CHECKLIST FOR THE FY 2016-17

Check List for IT Proof About the Exemption Documentation Required

1 House Rent Allowance Least of the following;
(a) 40% of Basic Salary (non-Metro) (or)
50% of Basic Salary(Metro)
(b) House Rent allowance (HRA
received)
(c) Rent paid minus 10% Basic Salary
1) Original Rent receipts (monthly or consolidated) to be submitted
2) As per the Income Tax department circular, employees paying
rentals in excess of INR 8,333/- per month are mandatorily
required to furnish the PAN # of the landlord in the rental receipt
submitted by them.

2 Self Occupied -House (a) You can claim deduction of 1) Original or scanned copy of the Bank Provisional certificate
Property (Interest) Rs.200,000/- on home loan interest if 2) House Property Declaration
the owner or his family reside in the 3) Possession/Occupancy certificate if the property has been
house property occupied during the current financial year.
(b) Housing Loan taken 4) Bank Certificate for Pre- EMI period for previous year/s if any.
for renovation/repairs, interest
restricted to Rs.30000/-
(c) Pre-EMI interest (EMI paid before
occupation of the house) is deductible
in 5 equal instalments starting from the
year when the construction is
completed and property is occupied.

3 Income / Loss from Let (a) No cap on maximum amount.
out House Property (b) Loan taken before 01/04/1999,
(Housing loan interest) interest restricted to Rs.30000/-
1) Original or scanned copy of the Bank Provisional certificate
2) House Property Declaration.
3) Possession/Occupancy certificate if the property has been
occupied during the current financial year.
4) Bank Certificate for Pre- EMI period for previous year/s if any
5) Rental Agreement executed with tenant to be produced.
 Income / Loss from Let (a) No cap on maximum amount.
out House Property (b) Loan taken before 01/04/1999,
(Housing loan interest) interest restricted to Rs.30000/-
1) Original or scanned copy of the Bank Provisional certificate
2) House Property Declaration.
3) Possession/Occupancy certificate if the property has been
occupied during the current financial year.
4) Bank Certificate for Pre- EMI period for previous year/s if any
5) Rental Agreement executed with tenant to be produced.

Deduction Under Chapter VI A

1 80C - 5 Years of Fixed Max of Rs.150000/- Photo copy of the deposit (bond) certificate/s
Deposit in Schedule
Bank / Post Office

2 80C - Children Max of Rs.150000/- Original fees paid receipt

Education
3 80C - Deposit in NSC Max of Rs.150000/- Photo copy of the deposit (bond) certificate/s

4 80C - Deposit in NSS Max of Rs.150000/- Photo copy of the deposit (bond) certificate/s

5 80C - Deposit in Post Max of Rs.150000/- Photo copy of the Post Office Savings Account
Office Savings Scheme

6 80C - Stamp Duty Max of Rs.150000/- Photo copy of the Stamp Duty Charges
Charges

7 80C - Registration Max of Rs.150000/- Photo copy of the Registration Charges

Charges

8 80C - Sukanya Max of Rs.150000/- Photo copy of the deposit (bond) certificate/s
Samriddhi Scheme
9 80CCD1(B) - Max of Rs.50000/- Photo copy of the NPS Account, PRAN Number & certificate/s
Contribution to NPS

10 80C - Life Insurance Max of Rs.150000/- Photo copy of the premium paid receipt / statement.
Premium

11 80C- Unit Linked Max of Rs.150000/- Photo copy of subscription paid to the fund
Insurance Plan (ULIP)

12 80C - Mutual Funds Max of Rs.150000/- Photo copy of subscription paid to the fund
(ELSS Scheme)

13 80C - Principal Loan Max of Rs.150000/- a) Original or scanned copy of the Bank Provisional certificate
Repayment (Housing b) Duly filled 'House property decl & Other Inc'
Loan)

14 80C - Public Provident Max of Rs.150000/- a) Photo copy of pass book Including cover page and highlighting
Fund the transaction for the year
15 80CCC - Contribution Max of Rs.150000/- Photo copy of the premium paid receipt / statement
to Pension Fund

