Numbers ‘Amount (Rs) ‘Rateof interest ‘tnterest amount ‘Statement showing details of Interest Accrued on NSC~ Vill Issue Under section 80 C Under Code :- 527 OrApros= aiMeros | 11.17% ‘OF AprOB = SE-Mar-10 3 1033% ‘DicApri0 = 3-Marit a 955% ‘Ga-aprii - aiward2 3 283% ‘Oi Apr 12 - 8-Maris 2 ai6% OL Apri3 ~ 3P-Mar-t4 7 TOTAL Wwill be informed laterDetails of LIC premium paid/payable and Mutual Fund Investment in 2014-2015 of the person and Relation M.Balayanesh(Self) 743648821 1824 'M Balaganesh(Self) "787692264 21220