Annexure 1

SELF-DECLARATION FOR EXISTING INVESTMENT & RENT PAYMENTS

Insurance Premium, Other Investments & Rent due after 1st January, 2016

To,
The Payroll Department
Accenture Services Pvt. Ltd.
Employee Name
Employee SAP ID
(8 Digit Numeric)

Employee PAN
(10 Character AlphaNumeric)

I hereby confirm that the followsdfing investment(s) / payment(s) are due after the cut- off dates laid out by you
for proof submission; therefore I request you to consider the same for the tax computation purpose for the
st
financial year 2015-2016. I undertake that I will be making the payment(s) by 31 March, 2016 and obtain the
receipts as per the due dates for such payments.

Particulars

Policy / Folio /
Account No.

Amount

Remarks

Life Insurance Premsdium:*

MF - ELSS (SIP)
80CCC (Pension plan)*
Tuition Fsdees
80 D (Medical Insurance)*
January16
Rent payable

Rs.

February16
Rs.

March16
Rs.

I hereby declare that the above mentioned information is true. I will be solely and wholly responsible to handle any queries
from any competent official asdsdnd / or to submit all relevant documents to Income Tax / Competent Authorities as and
st
when I am asked for the same. Moreover, I am fully aware that if the above investments / payments are made after 31
March, 2016, the same will be disqualified for tax benefit; this means I have paid short taxes to the Government which may
lead to query from Income Tax Authorities and I will be responsible to handle such queries.

Signature of the employee

Place:
Date:

*Encl: For all investments, please attach the relevant receipt of previous (14-15) financial year / premium notice to
prove that the policy is in force. Exemption will be provided only in case of the premium receipt provided for the
previous year and not otherwise.