investment declaration form 2015-16.xls

7/25/2019 Investment Declaration Form 2015-16.Xls

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INCOME TAX DECLRATION FORM FOR THE YEAR 2015-16 (A. Y. 2016-17)

(To be used to declare investment for Income Tax that will be made during the period 2015-16

Compan Nam!

Emp"o!! Nam!

Emp"o!! No.

Da#! O$ %o&n&n'AN Nm*!+

Ma++&!, o+ No#

No. o$ C&",

!#!+ an /#a$$ a+!&"! p+o&,!,(YN)

3+. No. Na#+! o$ 3a&n'/ R!*a#! 3!#&on o$ IT A# Ma4&mm L&m

1 HRA Rebate under I.Tax Rule-2 A and u/s 10 (13 A) 10 (13 A) As per Rule

PAN NO. OF AN!OR!""""""""

2 2# 200$000

D!#a&"/ o$ Ho/! &",&n' Loan

A%&unt &' &an !ate/ear- In *+,* &an !+sbursed.

In,&%e/&ss Fr&% H&use Pr&pert (n,l&se &%putat+&n-F&r% 12 )

3 1$000.00

# As per TA Rule

!ur+n t*e ear 201# es/N&

!ur+n t*e ear 201 es/N&



R!*a#!

n,!+ / 0C 0CCC 8 0 CCD(1) 10$000

(a) +'e Insuran,e Pre%+u% 40

!e'erred Annu+t

Publ+, Pr&5+dent Fund

!ep&s+t +n P&st O''+,e 6a5+ns 6,*e%e

7IP &' 7TI/I

Pr+n,+pal &an (H&us+n &an) Repa%ent

8utual FundsIn5est%ent +n In'rastru,ture 9&nds

Tu+t+&n 'ee ex,lud+n de5el&p%ent 'ee : d&nat+&n (7pt& 2 ,*+ldren)

!ep&s+t +n NH9

I hereb! declare and intend to claim rebate in the current "inancial #ear (2015-16$ under Income Tax %ections as indicate

herewith re'uisite self attested erox cop! of documents to claim rebate&

8&nt*l Rent Pa+d Rs.""""p.%. Rent re,e+pt dul 5er+'+ed b stt.&n,erned are en,l&sed *ere;+t*.

Interest &n &an b&rr&;ed '&r ,&nstru,t+&n /a,en exe%pt+&n '&r TA +n t*e '&ll&;+n ears

If I do not produce the bills to the satisfaction of the .ompan!$ then the .ompan! can consider the amount pai

taxable


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!ep&s+t +n N6

F+xed !ep&s+ts ;+t* 6,*eduled 9an> '&r per+&d n&t less t*an ears

An dep&s+t %ade +n 6u>ana 6a%r+d*+ A/,

Ot*ers (Please 6pe,+') PF ? PT

(b) Pens+&n 6,*e%e In5est%ents/@ee5an 6ura>s*a upt& Rs. 1.00 a,. 40

(,) &ntr+but+&n t& Ne; Pens+&n Fund (%pl&ee and &5tBs s*are b&t*) 40 ! (1)

40 ! (19) 0$000

40 2$000

4 8ed+,la+% P&l+, - 40 !

Ot*er Ind+5+duals 2$000

6en+&r +t+=en (0 ears and ab&5e) 30$000

30$000

C 40!!

1. +t* %&re t*an &r eeep +n '&r,e an

+nsuran,e &n t*e *ealt* &' su,* pers&n$ as d&es n&t ex,eed t*+rtt*&usand rupees s*all be all&;ed as dedu,t+&n under se,t+&n 40!.

xpend+ture '&r %ed+,al treat%ent &r dep&s+t %ade '&r *and+,appeddependent ;+t* dependent ;+t* d+sab+l+t . ert+'+,ate 'r&% Pres,r+bedAut*&r+t +n F&r% N&. 10-IA +s re


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1 P&ssess+&n/all&t%ent letter and 6an,t+&n etter &' &an +n respe,t &' pr&pert '&r ;*+,* rebate &' H9A ,la+%ed.

2 A,,rued H9A Pr+n,+pal/Interest ,ert+'+,ate 'r&% t*e 9&rr&;+n Aut*&r+t/9an> '&r t*e F.-201-1.

9an> 6tate%ent s*&;+n t*e H&us+n &an Instal%ents /dedu,t+&ns.

+

3lace 3&'na#+! o$ Em

4ate Nam!;;;;;;;;;

!eta+led ,al,ulat+&n &n a,,&unt &' rent/dee%ed rent &' a,ant FlatBs/H&useMs ;*+,* +s let &r dee%ed t& be let &ut s*

I$ declare that the above statement is true to the best of m! nowledge and belief& In the event of an! change tha

the !ear pertaining to the information given in the form$ I undertae to inform the same to the compan!& Incom

due to failure$ if an!$ for not maing * not intimating pa!ment * investment made or proposed to be made b! medeclaration would be m! responsibilit!&

I further undertae to provide all documentar! proofs of pa!ment made b! me before 15th arch 2016 and if I

compan! can mae full deduction of income tax dues from arch 2016 salar!&


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D!"a+!, Amon#

below& I enclose

tructed with capitalrom the end of

towards /T as


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n.

under G-


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"o!!

