Investment declaration form for FY 2022-23

PAN NO. SAP ID Name

I. A Details of Contributions/Payments (Chapter VIA) Amount (Rs.) PROOF CODE

1 Mediclaim Policy Premium paid directly [u/s 80D]-upto Rs. 55,000/-

Indicate if the premium paid includes coverage for Self (Rs.25000/-)
Indicate if the premium paid includes coverage for Parents Non Senior Citizen (Rs. 25000/-)
Indicate if the premium paid includes coverage for Parents Senior Citizen (Rs.50000/-)

2 Medical treatment of handicapped dependent [u/s 80DD]

3 Medical treatment - specified diseases [u/s 80DDB]-Actuals upto Rs. 1,00,000/-

4 Deduction in case of self being totally blind or physically handicapped [u/s 80U]

5 Payment of interest on loan taken for higher education for a full time course [u/s 80E]

6 Investment Rajiv Gandhi Equity Saving Scheme [U/s 80CCG] - upto Rs. 50,000/-

7 New Pension Scheme [80 CCD (1B)] - upto Rs. 50,000/-

B Investments for Deduction u/s 80C & 80CCC (Item 1 TO 10 Max Limit is Rs.1.5 Lakh p.a. ) Amount (Rs.) PROOF CODE

1 Contribution to Pension Plans

2 Payment of Life Insurance Premium (For self ,spouse & children )… mention details below

3 Deposit in Public Provident Fund (For self ,spouse & children )

4 Purchase of National Saving Certificates (VIII Issue)

5 Contribution to Unit Linked Insurance Scheme (ULIP)… mention details below

6 Contribution to Equity Linked Savings Scheme (ELSS)

7 Payment of Tution fees to any School, College, University or Educational Institution

8 Repayment of Principal Amount of Housing Loan

9 Fixed Deposit for 5 years with a Scheduled Bank

10 Investment in Sukanya Samriddi Account

11 Others (Please provide details)…………

IIA.
Self Occupied Property - Interest on Housing Loan

Date of Loan Sanctioned : Date of Possession Taken :

Note :- Exemption amount

1. Interest on Housing Loan sanctioned prior 31.03.1999 U/S 24 Max. Rs. 30,000/-
2. Interest on Housing Loan sanctioned from 01.04.1999 to 31.03.2013 U/S 24 Max Rs. 2,00,000/-

IIB.
Let out / Deemed Let Out Property (Income / Loss on Housing Property) [u/s 24(2)]

Rent receivable on Property Interest on Housing Loan

Municipal Taxes Standard Deduction Repairs @ 30%
Date of Loan Sanctioned : Date of Possession Taken :
I undertake that Interest on Housing Loan as claimed above is in respect of House Property, for which construction has been completed and the possession has already been taken by me OR is due
to be taken in the current financial year. (Refer note below)

III. House Rent Allowance

Name & Address of the Landlord Rent Amount p.m PAN of Landlord Period of Lease
From :
P Majusha
Upto :
From :
Upto :
Note :- Rent Agreement & Rent Receipt copies are mandatory

IV. Statement provided - Income from Previous Employer during FY 2022-23 (Yes / No)

Declaration:
I hereby confirm that I have invested/contributed the above amounts for the purpose of rebate/deduction to be considered in calculating my income tax for the F.Y. 2022-2023.
I further undertake that wherever eligible investments are made in the name of spouse/children/dependent parents, the same have been made out of my income and claim
thereof shall not be made elsewhere to get Income Tax benefit. I will produce the tenancy/lease agreement in respect of rents paid, or any other supporting documentation requested
by the Company, in support of my claim. I hereby declare that all the information given by me is true and correct and I undertake to notify you immediately of any change in the above
facts. I also confirm my understanding that I may be subject to disciplinary action, up to and including termination of my employment, for any false or tampered submission.
Any Income Tax liability arising out of a wrong declaration will be my responsibility, and I undertake to indemnify the Company and its officers from all consequences,
monetary and otherwise, arising out of any incorrect and/or incomplete information provided.

Place :
Signature
Dated :
NOTES TO DECLARATION OF INVESTMENTS FROM 01.04.2022 TO 31.03.2023

I A-1 Mediclaim Policy - Premium [u/s 80D] Back

- Deduction u/s 80D for Premium on Mediclaim Policy is allowable only in case of coverage to self, spouse, dependant parents and dependant children.

- The deduction u/s 80D is limited to an amount of Rs 25000 (Rs 50000 in case any beneficiary under the scheme is a Senior Citizen i.e age >= 60 years). Additional
benefit is available to the extent of Rs 25000/- in case the coverage under the Health Policy includes any of the parents of the employee (Rs 50000 in case of Senior
Citizen).

The service tax paid on medical insurance premium wont be allowed as a deduction under section 80D. Deduction under section 80D can be only claimed on the
- amount paid as Medical Insurance Premium and not on the service tax levied thereon.

