PROFORMA FOR DETERMINATION OF INCOME TAX DEDUCTION

FROM SALARY FOR THE YEAR 20 - 20 .

1. (i) Name :

(ii) PAN Number :

(iii) Designation & Section :

2. Basic Pay & Date of Increment : Rs. /-

3. Residential Address and :

period from which residing

4. House owned / rented :

DETAILS OF HOUSE PROPERTY

1. Location of the Property / Properties :

2. Date of acquisition / completion :

of Construction of the house

3. Sources of funds Own/HBA/Outside loan:

4. If finance is through outside loan

(a) Name of the Financial Institution :

(b) Amount of loan obtained : Rs.

(c) Date of borrowal of loan :

(d) Repayment of Principal

from 01.04.2007 to 31.03.2008 : Rs.

(e) Interest Paid (or) accrued towards

Loan from 1.4.2007 to 31.3.2008 : Rs.
(Enclose certificate
from the Institution) :

(P.T.O….2)
 -2-

5. Whether self occupied or let out / kept

vacant / Occupied by dependents :
(Incase of joint property, certificate from the
employer of the spouse must be produced.)

Deduction Under section 80 C

6. GPF subscription : Rs.

7. (i) CGEGIS : Rs.

(ii) Professional Tax : Rs.

8. Insurance company Policy No. Amount p.a. Total

LIC
LIC
LIC
LIC
LIC
LIC
SBI
LIC

10. Tuition fees paid (limited to 2 children) :

Enclose payment receipt). Only tuition fees paid
to any college, school or university is eligible.

11. House Building Advance (Principal)

(i) Recovery through office : -

(ii) Through financial institutions : -

(attach form 12C)

12. NSC purchased during the year : -

2007 – 2008 (Enclose Xerox copy of certificate)

13. Any other particulars :

Date : 24.09.2007

Signature of the Applicant