EMPLOYEES DECLARATION FOR INCOME-TAX DEDUCTION ON SALARY FY 2018-2019

Employee Code ……………………….. Name of Employee:-…………………………………………………………….. DOJ………………………. Location ………………………..

Name of the Company ……………………………………………………..PAN (Mandatory) ……………………………………………….Contact No: ……………………………………

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I certify that during the year ending 31 March 2019 the following amount/s has/have/will be/been paid by me directly out of my income chargeable to tax
and that appropriate deductions may please be allowed while calculating taxable Income under the head salary.

I. HOUSE RENT ALLOWANCE

This is to declare that I am presently staying in a rent accommodation paying a rent of RS /- per month,(from to as per copy of
Lease Agreement attached. The house is owned by

Mr./Mrs. …………..……………………………………………………. Address …………………………………………………………………………………………………………….

PAN of Landlord ……………………………………….. (if rent Exceeds Rs. 15000/-pm or 1.8 L Per annum) …………………… Metro …………………. Non Metro

Month Rent Paid Date of rent Month Rent Paid Date of rent Month Rent Paid Date of rent
Paid Paid Paid
Copy of Lease
Agreement
Apr- 2018 Aug - 2018 Dec- 2018
May- 2018 Sep - 2018 Jan- 2019
Jun- 2018 Oct - 2018 Feb- 2019
July- 2018 Nov - 2018 Mar- 2019
II. Housing Loan

Mandatory Requirement: Please enclose the EMI Payment Schedule or Provisional Certificate issued by the Housing Financial Institution or bank for F.Y. 2018- 2019and
proof of occupation of the house.

Please provide Date of Completion ____/____/____ Date of Occupation ____/____/____

From 1st April, 2018 to 31st March, 2019: (Without Provisional Certificate this figure will not be considered)

Principal Amount Interest Amount Paid to Financial Institutions PAN No. of Lender Date of Possesion

III. DEDUCTIONS UNDER CHAPTER VI-A: (Condition Apply)

DEDUCTION UNDER SEC. 80C :( Maximum of Rs. 1,50,000/- any of the following heads)
Name of the Savings Scheme Amount(Rs.)
Life insurance Premium (Premium paid to a max. of 10% of capital sum assured in a year
Investment in Mutual Fund-ELSS Equity Linked Saving Scheme
Investment Public Provident Fund (PPF)/ National Saving Certificates (NSCs)
Tuition Fees (Max 2 Children)
Any Other Please Specify
Sr. No. U/S Sec. Nature of Payment Paid/ Deposited Max. Deduction (Rs.)

A) 80D-Self Medical Insurance Premium Paid 15,000/-

B) 80D- Parents 15,000/-(if Sr. Citizen Rs.
20,000)
C) 80 DD Medical Treatment of Handicapped Dependent 50,000/- (If disability above
80% than 1 lac)
D) 80DDB Expenses on Medical Treatment on certain disease. 40,000/-(If Sr. Citizen than
60,000)
E) 80 E Payment of Interest towards loan taken for higher studies No Limit

F) 80 U Income of totally blind or physically handicapped person 50,000/- (If disability above
80% than 1 lac)
I Declare that the information given is true and correct to my knowledge and belief. I undertake to notify in writing any changes, but not later than 31st Dec 2018 to claim
relief from tax deduction. Further I Undertake to hold the company and its Officers other employees indemnified from all consequences, monetary and otherwise, arising out
of any incorrect and/or incomplete information provided by me here in above.

Date: Signature of the employee Checked By Approved BY