I A-2 Medical treatment of handicapped dependent [u/s 80DD] Back

-
Eligible Deduction u/s 80DD is Rs 75000/- from the Gross Total Income of the employee. However, where such person is a dependant with severe disability (disability
exceeding 80%) , the exemption shall stand enhanced to Rs 1,25,000.

- Deduction can be provided only for treatment for dependants of the individual i.e. spouse, children, parents, brothers or sisters only.

I A-3 Medical treatment of specified diseases for self/dependent [u/s 80DDB] Back
- Deduction can be provided only in case of amount spend on treatment of specified diseases or ailments under Rule 11DD as below :
Neurological Diseases where the disability level has been certified to be of 40% and above, i.e. Dementia, Dystonia Musculorum Deformans ,
Motor Neuron Disease, Ataxia, Chorea, Hemiballismus, Aphasia, Parkinsons Disease etc.: and
Malignant Cancers, Full Blown AIDS, Chronic Renal failure, Hematological disorders, Hemophilia & Thalassaemia.
- Eligible Deduction is on account of actual expenses, restricted to a maximum Rs 1,00,000 from the Gross Total Income of the employee. However, where such person
is a Senior Citizen, the limit shall stand enhanced to Rs 1,00,000.

- Deduction can be provided only for treatment for dependants of the individual i.e. spouse, children, parents, brothers or sisters only.

I A-4 Deduction in case of self being totally blind or physically handicapped [u/s 80U] Back
- Eligible Deduction u/s 80U is Rs 75,000 from the Gross Total Income of the employee. However, where employee is a person with severe disability (disability
exceeding 80%), the exemption shall stand enhanced to Rs 1,25,000.

I A-5 Payment of interest on loan taken for higher education for a full time course [u/s 80E] Back
- Deduction u/s 80E is eligible only for interest component repaid during the financial year. Deduction on account of Principal repayment is not eligible for deduction.

- Education loan should be from any Financial Institution or any approved charitable institution for the purpose of pursuing his/her higher education or relative of the
individual i.e spouse/children.

I A-7 Investment made under notified equity savings scheme [U/s 80CCG] Back
-
Newly inserted Section 80CCG provides deduction w.e.f. assessment year 2015-16 in respect of investment made under notified equity saving scheme
-

The deduction under this section is available if following conditions are satisfied:
(a) The assessee is a resident individual (may be ordinarily resident or not ordinarily resident)
(b) His gross total income does not exceed Rs. 12 lakhs;
(c) He has acquired listed shares in accordance with a notified scheme;
(d) The assessee is a new retail investor as specified in the above notified scheme;
(e) The investment is locked-in for a period of 3 years from the date of acquisition in accordance with the above scheme
(f) The maximum investment eligible for deduction, under this section, is Rs. 50000/-
(g) If any deduction is claimed by a taxpayer under this section in any year, he shall not be entitled to any deduction under this section for any subsequent year
- Deduction limited to 50% of amount invested in equity shares. However, the amount of deduction cannot exceed Rs. 25,000

I B-1 Contribution to Pension Plans Back

- Deduction on account of Premium paid to keep in force a Annuity Policy (Pension Plan) is eligible for deduction u/s 80CCC, and subject to a consolidated maximum
limit of Rs 1,50,000 u/s 80C.

I B-2 Payment of Life Insurance Premium (For self ,spouse & children ) Back
- The beneficiaries as per the Insurance Policy should either be the self individual, spouse or children of the individual. Premium paid for parents, brother or sister, even
if dependant on the employee, is not eligible. Hence if the Policy Premium receipt bears the name of a person, other than the individual, relationship of the
beneficiary to the individual should be clearly mentioned on the Receipt.

- Late Fee / Interest on late payment of Premium is not eligible for deduction u/s 80C

- If the annual premium of life insurance policy, issued before April 1,2017, is more than 20% of the sum assured of the concerned policy, benefit allowed should be
restricted to 20% of the sum assured.

- If the annual premium of life insurance policy, issued on or after April 1,2017, is more than 10% of the sum assured of the concerned policy, benefit allowed should be
restricted to 10% of the sum assured.

I B-3 Deposit in Public Provident Fund (For self ,spouse & children ) Back
- Contribution by the employee to PPF Account only in the name of self, spouse or children of the employee is eligible for deduction.

- Deposits under PPF is eligible only if the same is paid in the current Financial Year

I B-4 Purchase of National Saving Certificates (VIII Issue) Back

- Subscription to NSC is eligible only if the same is purchased in the current Financial Year. Interest on NSC is not eligible for deduction from Taxable Income u/s 80C.

- Subscription to NSC is eligible only if the Certificate is in the name of the employee.

I B-5 Contribution to Unit Linked Insurance Scheme (For self ,spouse & children ) Back
- The beneficiaries as per the Insurance Policy should either be the self individual, spouse or children of the individual. Premium paid for parents, brother or sister, even
if dependant on the employee, is not eligible. Hence if the Policy Premium receipt bears the name of a person, other than the individual, relationship of the
beneficiary to the individual should be clearly mentioned on the Receipt.

