I furnish below the necessary declaration for the payments/investments made by me during the period 1st April , 2015 to 31st March 2016 to enable me to
avail of the tax rebate as per the provisions of the Income Tax Act, 1961 (as amended up to date)
A Life Insurance Premium / Unit Linked Insurance Plan (ULIP) of UTI or LIC
Name of life insured & Relation POLICY No. Sum Assured Date of Policy Start Date of Maturity Annual Premium (Rs.)
with employee
Total Amount 0
Note - i) In case of monthly, qtrly , half yearly premium payment, mention the total rebate for the full year which you want to claim
ii) For policies issued before 1st April, 2012 - Rebate allowed is maximum of 20% of Sum Assured
iii) For policies issued after 1st April, 2012 - Rebate allowed is maximum of 10% of Sum Assured
iv) Insurance can be taken for self, spouse or children
v) If the sum assured is not declared in the format above then the rebate will not be allowed
vi) Furnish proof of payment
I hereby confirm that I have already paid the above mentioned premium / I intend to pay the above mentioned premium in the current financial year
if not already due as on the date of giving this declaration
Total Amount
Note - i) Furnish PPF challan / PPF statement / PPF passbook in support of your claim
ii) In case of passbook, it is mandatory to furnish a copy of the cover page of passbook and current deposit amount and date
iii) Income Tax relief will be given only for actual amount invested
C Investment in NSC (NATIONAL SAVINGS CERTIFICATE VIIIth ISSUE & IXth ISSUE)
Name of Holder Certificate No.: Date of Purchase Principal Amount (Rs.)
Total Amount
Note:- i) Rebate will be allowed only if the investment is in the name of employee as the first holder.
ii) Furnish copy of NSC certificate
Total Amount
Note:- i) Rebate will be allowed only if the investment is in the name of employee as the first holder.
ii) Furnish copy of NSC certificate for Accrued interest
Note : i) If you are claiming the rebate on housing loan principal etc. for the first time, please submit the sale deed as proof of ownership
ii) In case the sale deed is in regional language, furnish a certified English translated copy of the same or a copy of deed in regional language
along with a self declaration that the house is owned by the employee
iii) Furnish a certificate from bank specifying the principal and interest on loan for current Financial Year (FY 2015-2016)
iv) Rebate allowed for repayment of Principal amount of Housing Loan / Stamp Duty / Registration Fees for transfer of property
F Notified Annuity Plan (e.g.. New Jeevan Dhara, New Jeevan Akshay, etc.)
Name of the plan Policy No. Date of Investment Amount (Rs.)
Total Amount
Note:- i) In case of monthly, qtrly , halfyearly premium payment, mention the total rebate for the full year which you want to claim
ii) Rebate will be allowed only if the investment is in the name of employee as the first holder.
iii) If the premium frequency is monthly, quarterly or halfyearly, please submit proof of uninterrupted premium paid
from Apr to Nov to establish your intent to pay the remaining installments in current year.
iv) Furnish proof of investment
G Investment under ELSS (EQUITY-LINKED SAVINGS SCHEME) / Tax saving schemes of Mutual Funds
Scheme Name Date of Investment Amount (Rs.)
Total Amount
Note:- i) In case of monthly, qtrly , halfyearly premium payment, mention the total rebate for the full year which you want to claim
ii) Rebate will be allowed only if the investment is in the name of employee as the first holder.
iii) If the premium frequency is monthly, quarterly or halfyearly, please submit proof of uninterrupted premium paid
from Apr to Nov to establish your intent to pay the remaining installments in current year.
I Contribution to notified Pension Fund with LICI / UTI / Other Insurance Co.
Name of the plan Policy No. Date of Investment Scheme name Amount (Rs.)
Total Amount
Total Amount
Note:- i) Furnish copy of bond
K Term Deposit for a period of not less than 5 yrs with a Scheduled Bank under Bank Term Deposit Scheme, 2006
Name of Bank Tenure Date of Purchase Amount (Rs.)
Total Amount
Note:- i) Relief will not be considered if the term deposit receipt does not clearly specify that it is under
Bank Term Deposit scheme, 2006 or it does not IT Endorsement by banker extending benefit u/s 80C.
ii) Rebate will be allowed only if the investment is in the name of employee as the first holder.