16 80CCG - Rajiv Gandhi Max of Rs.25000/- Photo copy of the deposit (bond) certificate/s
Equity Savings Scheme
(RGESS)

17 80D - Medical a) Photo copy of Premium Paid receipt for current year
Insurance Premium b) Photo copy of Policy document
18 80DD - Medical a) Severe Disability Benefit is Rs.125000 a) 10 IA Form to be submitted with doctors attestation and
Treatment / Insurance b) Not Severe Disability Benefit is Certificate date should be between Apr to Mar
of handicapped Rs.75000 b) Proof for Insurance and medical expenditure incurred on
Dependencies handicapped dependents

19 80DDB - Medical a) below 60 years Rs.40000 a) Certificate should be between Apr to Mar.
Treatment b) Above 60 Years Rs.60000 b) Proof for Insurance and medical expenditure incurred on
c) Above 80 Years Rs.80000 Specific Disease.
20 80E - Repayment of Full amount of interest paid for the year a) Copy of Bank Certificate
Interest on Loan taken b) Bank certificate should contain purpose, amt, duration, loan
for higher education account number, etc.,

21 80EE - Deduction in Max Rs.50,000 1) Original or scanned copy of the Bank Provisional certificate with
Respect of Interest on Property value and loan value.
Loan taken for 2) Duly filled "House property decl & Other Inc" (mandatory)
Residential House 3) Possession/Occupancy certificate if the property has been
Property occupied during the current financial year.

22 80U- Person with a) Severe Disability Benefit is Rs.125000 a) 10 IA Form to be submitted with doctors attestation and
disability (Handicap) b) Not Severe Disability Benefit is Certificate date should be between Apr to Mar
Rs.75000

23 80TTA - Interest on Max Rs.10,000 Photo copies of the passbook evidencing the credit/receipt of
Deposits in Savings interest on deposits in Savings bank account
Account

Previous Employment Salary

1 Form 16 or Provisional This is not an exemption. Your tax will a) Photo copy of the Form 16 OR Income tax computation
Income Tax Calculation be re calculated on consolidated income statement for the current financial year
(form 12B)

Exemptions under Flexi Benefit Plan

1 Medical Exemption a) Max of Rs.15000/-
b) Expenses incurred on medical
treatment or drugs prescribed by any Click here to fill the Medical Bill details.
physician are covered. Expenditure up
to INR 15,000 per annum subject to
production of bills as proof of
expenditure.

2 Leave Travel Allowance

2 Leave Travel Allowance
a) The bills should pertain to current financial year (April to
March).
b) Employee shall avail leave and the proof of leave taken to be
submitted.
c) Original Bills and boarding pass to and fro need to be submitted.

Click here to fill the LTA details.

3 Vehicle Running and In case of 4 Wheeler:
Maintenance 1)1600 cc below then 1,800 per month
is exempted.
2)1600 cc above then 2,400 per month
is exempted.
1) Original bills pertains to current financial year to be produced.
2) Fuel expenses should be incurred within the city of
employment.
3) RC Copy of vehicle.
4) Petrol Bills (original bills), Service bills (original bills), Insurance
(photo copy).

Click here to fill the Vehicle Bill

details.

4 Professional Pursuits Maximum of Rs. 50000 per annum can 1) The bills should pertain to current financial year (April to
Exemption claimed. March).
2) Original bills to be submitted.

Click here to fill the Prof

Pursuit Bill details.
 5 Communication Maximum of Rs. 30000 per annum can 1) The bills should pertain to current financial year (April to
expenses (Telephone, claimed. March).
Internet and 2) Original bills to be submitted.
Broadband)
Click here to fill the
Communication Bill details.

