All the proofs

have to be uploaded using the scan image option using the link "Upload IPSF
COPYproofs will be accepted. Please ensure to consolidate all the images of your investmentProof Images[lmages Multiple". No hard
proofs and self-declarations and upload
accordin I
EMERSON EXPORT ENGINEERING CENTRE
IPSE ID : 00838000000000001612
Investment Proofs Submission Form for the Year 2023-2024
Em 10 ee ID*
1327153 Gender*
Name* Date of Joinin 09/08/2021
Rushikesh Ambul ekar No.of Children Goin to School
PAN* 0
BNEPV76S5J No.of Children Goin to Hostel
Re ime T e 0
Old Re ime
Section A - Rent Paid for claimin HRA exem tion Onl Rent Recei
ts will be considered
From Date To Date Address Rent Paid Per Rent Paid Per Property ID
Month Annual
01/04/2023 31/03/2024 Plot no 12, Aditya City, Near 15200.00 182400.00
Balaji Mandir, Nanded,

TRA
As Per Last Declaration Section B - Cha tcrVI A - Deductions from Total Income
Value of Proof Attached
O Medical Insurance - Self/ S ouse / Children <60 rs - With Insurance
o.oc
0 MedicalInsurance- Self/ S ouse / Children >=60 rs - With Insurance
o.oc
0 MedicalInsurance- Self/ S ouse / Children >=60 rs - Without Insurance
o.oc
25000 Medical Insurance for Parents <60 - With Insurance
o.oc
0 Medical Insurance for Parents >=60 s - With Insurance
o.oc
0 Medical Insurance for Parents >=60 s - Without Insurance
o.oc
0 Medical Treatment/Handica ed De endent /s SODD < 80%
o.oc
0 Medical Treatment/Handica ed De endent /s SODD >
o.oc
0 Interest on Educational Loan /s 80E o.oc
0 Permanent Ph sical Disabili 80 < 80%
o.oc
0 Permanent Ph sical Disabili Severe Disabili 80 > 80% o.oc
40000 Medical Treatment of S ecified Diseases 80DDB
o.oc
0 Additional Housino Loan Interest Benefit /s 80EE
o.oc
0 Medical Treatment of senior citizen 80DDB
o.oc
0 Medical Treatment of ve senior citizen 80DDB
o.oc
0 Atal Pension Yo •ana /s 80CCD I B
o.oc
50000 Additional NPS Em 10 ee Contribution /s 80CCDlB)
o.oc
0 Electric Vehicle Loan Interest Benefit /s 80EEB)
o.oc
0 Additional Housing Loan Interest Benefit /s 80EEA
o.oc
0 Deduction for Interest on De osits in Savin os Account /s 80TTA)
o.oc
0 Deduction for Interest on De osits in case of Senior Citizens /s 80TTB
o.oc
Section C - Cha ter VIA - Section 80C
10000 Contribution to Pension Fund 80CCC o.oc
0 Public Provident Fund PF
o.oc
20000 National Savin s Certificate SC o.oc
20000 Infrastructure Bonds
o.oc
0 Children Education Tuition fees
o.oc
79994 ui Linked Savin s Scheme ELSS
104993.0C
0 Mutual Funds
o.oc
0 Unit Linked Insurance Plan o.oc
0 5 Year De osit under Senior Citizen Savin Scheme o.oc
0 Cumulative Term De osits o.oc
0 Sukan a SamriddhiScheme o.oc
0 5 Year Time De osit in Post Office o.oc
O Atal Pension Yo•ana U/s 80CCD o.oc
O NPS Em 10 Contribution U/s 80CCD o.oc
200000 Housin Loan - Princi al Amount aid Re Jistration Fees Stam du o.oc
0 Fixed De osit Scheme Block Period of 5 rs ooc
0 NSC Interest Will also be considered as Other Incorne o.oc
Section G -Other Income
O Bank Interest excludin interest on savin s account 0.00
O Interest Income to Senior Citizen Considered as deduction u/s 80TTB u to Rs.50000 o.oc
O Interest on De osits in Savin s Account Considered as deduction u/s 80TTA u to Rs. 10000 o.oc
0 Others o.oc
 0 Interest on PF Account
0 NSC Interest Other Income 0.00