Total Amount
Note:- i) P.O. Recurring deposit do not qualify for rebate
ii) In case of passbook, it is mandatory to furnish a copy of the cover page of passbook.
Total Amount
I hereby confirm that I have already paid the abovementioned premium / I intend to pay the above mentioned premium in the current financial
year if not already due as on the date of giving this declaration
Note -
i) Maximum deduction of Rs.25,000/- for self, spouse and dependent children
ii) Additional deduction upto Rs.25,000/- for parents whether dependent or not.
iii) Additional Rs.5,000/- in case person for whom the policy is taken is a senior resident citizen i.e., age > 60 years at any time during the year
iv) No rebate allowed if premium paid in cash
v) The premium payment receipt must be in the name of employee.
Total Amount
Note:- i) Fixed deduction of Rs.75,000/- in case of disability or Rs.1,25,000/- in respect of a person with severe disability
ii) The deduction is allowed only if some expenditure has been incurred. Hence supporting for actual expenditure of any amount shall be furnished
iii) It is mandatory to furnish the certificate of disability in the format prescribed under Income Tax Rules
iv) Dependant means spouse, children, parents, brothers and sisters only.
5 Deduction u/s 80DDB Medical treatment for specific disease in respect of self or dependants
Name of dependent Relationship with employee Severe Disability ? (Y/N) Nature of ailment Amount (Rs.)
Total Amount
Note:- i) Deduction allowed for amount actually incurred or Rs.40,000 (Rs.60,000 for above 60 years) whichever is less.
ii) Supporting for actual expenditure shall be furnished.
iii) It is mandatory to furnish the certificate of disability in Form 10 - I prescribed under Income Tax Rules
iv) Dependant means spouse, children, parents, brothers and sisters only.
6 Deduction u/s 80E Interest on Loan for higher Education paid during the year
Name of loan beneficiary & Name of Bank Type of Course pursued Date of commencement Amount of Interest (Rs.)
relation with employee of interest payment
Total Amount
Note:- i) Education loan can be taken for Self, Spouse, Child or as a Legal guardian
ii) Please attach the certificate of interest from bank
A certificate showing only EMIs will not be sufficient if the same does not have break up of principal and interest
iii) Deduction is available for 8 financial years starting from the date of commencement of interest payment
I hereby confirm that I have paid all the EMIs for which I am claiming interest benefit u/s 80E and I intend to pay the remaining EMIs in the current FY
Total Amount
Note:- Rebate accepted only in case donation is eligible for 100% deduction under IT Act like donation to Prime Ministers National Relief Fund,
Chief Ministers Relief Fund & National Defence Fund
Total Amount
Note:- i) Eligible deduction Rs.75,000/- in case of disability or Rs.1,25,000/- in respect of a person with severe disability
ii) It is mandatory to furnish the certificate of disability in the format prescribed under Income Tax Rules
Note:- i) Your contribution to Provident Fund is already considered as part of rebate u/s 80C.
ii) No correspondence will be entertained if the forms are incomplete / or if the necessary documents are not attached in such cases
Income Tax relief will not be extended
Verification
I HEREBY CONFIRM THAT THIS DECLARATION IS TRUE TO THE BEST OF MY KNOWLEDGE. PROOF OF ACTUAL INVESTMENTS ARE ENCLOSED.
NOTE : ONLY ACCEPT HARD COPY DECLARATION WITH SIGNATURE DON'T SEND US SOFT COPY OF DECLARATIONS
STATEMENT SHOWING INCOME / LOSS FROM HOUSE PROPERTY FOR YEAR ENDING 31st MARCH 2016
(Under section 192B read with Rule 26B of Income Tax Rules)
Please do not fill this form if the property is still under construction or if you are not one of the owners as per sale deed.
Name : Employee No.
Grade Unit / Location :
e-mail ID Mobile No.
Nature of Occupancy
Particulars Self occupied Let out Deemed to be let out
Full Address of the house
Occupied from date
Occupied to date
(Note : Interest on pre-construction period allowed in 5 equal installments. Maximum deduction allowed for
interest on loan taken for acquisition or construction of house which is self occupied is Rs.2,00,000/-. In case
of let out property there is no cap)
Loan Details
Sl. No. Name and Address of the Lender Date of sanction Date of Purpose of loan Loan Amount
Possession
In case the house is unoccupied but treated as self occupied under IT Act, then please furnish the following confirmation :
(put tick) I hereby confirm that
(i) my residential house could not be occupied owing to my employment and that I am residing at some other place in a
building not belonging to me.