GENERAL INSTRUCTIONS
1 All photo copies of the documents mentioned above to be attested by the employees with date and employee ID.
2 Please ensure the documents that you are submitting are legible and complete in all respect as requested in the checklist. Incomplete & non legible documents m
THE FY 2016-17
Formats Attached/Important Points
a) Click here for Rent Receipt Format
In case of joint rent agreement monthly rent paid by the
employee shall be taken on a proportionate basis
a) Click here for House Property Declaration
b) Click here for Joint owner declaration
c) Employee cannot claim both Interest on Housing loan (Self
occupied property) and House Rent Allowance Exemption, if
both the properties are located in the same city.
a) Click here for Let Out Property Computation Form2`
b) Click here for Joint owner declaration
Points to note for Non-Exemption
If the Self-occupied property and Rented
property are in the same city then either one of
them will be considered for tax exemption.
Maintenance and electricity charges are not
considered as part of monthly rent.
If benefit is claimed for interest on housing loan
on Self-occupied property and HRA for the
same period, in the same city, then HRA benefit
is disallowed for the overlapping period
Interest benefit cannot be claimed, unless the
employee has taken possession of the property
on or before 31st Mar and employee furnishes
a copy of the possession/Occupancy certificate
to the employer
Interest benefit cannot be claimed, unless the
employee has taken possession of the property
on or before 31st Mar and employee furnishes
a copy of the possession/Occupancy certificate
to the employer.

c) If you have any loss under the head ‘House Property
Income’ please update the sheet ‘House property decl &
Other Inc'.
Interest benefit cannot be claimed, unless the
employee has taken possession of the property
on or before 31st Mar and employee furnishes
a copy of the possession/Occupancy certificate
to the employer.

d) If the premises is left vacant / occupied by family, as per

Section23 (1) (c), Notional Rental Income has to be arrived
and then, the net loss has to be arrived.
Notional rent to be taken as municipal valuation or the rent
which similar property in the same locality would fetch,
whichever is higher. However, if standard rent is fixed for the
property, then notional rent cannot exceed the standard rent.
e) If you have any other income that you would like to report
for taxation, please update the details in tab ‘House property
decl & Other Inc' and provide relevant supporting's.

er Chapter VI A
a) The investment shall be made during the period Apr to Mar
b) Investment should be in the name of employee
c) Certificate Should
contains seal - Exempted under Sec 80C of Income Tax or
Letter from bank specifying the eligibility u/s 80C
1) Certificates in the name of spouse, children
and parents are disallowed.
2) The certificate should specify about the
eligibility for Tax benefit U/s 80C, otherwise the
same will be disallowed.

a) Tuition fees and regular fees paid will be considered. Donations, Development fees, Capitation fees,
b Maximum of TWO children. Computer fees, Transport fees, Hostel fees,
c) Covers Play school activities, pre-nursery, and Nursery also. food fees, Uniform fees, Sports fees etc., are
d) University, college fees are considered. disallowed.
a) The investment shall be made during the period Apr to Mar Certificates in the name of spouse, children and
b) Investment should be in the name of employee parents are disallowed
c) Investments in NSC VIII Series/ Issue

a) The investment shall be made during the period Apr to Mar Certificates in the name of spouse, children and
b) Investment should be in the name of employee parents are disallowed

a) The investment shall be made during the period Apr to Mar Certificates in the name of spouse, children and
b) Investment should be in the name of employee parents are disallowed

a)The house property should be registered in the name of the

employee and co-owners if any.
b)Payment for commercial property is also not eligible for
deduction under this section
c) Stamp duty have to be remitted during current financial
year only

a)The house property should be registered in the name of the

employee and co-owners if any.
b)Payment for commercial property is also not eligible for
deduction under this section
c) Stamp duty have to be remitted during current financial
year only

a) Deposit in the name of girl child and one account per girl
child is allowed.
b)Parents can open this account for maximum two girl
children.
c)In case of twins this facility will be extended to third child.
Minimum deposit amount for this account is Rs. 1000/- and
maximum is Rs. 150000/-
a) The investment shall be made during the period Apr to Mar Certificates in the name of spouse, children and
b) Investment should be in the name of employee parents are disallowed

a) Premium paid for self and dependents (Spouse/Children) a) Late payment fees will not be considered.
can only be considered for tax benefit. b) Policy for parents and In-Laws are
b) Premium to be paid for Life insurance only disallowed.

