PPO No.

: _______________________
Account No : ____________________
Central Pensioner of _______________
ANNEXURE-I
ALLAHABAD BANK
Head Office : 2, Netaji subhas Road, Kolkata - 700 001

The AGM/ CM/ SM/ Manager

Allahabad Bank
______________ Branch

INVESTMENTS/PAYMENTS WILL BE MADE BEFORE 31.01.2020

Dear Sir,
Re: FINANCIAL YEAR 2019-20
Sub: DEDUCTION OF INCOME TAX

I furnish hereunder the particulars for the purpose of deduction of

Income Tax at source under section 192 of the Income Tax Act, 1961 from
my salary Income during the financial year 2018-19 i.e. from 01.04.2019 to
31.03.2020.

Full Name (in block letters) : ------------------------------------------------

Residential Address : -----------------------------------------------

Permanent account Number (PAN) : ------------------------------------------------

Mobile No. : -----------------------------------------------

Income from other sources Rs.

Interest paid/ to be paid on Housing Loan Rs.

during FY 2019-20 (section 24B)

Exemptions under 80C (maximum Limit Rs 1,50,000)

S.No Investment Head Amount
1. Contribution to recognized Provident Fund/NPS
2. Contribution to Voluntary Provident Fund
3. Contribution to Public Provident Fund
4. Tuition fees(Max. for 2 Children) excluding any payment towards any
development fees or donation or payment of similar nature whether at
the time of admission or thereafter to any University, College, School or
other educational Institution for the purpose of full time education of the
individual, child, wife or husband as the case may be in India

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5. Details of 6 years National savings Certificate (VIII issue) purchased
during the under noted years (Photo copies of attached certificates for
verification along with original)
Financial Amount Date Of N.S.C.Nos. NSC Intt.
Year (Rs.) Purchase
2014-2015
2015-2016
2016-2017
2018-2019
2019-2020
TOTAL
6. Details of repayment of Principle (Only) Amount of HBL

Amount Of Date of Sanction Name Of Amount Of Principle to be

Loan(Rs.) & Distribution Of Creditor repaid during the
Loan Current financial
Year(Rs.)

7. 5 year National Saving Certificates(s) – VIII issue

8. Unit Linked Investment plan
9. Equity Linked Savings Scheme / Contribution to notified Pension Fund of
U.T.I (Retirement Benefit Unit Scheme) / Sukanya samridhhi Accounts
10. Investments in Senior Citizen Schemes
11. Deposit in National Housing Bank
12. Stamp duty on House property
Total:

Provisions under other sections:

S.No. Section Investment details Maximum Limit Amount
1. 80E Repayment of interest on education Full
loan (self, spouse and dependent
children)
2. 80CCD(1B) Additional contribution to NPS Rs. 50,000/-

3. 80D Medical Insurance Premium (Self Rs. 25000/- below

with age _______ years) 60 years else Rs.
40000/-
4. 80D Medical Insurance Premium Rs. 20000/- below
(parents) 60 years else Rs.
(Age of Parents __________ years) 50000/-
5. 80DD Medical treatment of disabled Rs. 75000/- (subject
dependents with Disability % ______ to severe disability
Rs 125000/-)
6. 80DDB Medical treatment
7. 80G PM disaster relief fund and other
relief funds with 100% exemption
8. 80G (5) Donation to Institutions/ Fund (with
50% Exemption)
9. 80TTA Interest on saving account Rs. 50000/-
10. 80U Disability % _____ (if 40% or more) Rs. 75000/- up to
80% else 125000/-

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 DECLARATION
• I certify that the construction of the above house property, details of which have been
given in point no 6 above, was actually completed on ____________.

• The particulars given above are true to the best of my knowledge and belief.

• I undertake to make the investments/payments as mentioned above by 31st January,

2020 and submit proof thereof by 15th February, 2020 to the branch/office of my
posting.
Yours faithfully,
Place: _______________

Date: ________________
(Signature in full)
Name: _______________________
Address: _____________________
______________________________

FOR OFFICE USE

To be filled at To be filled at the time of submission of
the time of Investment/Payment
submission of
Declaration
Officer/clerk who Officer/clerk who Sr. Manager / Manager /
has entered the has entered the data Officer who has verified the
data of the of the investment / photocopies of the
declaration in the payment in the investment / payments from
module module the original
Name
Employee ID
Designation
Date of
verification /
entry in the
system
entry in the
system

Acknowledgment for Declaration Acknowledgment for Investment/Payment

for FY 2019-20
I acknowledge receipt of system generated
printout of data entered by the branch in
Web Pension Module as per the
declaration submitted by me and confirm
that the same has been found correct.
for FY 2019-20
I acknowledge receipt of system generated
printout of data entered by the branch in Web
Pension Module as per the proof of
Investment/payment submitted by me and
confirm that the same has been found correct.

Signature Signature
Name ________________ Name______________________
Date__________________ Date_______________________

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