(ii) my residential house is not let out, and
(iii) no other benefit there from is derived by me
I hereby request you to allow the Income Tax rebate / benefit to the extent of my share of repayment amount for the
financial year 2015-16
I confirm that Rs ……………………….. as principal and Rs ………………………. as interest is payable by me out of the total repayment
of Principal of Rs ……………… and interest of Rs ……………………… during the financial year 1.04.2015 to 31.03.2016 in respect of
the said housing loan taken for construction/ repairs/ acquisition/ reconstruction of the house or flat
Verification
I ……………………………………………………… do declare that what is stated above is true to the best of my information and belief.
Place :
Date: Signature of employee
Note :
1) You must be a sole / joint owner of the house property declared in this form and the construction of house is completed.
No deduction will be allowed in the absence of "completion certificate".
3) In case a house is let out for part of the year and self occupied for balance part then the house shall be treated as let out for the
full year
4) In case a house is let out for part of the year and vacant for balance part then the gross annual value shall be equal to actual
rent received / receivable for let out period.
5) In case of more than one self occupied property, only one house will be treated as self occupied and the others will be treated
as deemed to be let out. Notional rent should be considered as higher of municipal value or fair rental value but restricted to
the Standard rent for deemed to be let out property
6) Loss from interest will be allowed only if the construction is completed and possession of property is taken.
7) If Construction or acquisition is completed after 3 years from the end of financial year in which capital was borrowed then the
maximum interest allowed for a self occupied house is Rs.30,000/- only.
10) In all cases where interest deduction is claimed, a Certificate from bank specifying the principal and interest on loan for
current Financial year.
11) If you are claiming the rebate on housing loan interest for the first time please submit the following documents
1) Computation of Income/Loss from House Property as per this format
2) Proof of payment of Corporation/Municipal Tax/Possession certificate
3) Certificate from bank specifying the principal and interest on loan for current Financial year.
4) Letter of loan disbursement
5) In case the sale deed is in regional language, furnish a certified English translated copy of the same or a copy of deed in
regional language along with a self declaration that the house is owned by the employee
Statement of particulars of income under heads of income other than "Salaries" for
Deduction of Tax at Source for the year ending 31st March, 2016
(Under section 192B read with Rule 26B of Income Tax Rules)
Name Employee No
Grade Unit / Location
e-mail ID Mobile No.
Particulars Amount (Rs.)
Verification
Date
Place Signature of the employee
Leave Travel Assistance (LTA) Exemption Claim Form
(Current Block - 1st Jan 2014 to 31st Dec 2017)
Name K.BHARATHI Grade M12
Employee No : 21901
Unit / Location : CHERLAPALLY e-mail ID bkandimalla3@gmail.com
Division : R&D Mobile No. 9959156219
I hereby declare that I have proceeded on leave and traveled and am claiming LTA exemption
u/s 10(5) of Income Tax Act as per the following details :
Particulars Amount (Rs.)
LTA Received during the year 21,000
LTA exemption claimed
I hereby confirm that I have not claimed LTA rebate for two times in the current block of 4 years from 1st
Jan 2014 to 31st Dec 2017
Travel Details
i) Period of Leave ( From & To)
ii) Date of travel ( onward )
iii) Date of travel ( Return )
iv) Name of Place visited
(Anywhere in India by shortest route)
iv) Details of persons who traveled as per IT eligibility
(Eligible - Self / Spouse / Children / Dependent Parents or dependent brothers or dependent sisters)
Sl. No. Name of passengers Relationship with Mode of Travel Expense Amount (Rs.)
employee
1
2
3
4
5
Verification by employee
(Put tick in appropriate box)
a) I confirm that I had traveled by train by the shortest possible route.
b) I have not traveled by the shortest route. However the A/c first class fare by the shortest route to the
destination is Rs ……………
c) I confirm that I have traveled by air by the shortest and direct route to the destination in economy class
d) I have not traveled by the shortest /direct route in economy class. However the air fare by the shortest
/direct route in economy class is Rs. ………………
e) I confirm that I have traveled by car /hired car/taxi and also confirm that the comparative train fare by
A/C first class for the said route is Rs.
f) I have traveled to …………….. which is not connected by rail. The fare by the recognised public transport
system by the shortest /direct route is Rs. ……………
Signature of employee
Verification by unit HR
This is to confirm that the employee was on leave during the period mentioned in the form above
Verified by HR
Note :
i) Proof of travel i.e., tickets, Receipted copy of Travel Agent’s bill, trip sheet etc., should accompany the claim
ii) Exemption shall be available if the employee is travelling alone or accompanying his family. But, exemption
will not be available if the familiy members are travelling separately without the employee who is on leave.
