Manhattan Associates (India) Development Centre Pvt.

Ltd

DECLARATION TOWARDS FUTURE PAYMENTS FALLING DUE AFTER PROOF

CONFIRMATION DATE xxxxxxxxx

Emp Code: Name: Location :

Given below are the details of premiums that are due for payment after the proof confirmation date but are
payable before the financial year-end 2022-23. Please consider these premiums payable for the tax benefit
in the current financial 2022-23.

Sl. Policy - 80D Policy No. Due Date Amount

No Medical Insurance
1
2

Sl. Policy - 80CCC Policy No. Due Date Amount

No Pension Policy
1
2

Sl. Life insurance Policy No. Due Date Amount

No Premium
1
2

Sl. Unit Linked Policy No. Due Date Amount

No Insurance plan
1
2

Sl. Public Provident Account No. Due Date Amount

No Fund (PPF)
1
2

Sl. Sukanya Account No. Due Date Amount

No Samriddhi Scheme
1
2

Sl. Mutual Fund / Folio No. Due Date Amount

No ELSS
1
2

Sl. Children Tuition Class Due Date Amount

 No fees
1
2

Note: Benefit would be extended only on submission of this Form for any premiums falling due
after the proof confirmation date. New policy planned to take after proof confirmation date will
not be considered and disallowed.
Employee Declaration

I hereby declare that the information provided above is true and correct and will be solely responsible for any
situation arising out of non-payment of the above future premiums/payments before 31 st Mar 2024.

Signature: Date: