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Income Tax Declaration form F.Y.

2016-17

Name :Pushkar Jethwa


Employee ID : 1284
PAN : AQXPJ6973C
Designation : Corporate Trainer
Contact No : 9926113292
Residential Address : B517, New Ashok Nagar, New Delhi, 110059

House Rent Allowance (HRA)


Land Lord Name :
Land Lord PAN No :
Rental Address :
Rent Per month : Rs. 8000.00
Interest on Housing Loan [u/s 24(b)] :

Deductions u/s 80
Investments & Savings u/s 80C (Restricted to Maximum Rs.1,50,000/-)
Life Insurance premium :

PPF :

ULIP Plan/ Mutual Fund :

Payment of Tuition fees for two children :

Repayment of Housing Loan


(Only Principal Amount) :

Fixed Deposit of 5 Years or


More with a Scheduled Bank :

Any other Investment under Section 80C :

Mediclaim Policy Premium [u/s 80D] :

Medical treatment of handicapped dependent


[U/s 80DD] :

Medical treatment of dependent [u/s 80DDB] :

Repayment of interest on loan taken


For higher education [U/s 80E] :

Donation Paid [U/s 80 G] :

Date: 24/02/17 Signature

Pushkar Jethwa
Location: Delhi Employee Name

PS:- Land Lord PAN and Address details to be provided only if you are paying Rent for more than One Lac
in a year.

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