a) Premium paid for self and dependents (Spouse/Children) a) Late payment fees will not be considered.
can only be considered for tax benefit. b) Policy for parents and In-Laws are
b) Premium to be paid for ULIP only disallowed.
c)
Payment/Investment receipt should indicate the tax
exemption/benefit status

a) Only tax saving mutual funds are considered for the benefit Certificates in the name of spouse, children and
b) Following information shall be easily ascertainable in the parents are disallowed
document. I.e.., Mutual fund account number, amount paid,
paid for the year, paid by, tax saving/taxable, etc.
c) Payment/Investment receipt should indicate the tax
exemption/benefit status
d) Investment shall be in the name of employee only

a) Fill up 'House property decl & Other Inc' with the details

a) Photo copy of front page where the employee name and Counterfoil alone does not constitute as proof.
PPF account numbers are mentioned Passbook is mandatory
b) Current investment transactions are to be highlighted in the
document
c) The account should be in the name of Employee, Spouse,
Children only
d) This is not related to the PF contribution deducted from
your salary
a) Premium to be paid for Pension fund only Late payment fees will not be considered.
Policy for dependents are disallowed

a)The gross total income of the investor for the relevant Certificates in the name of spouse, children and
assessment year does not exceed Rs. 12 lacs parents are disallowed
b)The investment is made in such listed equity shares or listed
units of equity oriented mutual fund as specified in RGESS;
c)The investment is locked-in for a 3 year period from the date
of acquisition in accordance with RGESS
d)50% of the contribution will be considered for Tax
Exemption to the maximum limit of 25,000/-

a) Insurance taken on self, spouse, parents & children(Max Late payment charges and service tax will not
two) qualify for the benefit.
a) Dependents- Spouse, children, parents, brothers & sisters
b) Person is wholly or mainly dependent upon employee
c) If Disability less than 40% than NO Benefit
d) Form 10- 1A to be submitted to claim exemption

a) For the purpose of this section in the case of an employee

“dependent” means individual, the spouse, children, parents,
brothers and sisters of the employee or any of them,
dependent wholly or mainly on the employee for his support
and maintenance.
B) Specified diseases and ailments for the purpose of
deduction under section 80DDB- For the purposes of section
80DDB, the following shall be the eligible diseases or
ailments :
(I) Neurological Diseases where the disability level has been
certified to be of 40% and above,—
(a) Dementia; (b) Dystonia Musculorum Deformans; (c)
Motor Neuron Disease; (d) Ataxia; (e) Chorea; (f)
Hemiballismus; (g) Aphasia; (h) Parkinsons Disease;
(ii) Malignant Cancers;
(iii) Full Blown Acquired Immuno-Deficiency Syndrome (AIDS);
(iv) Chronic Renal failure;
(v) Hematological disorders :
(I) Hemophilia; (ii) Thalassaemia.
 a) Any kind of courses / education higher than Senior
Secondary Examination are allowed
b) Only full time courses are allowed for deduction
c) Only interest paid for the loan is allowed for deduction
d) Loan availed for higher education for Spouse/Children can
be taken considered for tax benefit
e) If
education loan taken on or before 31-Mar-2009 then benefit
will not be eligible

a) Loan amount should not exceed Rs.35lakhs. The deduction U/S 80EE shall not exceed Rs.
B) Property value should 50,000 lakh and the same will be allowed for
not exceed Rs.50lakhs. the current financial year.
c) However the deduction is available if the assesse
does not own any residential house property on the date of
sanction of the loan.
d) Loan has been sanctioned by the financial institution
during the current financial year (1st April to 31st March).
e) The home buyer should not have any other existing
residential house in his name.

a) Applicable to employee only.

b) If Disability less than 40% than NO Benefit
c) Form 10- 1A to be submitted to claim exemption

Saving accounts with any of following entities will qualify

a) Bank or banking company b)Co-
operative society engaged in carrying on the banking business
c)Post office
savings account

oyment Salary
 a) Upon completion of your settlement at previous employment you need to collect the provisional form16 or IT computation sheet b) Click here for form 12BA format

