INVESTMENT DECLARATION FORM for the period of APRIL 2013 TO MARCH 2014

EMP NAME : PAN No.

EMP NO : Location

DOJ : Client Name

Item Praticulars Max Limit Declared Amount
Deduction Under section 10
I am staying in a rented house and I agree to submit rent receipts
Residential property located at
House Rent when required. The Rent paid per month is (Rs…………….……) …………………………………….
(Specify the name of the city)

I have taken exemption for LTA in the following years

During the year 2009 - Yes / No
LTA - IF Applicable IDuring
will produce the2010
the year travel -bills
Yesas laid down under the LTA policy to
/ No
avail the deduction.

Medical Bills 15,000

MAX BENEFIT PERMISSIBLE (Rs) AMOUNT (RS)
Sec 80D Premium in respect of Medical Insurance 15000 (for self, 15000
spouce,dependent childern), Addl 15000 is allowed if parents (not
2 a Sr citizens) are covered. Another Addl 5000 is allowed if the
parents are Sr citizens Maximum of Rs. 35000/- is allowed under
this sec. 20000
Sec 80DD (Medical treatment of handicapped dependents) Maximum limit is 50,000 (In
Certificate from a doctor working in Government Hospital required case of severe disablity more
3 than 80% maximum limit is
-
Declaration by employee of amount incurred during the year
Rs.1,00,000)
Sec 80DDB (Medical treatment for specified ailments) Government
Doctor(not less an MD) certificate in Form 101 Declaration by 40,000/- or 60,000/- (Senior
4 Citizen)
60,000
employee of amount incurred during the year. Please mention if
treatment is on Senior Citizen
Sec 80E Interest paid on loan availed for higher education
5 Certificate from Financial Institution ( Only Interest part will be No Limit -
given as deduction and not Principal amount)
Sec 80U (Physically handicapped or totally blind employee)
Certificate from a doctor working in Government Hospital required Maximum limit is 50,000 (In
6 case of severe disablity 100,000
maximum limit is Rs.1,00,000)

DEDUCTION UNDER SEC 80C

Sec 80 CCC Contribution to Pension Fund (Maximum
7 Rs.1,00,000)
8 Life Insurance premium paid
9 Unit Linked Insurance Plan (ULIP)
10 National Savings Certificate (New Purchases)
11 Interest Accrued on NSC (Previous Investments)
Maximum Limit u/s 80C is
12 Public Provident Fund (PPF) (Maximum Rs.70,000)
Rs.1,00,000/- ( including
13 Equity Linked Savings Scheme PF deduction from
14 Principle repayment of Housing Loan Salary).
15 Mutual Fund Bonds (Notified or UTI)
16 Tutions fees (Maximum 2 children)
17 Infrastructure Bonds
18 Subscription to the bonds issued by NABARD
19 Fixed Deposits more than 5 years made in Banks

Note : The maximum amount of investments qualifying for deducation is Rs. 10,000/- under pension plan - 80CCC

20

Interest on Housing Loan 250,000

Deduction under
Section 24 Interest if the loan is taken before 01/04/99 30,000

Declaration:
1) I hereby declare that the information given above is correct and true in all respects.
2) I also undertake that the proof for the same would be provided in Dec 2012. 2) I also undertake to indemnify the company for
any loss/liability
* If House that may
rent more thanarise in the
15000/- pmevent of the aboveowner
Landlord/House information being
PAN must beincorrect.
updated.
Date : Signature of the Employee
Place:_____________
 INVESTMENT DECLARATION FORM FOR THE FINANCIAL YEAR 2017-18

EMP NAME PAN No.

EMP NO Location
DOJ Client Name
*Above fields are mandatory.
Deduction Under section 10/17 Eligibility and Limits of exemption Declaration
Monthly Rent
I am staying in a rented house and I agree to submit rent receipts Residential property located at (Specify the name of the Amount Rs.
House Rent
(originals) as I agreed below/when required. city)………………………………. _______________

I will produce the travel tickets (originals) as laid down under the LTA Eligible only if LTA is part of salary.
Leave Travel Max exemption is restricted to actual travel expenses or
policy to avail the deduction. I have taken exemption for LTA in the
Allowance
following years. LTA amount in Salary whichever is Less. Can be availed
(LTA)
only twice in a block of 4 years.
Applicable only if Medical Allow/Reimb is part of salary.
I will produce original medical bills before cut off time/ when you
Medical Bills Max exemption limit is Rs.15000 (subject to submission
required.
of original bills)

Deduction under Chapter VI Max Limit Declaration

Section 80C/80CCC/80CCD:
Life Insurance premium paid - (self, spouse,children)
Unit Linked Insurance Plan (ULIP)
National Savings Certificate (New Purchases)
Interest Accrued on NSC (Previous Investments)
Public Provident Fund (PPF)
Equity Linked Savings Scheme (ELSS)
Principle repayment of Housing Loan (Required Provision certificate) Maximum Limit u/s 80C is Rs.1,50,000/-
1
(including PF deduction from Salary).
Mutual Fund Bonds (Notified or UTI)
Tutions fees (Maximum 2 children)
Infrastructure Bonds
Subscription to the bonds issued by NABARD
Fixed Deposits (locking period should be 5 years)
Sukanya Samriddhi Scheme with Post Office/Bank
80CCC Contribution to Annuity Plan
80CCD (1): Contribution to NPS Scheme - Max 10% of Basic
Additional Rs.50000 over & above specified limit of
2 80CCD (1B) : Additional Contribution to NPS Scheme
Rs.1.50 lacs u/s 80C,80CCC & 80CCD
For Self, Spouse & Dependent
Children
3 Sec 80D: Medical Insurance Premium
Parents aged upto 80 years

Sec 80DD : Medical treatment Dependent with Disability. Certificate For Dependent with Disability
4 from a doctor working in Government Hospital is required along with
For Dependent with severe
employee declaration for the amount incurred during the year
disability (above 80%)
For Dependent other than Very
Sec 80DDB : Medical treatment for specified ailments: Certificate Senior Citizen
5 from Government Doctor(not less an MD) in Form 10 I & Declaration
by employee of amount incurred during the year. For Very Senior Citizen (Parent
aged above 80 years)
Sec 80E : Interest paid on loan availed for higher education (Only Need to be attached Loan
6 Interest amount is eligible for deduction and not Principal amount) saction letter

Employee with Disability

Sec 80U : (Physically handicapped or totally blind employee)
7 Certificate from a doctor working in Government Hospital required
(Form 10-I to be provide along with declaration) Employee with Severe Disability

Deduction under Section 24 Max Limit Declaration

1 Self Occupied
Interest on Housing Loan (Loan Sanction letter & Proviosion certificate should be attached)
2 Let Out (Rented) Property:
Interest on Housing Loan (Loan Sanction letter & Proviosion certificate should be attached) No Limit
Annual Rental Income
Municipal/Corporation Tax
Declaration:
1) I hereby declare that the information given above is correct and true in all respects.
2) I undertake to indemnify the company for any loss/liability that
may ariseundertake
3) I also in the event of the above
to submit information
necessary being
proofs by incorrect.2015
November
4) If House rent more than 8333/- pm Landlord/House owner PAN is mandatory.

Date : Signature of the Employee

Place:_____________