Employees Proofs Submission Form - Financial Year 2011 - 12

( Please read the instructions / guidelines attached carefully before filling up the form )

NAME OF COMPANY Green Infra Wind Farms Limited

EMPLOYEE CODE * GIWFL/04
NAME * Abhinandan Kumar
PAN NUMBER AXNPK5690G
LOCATION New Delhi
No of Children * None

* Mandatory

Proofs Submitted
Amount (to be filled by Amount ( to be filled by
S. No. Particulars employee) ( Rs. ) Accounts Deptt) Remarks
A Rent Receipts ( Pls mention the no. of months to be claimed)
From Date To Date Rent P.M.
1 1.04.2011 1.06.11 15000
2 1.07.11 1.09.11 15000
3 1.10.11 1.12.11 15000
4 1.01.12 1.03.12 15000
B Loss / Income from House Property (attach Form 12C / Computation Satement - Mandatory)
Housing Loan Interest Amount (upto 30k or 150k) Nil
Pl. mention whether loan was taken
before 01/04/99 or after 01/04/99
C Income from Other Sources, if any Nil
D Deduction under Chapter VI A
1 80D (Mediclaim- upto Rs. 15000 for Self, Spouse and Children)
(upto Rs.15000 for Parents & Addt Rs.5000 for Senior Citizen Parents)
2 80DD - Medical treatment for handicapped dependent
(with < 80% disability or > 80% disability, pl. specify)
3 80U - Medical treatment for handicapped Self
(with < 80% disability or > 80% disability, pl. specify)
4 80 E - Repayment of Interest on Education loan taken for
Higher Education for SELF, SPOUSE AND CHILDREN
E Deduction under section 80C
1 Life Insurance Premim ( LIC ) 44,100
2 Pension Plans u/s 80CCC
(Jeevan Suraksha / Pension schemes of any other insurer)
3 Public Provident Fund ( PPF )
4 Equity Linked Saving Scheme (ELSS)
5 Housing Loan Principal Repayment/Stamp Duty & Reg. Charges
6 Deposit in NSC
7 Interest on NSC - Accrued
8 Deposit in ULIP of UTI/LIC
9 Tax Saving Mutual Funds eligible for deduction u/s 80 C
10 Infrastructure Bonds / Tax saving bonds
11 Fixed Deposit in Banks eligible for Tax Saving u/s 80C
12 Children Education expenditure
- Pl.mention number of children studying in School/College
13 Tax Saving Systematic Investment Plan (SIP)
TOTAL

F Previous Employment Salary ( Salary Earned from 01/04/2011 till Date of Joining)
( Applicable only if you have joined ………………. (Green Infra Ltd.) after 01/04/2011)
If you have joined ….….…..(Green Infra Ltd.) after 1st April 2009, and you were working with some
other organisation before joining, Pl. enclose the Copy of FORM - 16 / Statement Certifying Earnings and Deductions
from your previous employer, which is mandatory.
1) I hereby declare that what is stated above is true to the best of my knowledge and belief.
2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information
being incorrect.

Date :
Place: Signature of the Employee
FORMAT OF RENT RECEIPT

RENT RECEIPT

Received from Mr./Ms. ………………………… of …….…………………[Name of the company]

a sum of Rs. ..……………..( Rupess ………………………………………

…………………………) towards rent for the period From …………….. To ………….. for the
property situated at …………..(Address of the property)

Name of the owner :

Address of the owner :

( SIGNATURE OF THE OWNER )

Computation of Loss from Self Occupied Property:

Name of the employee

Employee Code

Address of the Self Occupied House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction

Date of Occupation (Taken Possession)

Interest paid during the period Apr 09 to Mar 10

(Should match with the amount appearing in the certificate given by
the Bank / Financial Institution)

I hereby declare that what is stated above is true to the best of my knowledge and belief.
Please considered the above Loss from Self Occupied House Property
while computing the tax on salary.

Employee Signature
Computation of Income / (Loss) from Let Out Property - Rented property
(Do not disturb the formulas)

Name of the employee

Employee Code

Address of the Let Out House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction

Date of Occupation (Taken Possession)

COMPUTATION OF INCOME / LOSS FROM HOUSE PROPERTY ( RENTED OUT)

Annual Rental Income

Less: Municipal Tax paid during the financial year

Net Annual Rental Income 0

Less: 30% for Repairs & Maintenance on Net Annual Income 0

0
Less:
Interest paid on borrowed Loan (From Apr 10 To Mar 11)
(Should match with the amount appearing in the certificate given by
the Bank / Financial Institution)
1/5 th of Pre-Contruction Interest (if any)
(Should mention the year of instalment)

Net Income / (Loss) from House Property 0

I hereby declare that what is stated above is true to the best of my knowledge and belief.
Please considered the above Income / (Loss) from Let Out House Property
while computing the tax on salary.

Employee Signature
 FORM No. 12C
[See rule 26 B]

Form for sending particulars of income under section 192 (2B) for the year
ending 31st March, 2011

1 Name and address of the employee

2 Permanent Account Number

3 Residential status RESIDENT / NON RESIDENT

4 Particulars of income under any head of income other than "salaries" (not being a loss
under any such head other than the loss under the head "Income from house property")
received in the financial year.
Rs.
(i) Income from house property
(in case of loss, enclose computation thereof)

(ii) Profits and gains of business or profession

(iii) Capital Gains

(iv) Income from other sources

(a) Dividends Rs.
(b) Interest Rs.
(c) Other Income (specify) Rs.

Total Rs.

5 Aggregate of sub-items (i) to (iv) of item 4. 0

6 Tax deducted at source [enclose certificate(s) issued

under section 203]

Place _______________________________

Date ________________________________
Signature of the employee

Verfication

I, _______________________________________________________________________________
do hereby declare that what is stated above is true to the best of my knowledge and belief.

Verified today, the __________________ day of _____________________ 20________.

Place _______________________________

Date ________________________________
Signature of the employee