Indian Oil Corporation Limited Declaration for Claiming DEDUCTIONS in Income Tax for the financial year 2011-2012

Name: ________________ Emp. No._______ Deptt.: _________________ Contact No.______ Desig.____________ Unit/Location______ PAN No_______________

I hereby declare that the following sums (against serial no.1 to 14) have been directly paid/ deposited out of my income from salary chargeable to tax for the financial year 2011-2012, and the deduction there against shall not be claimed by any other person. A. DEDUCTION FOR SAVINGS U/s 80C AMOUNT
(Deposited/Paid(RS)

POLICY No./ CER. No/.

DATE OF

1 2 3 4 5 6
B.

Life Insurance Premium Paid Public Provident Fund (A/c No.__________) Sec. 80 CCC (Pension Fund) Tution Fee- For Maximum of 2 children ULIP / Mutual Fund (Notified in Off. Gazette) Others ( Please Specify ) Bank FD, NSC etc. TOTAL (80C,80CCC,80CCD) : Maximum Rs. 1 Lac
OTHER DEDUCTIONS :
Maximum Amount

AMOUNT
(Deposited/Paid

(Rs.)

POLICY No./ CER. No/.

DATE OF

(Rs.)

1 2 3 5 6 7
8

Sec 80 CCF (Infrastructure Bonds) Sec. 80 D (Medical Insurance Premium)

20000 15000/20000

Sec. 80 DD* (Expenditure on medical 50000 100000 treatment of handicapped dependent ) Sec. 80 DDB (Medical Treatment Sp. 40000/60000 Disease, Higher deduction for senior citizen) Sec 80 E (Interest on education loan) Sec. 80 U (Self Handicapped) * (if 50000/ 100000 disability more than 40%/80%) Others (Please specify)

Rs. 50000 if disability >40%, Rs 1 lac if > 80%,

C. OTHER INCOME (as per form attached). AMOUNT(Rs.)

BANK INTEREST ETC. ANY OTHER INCOME (Please specify)

D. INCOME/LOSS FROM HOUSE PROERTY (as per form attached). Income/Loss From House 3 Property (Use Negative sign for loss) E. RENT RECEIPT INFORMATION

Name of Owner & Relation if any

Address & PAN No. of Owner

Amount of Rent Paid per month

Period

A certificate of permanent physical disability from a physician/surgeon working in a Govt. Hospital/ dispensary has already been produced before the assessing officer in the earlier assessment year. A photocopy of the same is enclosed.

Signature: _____________________
FORMS, duly filled in along with the Photocopies of Savings may please be with Payroll Section and get it verified from payroll section. submitted

**It is mandator y to quote PAN no

NOTE: TDS on House Property(Self Lease) & Interests etc. cannot adjusted against Tax on Salary

Form for sending particulars of Income under section 192 (2B) For the year ending 31st March, 2012.
1. 2. 3. Name and address of the Employee : Permanent Account Number : Residential Status : _________________________ _________________________ _________________________ _________________________

4.

Particulars of Income under any head of Income other than SALARIES (not being a loss under any such head other than the loss under the head Income from House Property) received in the financial year: (i) (ii) (iii) (iv) Income from House Property (in case of Loss, enclose computation thereof ) Profits and Gains of business or profession Capital Gains Income from Other Sources : (a) (b) Interest Other Incomes (Specify) __________ __________ TOTAL_____________ 5. Aggregate of Sub-items (I) to (iv) of item 4 .. . . .

COMPUTATION OF INCOME FROM HOUSE PROPERTY FOR FINANCIAL YEAR 2011-12

Name : _____________________ Employee No.________________

1. Address of the Property : ________________________________________________ ________________________________________________ 2. Annual Value/Higher of Annual Rent received or receivable/reduced Annual Rent received or receivable because of vancancy: 3. Taxes actually paid to local authority: 4. Annual value of property (2-3) (Can not be negative) 5. Less: deductions claimed U/s 24: (a) Thirty percent of annual value

(b) Interest payable on borrowed capital- 6. Total of 5 above 7. Income chargeable under the Head INCOME FROM HOUSE PROPERTY (4-6) . .

Verification I, .do hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of ., 20 . Place: ______________ Date : ______________

Signature of the Employee