Flexi Benefit Plan

a) The bills should pertain to current financial year only (i.e. a) Medical expenses which are claimed under
April to March) any insurance scheme cannot be claimed.
b) Employees who have joined during the year can submit bills b) Toiletries, food preparations, cosmetic
beginning from their employment commencement date with medicine/treatment and cosmetic dental
the Company treatment are all not eligible items of
c) Expenditure incurred on family can be claimed. Family expenditure under this head.
includes spouse, children and dependent parents. c) Bills should not be altered and tampered in
d) Original bills should be submitted. The bills should contain any way.
the date, details of medicine and the patient’s name. d) Photo copy will not be accepted for
e) Dental expenditures / treatment are allowed only with exemption.
doctor’s prescription.
f) Skin and Hair treatment will be allowed only for diseases
treatment with doctor’s prescription.
g) In case of optical treatment, only cost of lens will be
allowed with doctor’s prescription. Cost of frames will not be
allowed.

a) Travel fare can be claimed only for employee, spouse,
children and dependent parents.
b) Travel can be performed only twice in a block of 4 years
(2014-2017).
c) Available only towards travel fare and does not include any
other expenses like boarding/lodging etc.
d) The travel should be made from the city of employment
and the employee shall accompany their family during the
travel.
e) Bus fare is allowed only where rail & air service is not
available.
a) Round trip will be disallowed.
b) Shortest route will be treated for exemption.
c) Without leave application LTA claim will be
disallowed.
d) There is no tax exemption with respect to
stay expenses incurred while on travel.
e) Photo copy will not be accepted for
exemption.
a) Travel fare can be claimed only for employee, spouse,
children and dependent parents.
b) Travel can be performed only twice in a block of 4 years
(2014-2017).
c) Available only towards travel fare and does not include any
other expenses like boarding/lodging etc.
d) The travel should be made from the city of employment
and the employee shall accompany their family during the
travel.
e) Bus fare is allowed only where rail & air service is not
available.
a) Round trip will be disallowed.
b) Shortest route will be treated for exemption.
c) Without leave application LTA claim will be
disallowed.
d) There is no tax exemption with respect to
stay expenses incurred while on travel.
e) Photo copy will not be accepted for
exemption.

1) Fuel expenses should be incurred within the city of 1) Out station bills will be disallowed.
employment. 2) Vehicle is registered in In-law's or friends will
2) RC copy of vehicle. If vehicle is registered on employees be disallowed.
immediate relative then employee has to produce the
declaration stating that the vehicle is used by them from the
vehicle owner.

1) The Tuition fees and the Admission fees are allowed. 1) Membership fee paid is not allowed.
2) The course should be from a recognized institute and 2) Books and periodicals are not allowed.
should enhance professional competence of the employee.
3) Carrier oriented courses and higher education courses
receipts are allowed.
 1) The landline, mobile phone, internet connection must be in
employee’s name and the bills should reflect the same
2) The landline/mobile phone and broadband connections
must be installed in the city where the employee is employed
1) Expense towards Prepaid connection are
disallowed
2) If Company has provided landline, mobile
phone and internet connections to an
employee, the employee is not eligible to claim
tax deduction for these.

t. Incomplete & non legible documents may lead for rejection of the benefit.
 FAMILY MEMBERS DECLARATION FORMAT

Employee No

Employee name

"I am declaring my family members details as below;"

Sl.No Name of Family Member Relationship Age (Years)Whether Dependent?

1 YES / NO

2 YES / NO

3 YES / NO

4 YES / NO

5 YES / NO

6 YES / NO

7 YES / NO

8 YES / NO

Place:

Date:

Signature of the Employee

ent?
 MONTHLY RENT RECEIPT

Landlord PAN:
Note:-This is to bring to your notice that the CBDT vide Circular No 8/2013 dated 10/10/2013 has made it mandatory for the
employees, claiming exemption in respect of House Rent Allowance, to report PAN of the landlord to employer in case rent
payment to the landlord exceeds Rs.8333/- per month.

