Form of declaration from employee for TDS for the F.Y. 2011-2012

DECLARATION  FORM FOR THE F.Y. 2011-2012
PLEASE NOTE:
            »         PAN  & Address are mandatory. Please do not fail to furnish the same.
            »         Please indicate details of your investments in appropriate columns only.
(1)     Full Name:
            Mr. /Mrs./Ms. __________________________________________________________________________
            Department ____________________________________ Designation __________________________
            Branch _________________________________________________________________________________
            Contact No. ____________________________________   Male / Female  ______________________
            Email Id __ _____________________________________________________________________________
            Date of Birth ___________________________________  Date of Joining ______________________
(2)     Income Tax Permanent A/c. (PAN) No. : ___________________________________________
            (MONDATORY) Please provide Xerox / Scan copy of PAN Card.
            Deduction available from salary income under chapter VI A:
           
Sr.
No.
Description of
Investment/s
Documents Required
Maximum
Limit
Rs.
Amount in Rs.
(to be filled in by the employee)
1
House Rent paid to the Landlord
Original Rent Receipts every month (with Revenue Stamp above Rs.4999/-) or Rent Agreement
(Monthly Rent Amount)
2
Mediclaim – 80 D
Mediclaim Policy Copy or Premium Certificate
15,000/-
3
Mediclaim – 80 D
(Parents)
Mediclaim Policy Copy or Premium Certificate
20,000/-
4
Interest on Housing Loan Loan taken prior to 01/04/99
Certificate from Bank / Financial Institution
30,000/-
5
Interest on Housing Loan  Loan taken after 01/04/99
Certificate from Bank / Financial Institution
1,50,000/-
6
Expenditure on Dependant with – Disability Rs. 50,000 – Several Disability Rs. 1,00,000-80-U
Certificate from Prescribed Authority in Form No. 10-IA Sec. 80 DD
1,00,000/-
7
Expenditure on Specified Disease
Certificate from Prescribed Authority in Form No. 10-I Sec. 80 DDB
40,000/-


Deduction u/s 80 C (Maximum of Rs. 1,00,000/-)
Sr.
No.
Description of
Investment
Documents Required
Maximum
Limit
Rs.
Amount in Rs.
(to be filled in by the employee)
1
Public Provident Fund
Copy of Payment Receipt / Passbook
70,000/-
(Do not write EPF)
2
Life Insurance Premium including Pension Plan & ULIP
Copy of Premium Payment Receipt (proposal receipt will not be considered)
3
Repayment of Housing Loan Principal
Certificate from Bank / Financial Institution
4
Mutual Fund (Equity)
(Sec. 10(23D))
Statement of Holding
5
NSC Purchased during the year
Copy of NSC Certificate/s
6
Interest on NSC Purchased
Statement regarding date of purchase & amount
7
Tuition Fees
(Up to Two Children)
Copy of Payment Receipt from School
8
National Saving Scheme
Copy of NSS Certificate/s
9
Bank Fixed Deposit (More than 5 Years)
Copy of FD Receipt
10
Infrastructure Bond
Statement of Holding
(In addition to Rs. 1,00,000) 20000/-
11
Donation to Registered Trust – 80 G
Original Donation Receipts & PAN of Donnie
12
Other Investments
Medical Bill Reimbursement
Original Medical Bills (including Parents, Wife/Husband, Children)
1250/- every month
DECLARATION
I, declare that the above statement is true to the best of my knowledge and belief. In the event of any change that may occur during the year pertaining to the information given in the form, I undertake to inform the same to the company. Income Tax liability arising due to failure, if any, for not making / not intimating payment / investment made or proposed to be made by me and / or any wrong declaration would be my responsibility.
I further undertake to provide all documentary proofs of payment made by me before 15th March 2012 and if I fail to do so, the company can make full deduction of income tax dues from March 2012 salary.
Date : ___________________________                                                                     _________________________________
                                                                                                                            Signature of the Employee
DECLARATION FOR HOUSE RENT ALLOWANCE RELIEF – FINANCIAL YEAR 2011-12
Details of rent actually paid:
a.       Address of residential property in respect of which rent paid.
       ________________________________________________________________________
       __________________________________________________________________________
b.       Name of Landlord to whom rent is paid: ________________________________
c.       Rent payable / paid during the Financial Year:  Rs.____________________
(Please attach copy of Lease / Rent Agreement. In case no agreement is executed submit copy of ORIGINAL rent receipts. In case rent receipt is not submitted, the relief will not be given.)
DECLARATION:
i.        I hereby declare that I shall inform immediately to the company any change in monthly rent stated above or discontinuation of house rent payments.
ii.       I also declare that no residential accommodations owned by me or by my spouse or by my child or by HUF of which I am a member at the place where I reside or perform the duties of employment.
iii.     I hereby declare that what is stated above is true and correct. Any Income Tax dues arising out of wrong declaration will be my sole responsibility.
Date : ______________________________                                                               _________________________________
                                                                                                                                          Signature of Employee

Leave a Reply

Your email address will not be published. Required fields are marked *