2012-2013

Income Tax Declaration for the Financial Year 2012-13

Assessment Year 2013-2014

./PAN NO. (COMPULSORY)

/NAME IN BLOCK LETTERS __________________________________________________/DESIGNATION :

/RESIDENTIAL ADDRESS :________________________________________________________________________________
_________________________________________________________________________________
Station

1. Gross Salary (includes Basic, DA, HRA, OTA, Honorarium,Emplo.cont.to New pension.
leave encashment on LTC)-------------------------------------------------------------------------------------------Less: TRA, Hill Compensatory Allow,Washing allowance etc. Under Section 10(14)
TOTAL SALARY_______________________________________________________________________.
a) Employers contribution to New pension Fund Fund--------------------------------------------Rs
b) Bonus ------------------------------------------------------------------------------------------------------------- Rs
c) DA Arrears I------------------------------------------------------------------------------------------------------ Rs
d) DA Arrears I------------------------------------------------------------------------------------------------------Rs
e) Pay Arrears ( like increment promotion)-------------------------------------------------------------Rs
f) Medical reimbursement (if it exceeds Rs15000/-)----------------------------------------------Rs.
g) Tution fees reimbursement-----------------------------------------------------------------------------------Rs.
h) Other Income if any------------------------------------------------------------------------------------------- Rs.
Total ----------------------------------- a to h-------------------------------------------------------------------------Rs.
2 GROSS INCOME _____________________________________________________________________
3. Less : Deduction (those who are staying in a rented house/flat.)
Exemption of HRA, least of the following
a. The actual amount of HRA received (HRA x 12)----------------------------------------------------Rs.
b. The excess of (rent paid -10% of basic salary & DP)x12---------------------------------------Rs.
c 50% or 40% of the basic 12 months salary as per class of city.
Rs.
(50% if house is situated in Mumbai, Calcutta, Delhi & Chennai
and 40% if house is situated in any other place)
4 Professional Tax ________________________________________________________________________________________
5 TOTAL INCOME __________

________________

6 Less : Interest on house property (deduction of interest on capital

borrowed from Housing boards, Banks, etc.) max. upto Rs.1,50,000/- -----------------------------------------------7. Less : Deduction under Chapter VIA
(a) Any premium paid by cheque for medical insurance subject to a maximum of ----------------Rs.15,000 under any scheme sponsored by the GIC or any other insurer U/s. 80D
including deduction of Rs 5000/-(Max)for preventive health chek-up
(b) Donation U/s. 80G
______________________________________________ _____________________________________
(c) Deduction if any,.-----------------_________________________________________________________________________________
8. NET INCOME _______________________________________________________________________
9 Less : Deduction
U/s 80C
a) GPF/EPF -----------------------------------------------------------------------------------------------------b) GSLI (Office)---------------------------------------------------------------------------------------------------c) HBA recovery (Office)----------------------------------------------------------------------------------------d) LIC (Office)---------------------------------------------------------------------------------------------------e) LIC ( Directly)--------------------------------------------------------------------------------------------------f) NSC/ULIP---------------------------------------------------------------------------------------------------g) PPF----------------------------------------------------------------------------------------------------------h) Any instalement of principle amount paid to ------------------------------------------------------Housing Boards, LIC, Banks, Finanancial
Institutions etc.( includes stamp duty, registration fee
& other expenses for the purpose of transfer
of such property.
i ) Tution fees paid limited to two Children------------------------------------------------------------------- Rs.
thereafter.
continue to page 2

j) Subscription to units of any Mutual Fund----------------------------------------------------------------k) Any other savings -------------------------------------------------------------------------------------------10)Total Deduction under section 80-C____________________

(a to K)

11) Contribution up to one lakh rupees per annum to the new

pension fund introduced by the LIC or any other insurer notified by
the Central Govt. under Section 80-CCC (Prudential).

Rs.

12) Contribution to the New Pension scheme limited 10% of salary

(Employees contribution ) under section 80 CCD
13) The aggregate amount of deductions under Sections 80-C, 80-CCC,80CCD
and should not exceed Rs.1,00,000/-. (10+11+12)_______________________________
14) Deduction under section 80-CCE
a) Cont. to the New Pension Scheme, upto 10% of salary.------------------------------------(Government'S Contribution to New Pension Scheme)
* From 2012-13 Contribution made by the Government to the New Pension Scheme will be excluded from the limit
of one lakh under section 80 CCE
15 50% of invested amount max.Rs 25000/- up to gross income Rs 10.00 lakhs notified by govt.________________________

16) TOTAL DEDUCTION _______________________________

17) TAXABLE INCOME ________________________________

Taxable Income
Upto Rs 2,00,000
Rs 2,00,001To 5,00,000
Rs 5,00,001 To 10,00,000
Rs 10,00,01 and above

INCOMETAX
Rate of Income Tax
NIL
10% of income
Rs 30,000+20%of income
Rs1,30,000+30% of income

exceeding Rs. 2,00,000

exceeding Rs 5,00,000
exceeding Rs 10,00,000

Add : Education Cess (3% on income tax)________________

Rs.

Total Income Tax & Cess payable._______________________

Rs.

Tax recovered from salary_____________________________________________________________________

Rs.

Tax to be recovered ____________________________________________________________________

Rs.

The documentary evidence in relation to concessions sought by me will be produced herewith as per guidelines adopted
in the meeting of the Vigilance Officers on circular dated 22.06.2006.
I here by declare that I will produce Investment proof as mentioned in declaration form by 31.3.2012
If shortfall in investment as per mentioned in declaration form, I am liable to pay required Income tax
to Income tax department directly.
PLACE :
DATE

Signaure
Name:--