Received Rs. Per month (In Words )

from Mr. / Ms. residing at

towards rent for the month of

Date:
Place:
Landlord Name:
Landlord Address:

Landlord Signature
 CONSOLIDATED RENT RECEIPT
Landlord PAN:
Note:-This is to bring to your notice that the CBDT vide Circular No 8/2013 dated 10/10/2013 has made it mandatory for the
employees, claiming exemption in respect of House Rent Allowance, to report PAN of the landlord to employer in case rent
payment to the landlord exceeds Rs.8333/- per month.

Received Rs. (Rupees )

from Mr. residing at

towards RENT for the period FROM TO where rent per

month is Rs.
Date:
Place:
Landlord Name:
Landlord Address:

Landlord Signature
 House property declaration
(please fill the relevant details before printing the document)

1 Employee name
2 Employee number
3 Employee PAN number
4 Postal address of the property in respect of which the housing loan has been availed
5 Date of sanction of housing loan
(Sanctioned date/1st instalment release date)
6 Status of occupancy of the house Self Occupied
(Tick the applicable box)
Occupied by family
members
Under Construction
Let Out
Vacant/Construction
completed
7 Date of acquisition or construction completion (Enclose Possession Certificate / Self Declaration of Possession (click on this) is mandatory along with copy o

8 Name of the Bank / Person / Company / Institution /Lender from where the housing loan has been
availed
9 Address of the Lender
10 Permanent Account Number of the Lender
11 Loan account number
12 Annual Interest paid/payable during the FY
(attach Provisional banker's certificate for both actual paid & accrued amount)
13 Annual Principal paid/payable during the FY
(attach Provisional banker’s certificate for both actual paid & accrued amount)
14 Please enclose relevant period's banker certificate if you are claiming Pre EMI interest. (Pre
EMI=Interest paid from date of sanction of the loan to date of occupying the property)
15 In case of joint property / joint loan enclose the Joint Owner's Declaration (click on this)
16 Computation of Income from Let Out House Property

Gross Rent received during the current financial year -

Less: Property tax paid (Enclose tax paid receipt) -

Net Rent Received -

Less: Standard Deduction @ 30% of Net Rent received for repairs and maintenance -
Net Income from House Property -
Interest on Housing Loan as per Certificate -

Net Income / (loss) from Let out House property -

17 Computation of Interest on Self Occupied House Property

Interest on Housing Loan paid during current financial year as per Provisional certificate
Add: 20% of Pre construction period interest (if any) (Enclose Interest certificate)
Interest on Self occupied Property (max of Rs.2.00 lakhs) -
18 Income from other sources (If any, attach relevant supporting documents) -

-: Verification :-
I declare that the above details furnished are correct to the best of my knowledge and will be personally responsible for any Income Tax related issues
arising out of this declaration in the future

Date
Place Signature of the employee
 Self -Declaration format for Possession

Date:

To,
……..Company Name……..
……..Address……..
……..Address……..
……..Address……..

From,
Employee ID:
Employee Name:
……..Address……..
……..Address……..
……..Address……..

Sub: Self declaration for confirmation of Date of possession

I _________________hereby declare that property at _______________address __________ has

been purchased from ___________<Name & address>_________vide sale deed
________dated________ and registered on ________<date>________ & the same has been
occupied by me on ___________date_____________.

I declare that the above details furnished are correct to the best of my knowledge and will be
personally responsible for any Income Tax related issues arising out of this declaration in the future.

(Signature of the employee)

 Housing Loan Joint Owner's declaration

Employee ID
Employee Name
Housing Loan A/c No

I ___________________________, hereby declare that the above Housing Loan that I have availed is in the
Joint name with________________________ who is my________________. The EMI is being paid by us
in below mentioned pattern.

I declare that the above details furnished are correct to the best of my knowledge and I will be
personally responsible for any Income Tax related issues arising out of this declaration in the future.