- Late Fee / Interest on late payment of Premium is not eligible for deduction u/s 80C
I B-6 Contribution to Equity Linked Savings Scheme (ELSS) Back
- Subscription to ELSS is eligible only if the units are purchased in the current Financial Year and the same is in the name of the employee only.

- Subscription to ELSS is eligible only if the same is a Tax Saver Scheme. All Mutual Fund Schemes are not Tax Saver Schemes and hence any investment in a Mutual
Fund is eligible only if it is a Tax Saver Scheme.

I B-7 Payment of tuition fees to any School, College, University or Educational Institution Back
- Tuition Fees is eligible only if the same is with respect to any two children of the employee.

- Payment on account of tuition fees, term fees, admission fees etc .only is eligible for Deduction as per Tax Rules. Any and any other payout like development fees,
capitation fees, donation etc. are not eligible.

- Payment should be to a University, School, College or other Educational Institution in India for the purpose of full-time education and includes any payment for play-
school, pre-nursery or nursery activities. Exemption will be provided for actual payments only.

I B-9 Repayment of Principal Amount of Housing Loan Back

- Any sum paid on account of purchase or construction of a residential house property is eligible for deduction, wherein such payment is made by way of instalment or
part/full repayment towards principal loan due to any institution engaged in the business of providing long term finance.

- Payment on account of Stamp Duty, Registration fees or any other payment incurred for the purpose of transfer shall also be covered hereunder.

I B-10 Fixed Deposit for 5 years with a Scheduled Bank Back

- Subscription to Fixed Deposit is eligible only if the same is for a fixed period of not less than 5 years with a Scheduled bank and notified under the Bank Term Deposit
Scheme, 2006.

- Subscription to Tax Saver Fixed Deposit is eligible only if the same is purchased in the current Financial Year and in the name of the employee.

I B-11 Fixed Deposit for 5 years with a Scheduled Bank Back

- • Investment in Sukanya Samriddi Account will be eligible for deduction u/s 80C. Interest on such investment will be exempt from income tax w.e. from F.Y.’22-‘23

IiA Loss on Self-Occupied House Property Income (Interest on Housing Loan) [u/s 24(2)] Back
- Deduction u/s 24(2) is allowable in respect of interest paid, upto a maximum of Rs 2,00,000, if such loan has been taken after 1.4.1999 for constructing or acquiring a
residential unit.

- Benefit for Interest on Housing Loan is eligible only in case, the employee has taken possession or due to take possession of of the House Property in the current
financial year. Status of possession of property will be considered as per the Declaration by the employee on the Proof Cover Memo.

IiB Income / (Loss) on Let out / Deemed Let Out Property [u/s 24(2)] Back
- The calculation of Income / Loss from house property is done as under:
Rental income / Deemed Rental Income = Gross Annual Value
Less : Municipal taxes = Net Annual Value
Less : 30% of Net Annual Value as a standard deduction
Less: interest payable on any loan taken for acquisition or construction of this property
= Income / Loss from House property

- Where the property is given on rent, the annual value will be calculated based on the actual rental and the final income (or loss) from house property will be
calculated as given above. In such a case, there is no restriction on the maximum amount of deduction available in respect of Interest.

III House Rent Allowance (HRA) Rebate Back

- HRA Rebate is calculated at minimum of the following :
a. The actual amount of HRA received by the assessee in respect of the relevant period.
b. The amount by which Rent actually incurred by the assessee exceeds 10% of the Basic Salary
c. An amount equal to -
(i) where such accommodation is situated in Mumbai, Kolkata , Delhi or Chennai, 50% of the Basic Salary
(ii) where such accommodation is situated at any other place ,40% of the Basic Salary

- If annual rent paid by the employee exceeds Rs 1,00,000 p.a., it is mandatory for the employee to report PAN of the landlord to the employer. In case the landlord
does not have a PAN, a declaration to this effect from the landlord along with the name and address of the landlord should be filed by the employee. In the absence of
the the PAN / Declaration, the Rent declaration is liable to be rejected.

IV Details of Salary Income from Previous Employer during the Financial Year. Back
- Details of any Salary Income received by the employee from Previous Employer during the Financial year 2022-23 (New Joinees post 1st April 2022), shall be in
consolidated in the Tax Calculation of the employee on the basis on complete details provided by the employee.

- Documents submitted with respect to Previous Employer Income shall be considered as below :
- Form 16/Final Tax Computation Sheet from the Previous employer shall be considered as a valid document for inclusion of previous
employment income details for the current financial year.
- Payslips for earlier months from the previous employer is not a valid document as the same does not provide information in respect of
exemptions / deductions.
- Please note that offering previous employer income may result in a higher taxable income thereby resulting in additonal tax liability,
therefore, please consult your CA/Tax consultant for further advise