Pa roll Deduction
Amount
Particulars
49572.00
Provident Fund
49572.00
Pa roll Deduction - Total

De endent Details:
De endent Name Relationshi
Self 26
RushikeshAmbul ekar
Father 53
Vasudev Joshi Ambul ekar
Mother 51
Pravina Joshi Ambul ekar
Brother 24
Aksha Ambul ekar

Declaration:
and that, all information, documents provided are true and correct in
I. I hereby declare that I have read and understood the guidelines provided in "Proofs Option Document"
all respects.
claimed twice in a lock of 4 years (irrespective of the number of
2. LTA exemption claimed by me (if applicable) is as per IT rule which specifies that exemption can be
employers in the block period)
of any incorrect information, documents provided by me.
3. I also undertake to indemnify the company for any loss/liability that may arise, in the event
Date:

Place:
Signature of Employee *
please fill and submit the form.
* Indicates mandatory fields as per our database. Please verify the same and if blank,
HRA Land Lord Details
Landlord Pan Landlord Address Annual Rent
Pro e Landlord Name
Plot no 12, Aditya City, Near 18240C
Akshay Ambulgekar CCLPA3257P
1
Bala•iMandir Nande 431605
 FORM NO. 12BB
(See rule 26C)

Statement showing particulars Ofclaims by an employee for deduction of tax under section 192
l. Name and address of the employee Rushikesh Ambulgekar
BNEPV7655J
2. Permanent Account Number of the employee
3. Financial year : 2023-2024

Details of claims and evidence thereof

Amount(Rs.) Evidence/Particulars
Sl. No. Nature of claim
(3) (4)
(1) (2)
House Rent Allowance:
Property No : 1
(i) Rent paid to the landlord Rs. 182400

(ii) Name of the landlord Akshay Ambulgekar Rs. 182400.0 House Rent Receipts
l.
(iii) Address of the landlord Plot no 12, Aditya City, Near Balaji Mandir,
Nanded, 43 1605

(iv) Permanent Account Number of the CCLPA3257P

landlord

Rs.O.O Travel Receipts/Tickets

2. Leave Travel Concessions or Assistance

Deduction of Interest on Borrowing:

(i) Interest Payable/Paidto the Lender

(ii) Name of the Lender
(iii) Address of the Lender Provisional Certificate from
Rs.O.O Bank/Financial Institution/Lender
3.
(iv) Permanent Account Number of the Lender
(a) Financial Institutions
(b) Employer
(c) Others

Deduction under Chapter VI-A

(A) Section 80C,80CCC and 80CCD

(i) Section 80C
: Rs.49572
(a) Provident Fund
Rs.104993 Photocopy of the investment
(b) Equity Linked Savings Scheme (ELSS) Rs. 154565.0
4. proofs
(ii) Section 80CCC

(iii) Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.

Verification

I Rushikesh Ambul ekar Son/Dau hter of Vasudev Joshi Ambul ekar. do hereb certi that the information iven above is com lete and correct.

Place : PUNE

Date : 19-01-2024
Si nature of the m 10 ee

Desi ation : Officer A lication Su ort Full Name: Rushikesh Ambulgekar

login on
Note: The information/details above, as required for deduction of tax u/s 192 of the Income Tax Act, has been entered by the employee through an authorized
the portal.
 IIRA FUTURE RENT DECLARATION
EMERSON EXPORT ENGINEERING CENTRE
EMP ID 1327153
EMP NAME Rushikesh Ambulgekar
RENT AMOUNT PER MONTH 15200
FOR THE PERIOD 01-01-2024 TO 31-03-2024
LANDLOARD NAME Akshay Ambulgekar
LANDLOARD PAN CCLPA3257P

The proofs/original rent receipts would be submitted on request along with the copy of the Self declaration.

Employee Declaration

Date Tan 20
Place
Signature of Employee *
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 rent.