Investment Declaration Form 2013-14
 (To be used to declare investment for income Tax that will be made during the period 2013-2014)
1  Company    EmployeeID  
2  Employee    
3  PAN Number    
Item Particulars Max. Limit Declared_Amt
 Deduction Under Section 10
4  House Rent Sec 10(13A)  I am staying in a house and I egree to submit rent receipts when required. The Rent paid is (Rs._______ Per Month) & the house is located in Non-Metro  
5  LTA Sec 10(5)  I will provide the tickets/ Travels bills in original as per(twice basic monthly) the LTA policy or else the company can consider amount as taxable. 0
6  CEA Sec 10(14)  I will provide the copy of tution fees reciept as per CEA policy or else the company can consider amount as taxable.(Rs100/- per month per child upto max of two children) 2400
7  Medical Sec 17(2)  I will produce the Medical Bills to the Satisfacton of the company for my eligibility of Rs. 15000/- as per Income Tax Act of else the company can consider the amount paid as taxable 15000
 ** If you have opted for the medical reimbursements ( being Medical expenses part of your CTC)
Max. Limit Declared_Amt
8  Deductions Under Chapeter VI A  Sec.80D - Medical Insurance Premium (If the policy covers a senior Citizen then additional deduction of Rs.5000/- is available & deduction on account of expenditure on preventive Health Check-Up (for Self, Spouse, Dependant Children & Parents )Shall not exceed in the aggregate Rs 5000/-.) 15000
 "Sec. 80DD - Medical treatment/insurance of Handicapped Dependant A higher deduction of Rs. 100,000 is available, where such dependent is with severe disability of > 80%" 50,000
 "Sec 80DDB - Medical treatment (specified diseases only) (medical treatment in respect of a senior Citizen then additional deduction of Rs.20,000/- is available)" 40,000
 Sec 80E - Repayment of Loan for higher education (only interest)  
 Sec 80U - Handicapped 50,000
 Sec 80G - Donation to certain funds
 Sec 80GGA - Donation for scientific research  
Max. Limit Declared_Amt
9  Deduction Under Section 80C  Sec 80CCC - Contribution to Pension Fund (Jeevan Suraksha) 100,000
 Life Insurance Premium 100,000
 Defferred Annuity 100,000
 Public Provident Fund 100,000
 Time Deposit in Post Office / Bank for 5 year & above 100,000
 ULIP of UTI/LIC 100,000
 Principal Loan (Housing Loan) Repayment 100,000
 Mutual Funds 100,000
 Investment in infrastructure Bonds 100,000
 Children- Tution Fee restricted to max.of 2 children 100,000
 Deposit in NHB 100,000
 Deposit In NSC 100,000
 Others (please specify) Employee Provident Fund 100,000
Max. Limit Declared_Amt
10  Previous Employment Salary (Salary earened from 01/04/12 till date of joining)  If yes, Form 16 from previous employer or Form 12 B with tax computation statement  
 Salary paid by the Previous Employer after Sec.10 Exemption  
 PROFESSIOAL TAX deducted by the Previous Employer  
 PROVIDENT FUND deducted by the Previous Employer  
 INCOME TAX deducted by the Previous Employer  
 
11  Income other then Salary Income  If yes, then Form 12C detailing other income is attached(only interest)    
Max. Limit Declared_Amt
12  Deduction under Section 24  Interest on Housing Loan 1,50,000.00
 Interest if the loan is taken before 01/04/99 30,000.00
 Note: Form 12C along with the calculation of loss on house property heeds to be attached for considering the above
 Declaration:
 1) I hereby declare that the information given above is correct and true in all respects.
 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