Thus the employee must accompany the family, at least for one part of the journey, i,e, either at the time of
going on leave or at the time when the family returns from leave, if cost of travel of family members is
declared above
iii) For claiming rebate, the period of leave of the employee must tally with the actual period of travel at
least one way for enabling the LTA claim to be accepted
iv) Leave verification by unit HR is mandatory.
For A.Y. 2015-16 (Refer Notes)
Income Rate (%)
Up to ₹ 250,000* NIL
₹ 250,001 to ₹ 500,000 10%
₹ 500,001 to ₹ 1,000,000 20%
Above ₹ 1,000,000 30%
Notes:
80CCF Individual/HUF
80EE An Individual
2 Telecommunication undertakings
: basic or cellular, radio paging,
domestic satellite service or
network of trunking and electronic
data interchange services,
broadband network & internet
services.
4 Power undertakings : –
undertakings engaged in a.
generation; or b. generation and
distribution of power.
– undertakings engaged in
transmission or distribution (only
profits derived from laying of such
network of new lines) – undertakes
substantial renovation and
modernisation (i.e., increase in
book value of plant & machinery
by 50% as compared to book value
as on 1-4-2004) of existing
transmission or distribution lines
as defined in Explanation to sec.
80-1A(4)(iv)(c)
80CCG Individual
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Deductions and Rebates
Qualifying Payments/Income
3
ncome
1. LIP; (restricted to 20% of actual capital sum assured for policies taken before
1.4.2012 and for policies taken on or after 1.4.2012 restricted to 10% of actual capital
sum assured. However, in case of policy issued on or after 1.4.2013 for insuring the
life of any person who is – (a) a person with disability or a person with severe
disability as referred to in S. 80U; or (b) suffering from disease or ailment specified
in the rules made u/s 80DDB, the premia can be up to 15% of the sum assured
instead of 10%.).
2. Assessee’s own contri-bution to – (a) PF, (b) Superannuation Fund, (c) PPF, (d)
RPF.
6. Deposits under notified deposit scheme or notified pension fund set up by National
Housing Bank.
9. Payment to effect or keep in force a contract for notified annuity plan of LIC or of
any other approved insurer.
12. Tuition Fees (not donation or development fees) towards full time education of
any 2 children of an individual paid to university, college, school or other educational
institution situated in India.
14. Investments in units of notified mutual fund investing in approved public cos. as
in 13 above.
17. Five year time deposit in an account under Post Office Time Deposit Rules, 1981.
Amount paid or deposited in his account under a pension scheme notified by the
Government.
Amount paid or deposited, during the previous year, as subscription to notified long-
term infrastructure bonds.
Amount invested in (a) acquiring listed equity shares, or (b) acquiring listed units of
an equity oriented fund (w.e.f. 1.4.2013) as may be specified, under a scheme to be
notifed by the Central Government. Equity Oriented Fund shall have the meaning
assigned to it in Explanation to S. 10(38).
In case of an Individual - 1 Aggregate of -
(a) Premia paid out of taxable income to approved scheme of GIC (Mediclaim,
Bhavishya Arogya) or any other approved insurer to insure the health of assessee or
his family; and
Amount actually paid for medical treatment of such disease or ailments as may be
specified.
Payment (out of taxable income) of interest on loan taken for pursuing his own
higher education or higher education of his relative (w.e.f. A.Y. 2008-09).
Interest payable on loan taken by the assessee from any financial institution.
— do —
Date of Commencement
3
After 1.4.1995
1.4.1995 to 31.3.2005
1.4.1993 to 31.3.2017
1.4.1999 to 31.3.2017 1.4.2004 to 31.3.2017
1.4.1991 to 31.3.1995
1-4-1995 to 31-3-2002
Assessee fails to comply with any condition specified in 80CCG(3) {see column 4
against the deduction 80CCG under the heading Important Deductions under Chapter
VI-A}
Deductions and Rebates
Conditions/Incidents Qualifying Amt
4 5
4. Stamp duty, registration fee and other expenses for the purpose of
transfer of such house property to the assessee qualify for deduction
under this section.