The Details are given below:

Name of Owner
% of EMI distribution:

(Signature of the employee) (Signature of the CO OWNER)

( PAN of CO OWNER)
Date:
 FORM NO 12B
(See rule 26A)

Form for furnishing details of Income under section 192(2) for the year ending 31st March, 2017

Employee Name :
Address :

Emp No. :
Permanent Account No. :
Residential Status : INDIVIDUAL

1 2 3 4 5 6 7 8 9 10
Sl. No. Name and address TAN of the Permanent Period of Particulars of salary as defined Total of Amount deducted
of the employer(s) employer(s) Account employment in Sec 17, paid or due to be paid columns in respect of life
as allotted by No of the to the employee during the year 6,7 & 8 insurance premium,
the ITO employer(s) provident fund
Total amount of Total amount of Value of perquisites contribution etc.; to
salary excluding house rent allowance and amount of which sec 88
amounts required conveyance allowance accretion to applies
to be shown in and other allowances employee's ( give details )
col 7 & 8 to the extent chargeable provident fund
to tax [ see sec 10(13A) account
read with rule 2A and
sec 10(14) ]
 FORM NO 12B
(See rule 26A)

_______________________________
Employee Signature
 FORM NO 12B
(See rule 26A)

der section 192(2) for the year ending 31st March, 2017

11 12
Total amount Remarks
tax deducted
during the year
( enclose
certificate
issued u/s 203)
 Medical Reimbursement Claim Form for 2016-17

Emp Name:
Emp No:

Relationship Bill / Invoice Bill / Invoice Name of the

Sl. No. Name party to
with employee No. Date whom paid

Total

I, hereby declare that the aforesaid information and enclosed documents are true and correct, and I shall indemnify th
against all costs and consequences if any information or document is later proved to be false.

Date :
Place: Signature of Employee
-17

Nature Of Amount
Expenditure Rs.

correct, and I shall indemnify the company

alse.

Signature of Employee
 LTA Reimbursement Claim Form for 2016-17

Emp Name
Emp No

I had availed___________ days of leave during the period from ________to__________& I have incurred the
following expenses towards travel.

Relationship with Place of Journey Date of Mode of

Name of persons travelled employee From To Travel Travel

Total

I, hereby declare that the aforesaid information and enclosed documents are true and correct, and I shall indemnify
the company against all costs and consequences if any information or document is later proved to be false.

Date :
Place :
Signature of Employee
incurred the

Amount

nd I shall indemnify
o be false.

gnature of Employee
 Vehicle Maintenance Claim Form for 2

Employee No:

NAME

Date Bill No Bill Dated

1
2
3
4
5
6
7
8
9
10
11
12

TOTAL

Note: 1. Original Bills to be submitted

2. Charges towards personal calls/expenses should be excluded

3. RC copy to be submitted

I, hereby declare that the aforesaid information and enclosed documents are true and correct, and the abo

Date:

Place:
enance Claim Form for 2016-17

Type of Vehicle

Cubic Capacity
of the vehicle

AMOUNT (Rs.) Remarks

e true and correct, and the above expenses have been incurred by me

Signature of Employee
 Professional Pursuits Claim Form for 2016-17

Employee Name :

Employee No :

Date of Joining :

Sl. No. Name of the Institute Brief Description of the Course Bill / Invoice No. Bill / Invoice Date Amount

GRAND TOTAL -

NOTE : Please attach all relevant supporting evidences and Course Completion Certificate.

Place:

Date:

I hereby declare that I have incurred the above expenditure in my official capacity and in the course of discharging my responsibilities as an employee.
I hereby declare that what is stated above is true to the best of my knowledge and belief.
 Communication Bills for 2016-17

Employee No.
Employee Name

Mobile / Land Line /

Sl.No Date Bill No Communication Number AMOUNT (Rs.) Remarks
Broadband / Data Card

0.00
1

2 0.00

3 0.00

4 0.00

5 0.00

6 0.00

7 0.00

8 0.00

9 0.00

0.00
10

11 0.00

0.00
12
TOTAL -

Note: 1. Original Bills to be submitted

3. Telephone/Board band bills should be in the name of the employee
3. Maximum of one Landline and One Mobile would be considered

I, hereby declare that the aforesaid information and enclosed documents are true and correct, and the above expenses have been incurred by me.

Date:

Place: Signature of Employee