Investment Submission Form
(To be used to declare investment for income Tax that will be made during the period )
Company
EmployeeID
Employee
PAN Number
Item
Particulars
Max. Limit
Declared_Amt
Submiss
n
_Amt
Admin_Amt
Deduction Under Section 10
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
0
0
LTA Sec 10(5)
I will provide the tickets/ Travels bills in original as per(one basic annually) the LTA policy or else the company can consider amount as taxable.
0
0
0
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
Child 1
Child 2
0
0
** If you have opted for the medical reimbursements ( being Medical expenses part of your CTC)
Max. Limit
Declared_Amt
Submiss
n
_Amt
Admin_Amt
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/-.)
0
0
"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%"
0
0
"Sec 80DDB - Medical treatment (specified diseases only) (medical treatment in respect of a senior Citizen then additional deduction of Rs.20,000/- is available)"
0
0
Sec 80E - Repayment of Loan for higher education (only interest)
0
0
Sec 80U - Handicapped
0
0
Sec 80G - Donation to certain funds
Select
50%
100%
0
0
Sec 80GGA - Donation for scientific research
0
0
Max. Limit
Declared_Amt
Submiss
n
_Amt
Admin_Amt
Deduction Under Section 80C
Sec 80CCC - Contribution to Pension Fund (Jeevan Suraksha)
0
0
Life Insurance Premium
0
0
Defferred Annuity
0
0
Public Provident Fund
0
0
Time Deposit in Post Office / Bank for 5 year & above
0
0
ULIP of UTI/LIC
0
0
Principal Loan (Housing Loan) Repayment
0
0
Mutual Funds
0
0
Investment in infrastructure Bonds
0
0
Children- Tution Fee restricted to max.of 2 children
0
0
Deposit in NHB
0
0
Deposit In NSC
0
0
Sukanya Samriddhi
0
0
Others (please specify) Employee Provident Fund
0
0
Max. Limit
Declared_Amt
Submiss
n
_Amt
Admin_Amt
Sec. 80CCD(1B)
NPS (National Pension Scheme)/ Atal Pension Yojna(APY)
0
0
Sec. 80CCD(2)
Corporate NPS Scheme
10% Of Basic Salary
0
0
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
0
0
Salary paid by the Previous Employer after Sec.10 Exemption
0
0
PROFESSIOAL TAX deducted by the Previous Employer
0
0
PROVIDENT FUND deducted by the Previous Employer
0
0
INCOME TAX deducted by the Previous Employer
0
0
Income other then Salary Income
If yes, then Form 12C detailing other income is attached(only interest)
Max. Limit
Declared_Amt
Submiss
n
_Amt
Admin_Amt
Deduction under Section 24
Interest on Housing Loan
0
0
Interest if the loan is taken before 01/04/99
0
0
Total :
0
0
0
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 :
Admin Signature