` 20,000.
5. The assessee does not own any residential house property on the
date of sanction of the loan.
1. Donations should not be in kind. Amount of Donations, not exceeding
10% of GTI (As reduced by other
deductions). In certain cases this limit
does not apply. Please see S. 80G(4).
Amount of Donations, not exceeding
10% of GTI (As reduced by other
deductions). In certain cases this limit
2. If paid out of another year’s income or out of income not does not apply. Please see S. 80G(4).
includible in the assessment of the current year the deduction still
available [Lt. F. No. 45/313/66-ITJ(61) dt. 2-12-1966].
2. This section does not apply where the assessee owns residential
accommodation at any other place, annual value of which has been
computed u/s 23(2)(a) or 23(4)(a).
1. For the meaning of term 'political party', refer to Explanation to Amount of Contribution.
section 80GGC. 2. Contributions to an electoral trust qualify for
deduction w.e.f. A.Y. 2010-11. w.e.f. A.Y. 2014-15 the contributions
made in cash will not qualify for deduction.
Conditions/Incidents
4
Infrastructure facility, starts providing Telecommunication Service or Developing an Industrial Park or
Developing a Special Economic Zone or Generates Power or commences Transmission or Distribution of
Power or undertakes substantial renovation and modernisation of the existing trans mission or distribution
lines, now it will also be available to an undertaking which lays and begins to operate cross country natural
gas distribution network w.e.f. 1-4-2008; i.e., A.Y. 2008-09.
The benefit of section 80-IA shall not be available to an amalgamated or demerged entity after 1-4-2007.
80-IA benefit will not be available to a person who executes a works contract w.e.f. 1-4-2000.
In case there is a transfer of goods or services from eligible business to any other business or vice versa and
in either case the consideration for such transfer as recorded in the accounts of the eligible business does not
correspond to the market value of such goods or services as on the date of transfer then for the purposes of
the deduction under this section, the profits and gains of eligible business shall be computed as if the transfer,
in either case, had been made at the market value of such goods or services as on that date. “market value” in
Where it appears to the AO that, owing to the close connection beween the assessee carrying on the eligible
business to which this section applies and any other person, or for any other reason, the course of business
between them is so arranged that the business transacted between them produces to the assessee more than
ordinary profits which might be expected to arise in such eligible business, the AO shall, in computing the
profits and gains of such eligible business for the purposes of deduction under this section, take the amount
of profits as may be reasonably deemed to have been derived there from. Provided that in case the aforesaid
arrangement involves a specified domestic transaction referred to in S. 92BA, the amount of profits from
such transaction shall be determined having regard to arm’s length price as defined in S. 92F(ii).
25% (30% for Cos.) First 10 A.Ys.
Proof of payment of Securities Transaction Tax (STT) in the Amount of STT paid.
prescribed form to be furnised with return.
— do — — do —
P.Y. in which amount is so received. To the extent of original investment.
Previous Year in which there is failure to comply with the conditions Amount of deduction originally
specified in 80CCG(3). allowed.
Quantum
6
(b)
` 25,000. Note : Up to AY 2013-14 where assessee has
claimed and allowed a deduction under this section for
any assessment year in respect of any amount, he shall
not be allowed any deduction under this section for
any subsequent assessment year. With effect from AY
2014-15, the deduction shall be allowed for 3
consecutive assessment years, beginning with the AY
in which the equity shares or units referred to in
column 3 were first acquired.
` 15,000 to
` 20,000).
– ₹ 50,000 for ordinary disability –
Least of –
(b) ₹ 2000.
Amount of Rebate LOWER OF – (c) Amount of STT
paid; OR (d) The income tax calculated at the average
rate of tax.
Remarks
6
1 Amount paid after the death of an individual to the
legal heirs is not taxable. (Cir. No. 532 - dt.
17.3.1989).
2 Repayment of NSS is subject to TDS u/s. 194EE
except when made to the heirs of the assessee.
—
1 Deduction amount not exceeding
` 10,000/-. Amount received in excess of original
investment is taxable as capital gains u/s. 45(6).