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No.Of Document Enclosed

T10100358161216161711314128

Mode of Submission : Offline Mode

Tax Proof Declaration FY 16 - 17

RefNo: 10100358

For Allsec internal use

Employee Code 11314128 Name Subrahmanyam Sudi


Department OPERATIONS-I PAN NO CFBPS7876E
DOJ 02/Nov/2016 Location Bangalore

Life Insurance Premium

Declaration Proof Cleared Remarks

27614 27614 0

Name of Policy No. Date of Sum Premium Frequency Number of Number of Amount Amount Total Relationshi
the Commence Assured Amt Installment Installment Paid on or Payable on Amount FY p
Insurance ment Paid on or Payable on after 1st or before 16-17 (Paid
Company (dd/mm/yy after 1st or before Apr 16 31st Mar Amt
yy) Apr 16 31st Mar (Amt) 17(Amt) +Payable
(Count) 17 (Count) Amt)
LIC 846026981 20/11/2014 500000 27614 Yearly 1 0 27614 0 27614 Self

Sukanya Samiriddhi Account Scheme

Declaration Proof Cleared Remarks

12000 12000 0

Name of the Investor Name of Girl Child Post Office / Bank Name Account No Amount

subrahmanyam sudi sudi tanusree sanampudi 3324264646 12000

16 Dec 2016
Employee Code:11314128
Allsec SmartPay Services
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Rent Paid (For HRA Exempt)

April May June July August September October November December January February March

Declared 0 0 0 0 0 0 0 8333 8333 8333 8333 8333

Proof 0 0 0 0 0 0 0 8333 8333 8333 8333 8333

Cleared 0 0 0 0 0 0 0 0 0 0 0 0

H.no #10,4th H.no #10,4th H.no #10,4th H.no #10,4th H.no #10,4th
floor,SGR floor,SGR floor,SGR floor,SGR floor,SGR
Address dental college dental college dental college dental college dental college
road,martaha road,martaha road,martaha road,martaha road,martaha

City Select Select Select Select Select Select Select Bangalore Bangalore Bangalore Bangalore Bangalore

P. P. P. P. P.
Landlord
Venkateswarl Venkateswarl Venkateswarl Venkateswarl Venkateswarl
Name u u u u u
H.no #10,1st H.no #10,1st H.no #10,1st H.no #10,1st H.no #10,1st
Landlord floor,SGR floor,SGR floor,SGR floor,SGR floor,SGR
Address dental college dental college dental college dental college dental college
road,martaha road,martaha road,martaha road,martaha road,martaha

Landlord
PAN

I certify that the payments listed above has been made by me out of my income chargeable to Income-tax during the financial year 2016 - 2017.

I undertake that I will be depositing those premium / investment / rent payments that are due for payment after the cut-off dates laid out for proof
submission and obtain the receipts as per the due dates or by 31st March 2017 .

I therefore request you to consider the same for the tax computation purpose for the financial year 2016 - 2017. I will be held responsible for any
consequences of not remitting these payments and any liabilities arise out of this.

Signature :
Date : 16 Dec 2016

16 Dec 2016
Employee Code:11314128
Allsec SmartPay Services
Page 3 Of 3

FORM NO. 12BB


(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
Subrahmanyam Sudi
2-116,SANAMPUDI POST
SINGARAYAKONDA MANDAL
1. Name and address of the employee: SINGARAYAKONDA
PRAKASAM
Andhra Pradesh
India - 523101

2. Permanent Account Number of the employee: CFBPS7876E


3. Financial year: 2016 - 2017
Details of claims and evidence thereof
Sl No. Nature of claim Amount (Rs.) Evidence / particulars
(1) (2) (3) (4)
House Rent Allowance:
(i) Rent paid to the landlord 41665

1. (ii) Name of the landlord P. Venkateswarlu


H.no #10,1st floor,SGR dental college
(iii) Address of the landlord
road,martahahalli,bangalore,karanataka - 560037
(iv) Permanent Account Number of the landlord
Note: Permanent Account Number shall be furnished if the aggregate rent paid during the previous year exceeds one lakh rupees
2. Leave travel concessions or assistance
3. Deduction of interest on borrowing:
(i) Interest payable/paid to the lender
(ii)Name of the lender
(iii) Address of the lender
(iv) Permanent Account Number of the lender
(a) Financial Institutions(if available)
(b) Employer(if available)
(c) Others
4. Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C
Life Insurance Premium 27614
Sukanya Samiriddhi Account Scheme 12000
(ii) Section 80CCC
(iii) Section 80CCD
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
Verification
I, Subrahmanyam Sudi ,son/daughter of VENKATA SUBBAIAH SUDI do hereby certify that the information given above is complete and correct.

Place : Bangalore
Date : 16/12/2016 (Signature of the employee)
Designation : 11 Full Name: Subrahmanyam Sudi

16 Dec 2016
Employee Code:11314128