;;;;;;;;;;;;;;;;

uld be p&s+t+5el

ma! occur during

Tax liabilit! arising

nd * or an! wrong

ail to do so$ the


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FORM NO. 12


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ANNEX?RE


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ANNEX?RE

(Con#,.)

1 10 11 12

Na%e &' %pl&eeG-

Pla,e

Na%e &' t*ee%pl&ee

*et*er an ,&n5ean,e *as been pr&5+ded b t*e e%pl&er 'ree &r at a ,&n,ess+&nal rate &r;*ere t*e e%pl&ee +s all&;ed t*e use &' &ne &r %&re %&t&r ,ars &;ned &r *+red b t*e

e%pl&er$ est+%ated 5alue &' per


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6+nature

!ateG-


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Re%ar>s

4 C 10 11 12

6+nature &' t*e e%pl&ee


r due t& be pa+d t& t*e

T&tal &' ,&lu%ns$ $ and 4

A%&unt dedu,ted +n

respe,t &' l+'e+nsuran,e pre%+u%$

pr&5+dent 'und,&ntr+but+&n$ et,.$ t&

;*+,* se,. 40 appl+es (+5e deta+ls)

T&tal a%&unt

&' taxdedu,teddur+n t*e ear

(en,l&se,ert+'+,ate

+ssued underse,t+&n 203)

alue &' per


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!n# $n, aon#

ed b t*e e%pl&er (+5e bas+s &' ,&%putat+&n)6ee rules 3(a) and 3(b)

s*ed

4 C

Per


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13 1# 1 1


st+%ated 5alue &' an &t*er bene'+t &r

a%en+t pr&5+ded b t*e e%pl&er$ 'ree &',&st &r at ,&n,ess+&nal rate n&t +n,luded+n t*e pre,ed+n ,&lu%ns (+5e deta+ls)$

e..$ suppl &' as$ ele,tr+,+t &r ;ater '&r*&use*&ld ,&nsu%pt+&n$ 'ree edu,at+&nal

'a,+

%pl&erMs

,&ntr+but+&n t&re,&n+sed pr&5+dent'und +n ex,ess &' 12D

&' t*e e%pl&eeMssalar 6ee 6,*edule

I - Part A

Interest,red+ted t& t*e

assesseeMsa,,&unt +n

re,&n+sedpr&5+dent 'und

+n ex,ess &'t*e rate '+xed

b t*e entral&5ern%ent

6ee 6,*eduleI - Part A

T&tal &'

,&lu%ns Ct& 1,arr+ed t&

,&lu%n 4 &'F&r% N&.

129


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15/15

FORM NO. 12C

Fo+m $o+ /!n,&n' pa+#&"a+/ o$ &nom! n,!+ /!#&on 1B2(2) $o+ #! !a+ !n,&n' 1/# Ma+ ...

1 Na%e and address &' t*e e%pl&ee

2 Per%anent A,,&unt Nu%ber

3 Res+dent+al status

#

R/. R/.

(+) In,&%e 'r&% *&use pr&pert

(+n ,ase &' l&ss$ en,l&se ,&%putat+&n t*ere&')

(++) Pr&'+ts and a+ns &' bus+ness &r pr&'ess+&n

(+++) ap+tal a+ns

(+5) In,&%e 'r&% &t*er s&ur,es

(a) !+5+dends 0

(b) Interest 0

(,) Ot*er +n,&%es 0 0

Areate &' sub-+te%s (+) t& (+5) &' +te% #

Tax dedu,ted at s&ur,e en,l&se ,ert+'+,ate(s) +ssued under se,t+&n 203

Pla,e .................... 3&'na#+! o$ Emp"o!!!ate .................... Nam!;;;;;;;;;;;;;;;;;;

7erification

Pla,e .................... 3&'na#+! o$ Emp"o!!

!ate .................... Nam!;;;;;;;;;;;;;;;;;;

Part+,ulars &' +n,&%e under an *ead &' +n,&%e &t*er t*an Ksalar+esL (n&t be+n al&ss under an su,* *ead &t*er t*an t*e l&ss under t*e *ead KIn,&%e 'r&% *&usepr&pertL) re,e+5ed +n t*e '+nan,+al ear

I$ .......................... .............. d& *ereb de,lare t*at ;*at +s stated ab&5e +s true t& t*e best &' % >n&;lede and bel+e' er+'+ed t&da$t*e ........................................ da &' .................................. Q Q

investment declaration form 2015-16.xls

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