ACTUAL INVESTMENT PROOF FORM

(FOR FINANCIAL YEAR 2016 2017)

[As Amended by Finance Act, 2016]
PERSONAL INFORMATION
Employee ID * 1264
Name of the Employee ROMY GOYAL
Designation ASSISTANT MANAGER-SALES
Company Name * CHD DEVELOPERS LIMITED
PAN * AVFPG5002J
Date of Joining 01-12-2014
(Required only if joined on or after 1st April, 2016)
Contact No. / Extn. No. * 9034715481 / 9996032997

SECTION I
DECLARATION OF RENT FOR THE PURPOSE OF EXEMPTION U/S 10(13A)
Rent Paid*# (per month) 7500/-
Location of Property taken on Lease/Rent* KARNAL, HARYANA (NON METRO)
Metro (only in case of Delhi/ Mumbai/ Kolkata/ Chennai)
Non Metro Any other State
*(Rent Receipts should be submitted as proof, duly affixed with revenue stamp at the time of leaving/whenever called for)
#If Rent exceeds Rs.1,00,000/- per annum, copy of PAN Card of Landlord is mandatory.

SECTION II
INVESTMENT PROFILE
S. No. Description Amount (INR)
1. Section 80C
-- LIC Premium
-- Public Provident Fund (PPF) 50,000/-
-- NSCs
-- Investment in Notified Mutual
Funds/Infrastructure Bonds / UTI / ULIP
-- Principal on Housing Loan
-- Child Education Fees (Tuition Fees)
(subject to 2 children only)
-- Investment in Fixed Deposit for 5 years or
more with a scheduled bank as notified by
Central Government
-- Investment in Five Year Time Deposit
Scheme in Post Office
-- Subscription to Sukanya Samriddhi Account
Scheme
2. Section 80CCC
-- Premium paid under certain Pension Funds
3. Section 80CCD
(1) -- Contribution to towards National
Pension Scheme (NPS) by employee
(1B) Additional contribution upto INR
50,000/- towards NPS
Aggregate amount of deduction under sections 80C, 80CCC & 80CCD(1) shall not exceed INR 150,000/-[Sec 80CCE]
On additional contribution under section 80CCD(1B), the ceiling of INR 150,000/- u/s 80CCE will not be applicable

4. Section 80D
-- Medical / Health Insurance Premium (paid via
any mode other than cash)
-- Preventive Health Check-up (upto INR
5,000/-, cash payment allowed)

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 [Overall Limit shall not exceed INR 25,000/-; Further for Parents
(if Senior Citizen INR 30,000/-, otherwise INR 25,000/-)]*
5. Section 80DD
-- Maintenance including medical treatment of
Handicapped dependent
6. Section 80E
-- Interest on Education Loan
7. Section 80U
-- Deduction in respect of physical disability
(Handicapped employee)

SECTION III
DECLARATION FOR THE PURPOSE OF DEDUCTION U/S 24 OF INCOME TAX ACT, 1961
S. No. Particulars
1. Address of property purchased / constructed *

(Mandatory Field)
2. Status of Property *
(Self-occupied/Let-out/Vacant)
(Mandatory Field)
3. Housing Loan taken from *
(Name of Bank/Institution)
(Mandatory Field)
4. Purpose of Loan
(Construction/ Acquisition/ Reconstruction/ Repair)
5. Date on which construction is/will be completed
(mm/yyyy) (Mandatory)
6. Section 24(b)1 INR
-- Amount of Interest for the financial year 2016
- 2017
(Certificate from Banks, etc should be submitted as proof)
(Max Limit : INR 2,00,000/-)

DECLARATION

I ROMY GOYAL Emp. ID. No. 1264 do hereby declare that the proof of investment as stated above is
correct and true in all respect. I am also aware that the company will be considering the above mentioned
details in utmost good faith based on the details provided by me and that I am personally liable for any
consequences arising out of errors, if any in the above information.

Date : 20-01-2017

Place : KARNAL (Signature of Employee)

1 Abstract from Finance Act:Interest on Loan taken for purchase, construction, re-construction, repair or
renewal of Property is deductible u/s 24(b) upto Rs.30,000/-. However, if the following conditions are
satisfied, interest is deductible upto Rs.2,00,000/-:
a) Capital is borrowed on or after April 1, 1999 for acquiring or constructing a property;
b) The acquisition or construction should be completed within 3 years from the end of financial year in
which capital was borrowed; and
c) Interest certificate for the Financial Year.

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