Income Tax Declaration Form for the Financial Year 2006-07

Name: Karthikeyan T Location: Chennai

Emp No: 1056 PAN No:

DOJ: 2/6/2003 Gender: Male

Exemptions under Section 10 & 17 Employee's Declaration Value of Proof / Bills Produced

House Rent Paid (Sec 10 (13A)) 12,000.00

Medical Bills Exemption (Sec 17(2)) 15,000.00

Children's Education Allowance Exemption (Sec 10 (14))

LTA Exemption (Sec 10(5))

Vehicle Maintenance (Petrol / Maint. Bills) (Sec 10 (14))

Total 27,000.00 -

Other Income

House / Property Income or Loss (Enter Loss as Negative)

Interest on Housing Loan (for Tax Exemption)

Other Income (Interest, etc.)

Deductions under Chapter VI-A - -

Medical Insurance Premium (Sec 80D)

Medical for Handicapped Dependents (Sec 80DD)

Medical for Specified Diseases (Sec 80DDB)

Higher Education Loan Interest Repayment (Sec 80E)

Donation to Approved Fund and Charities (Sec 80G)

Rent Deduction (Sec 80GG) only if HRA Not Received

Deduction for Permanent Disability (80U)

Any Other Deductions

Total - -

Deductions under Chapter VI (Sec 80C)

Deduction under Pension Scheme (Sec 80C)

NSC (Sec 80C)

Public Provident Fund (Sec 80C)

Employees Provident Fund & Voluntary PF (Sec 80C)

Children's Education (Sec 80C)

Housing Loan Principal Repayment (Sec 80C)

Insurance Premium (Sec 80C) 6,060.00

Infrastructure Bonds & others (MF, ULIP, etc.) (Sec 80C)

Total Investments 6,060.00 -

I _______________________________________________ do hereby declare that what is stated above is true to the best of my
knowledge and belief.
Date: Signature:
Employee's Income Tax Declaration Form for the Financial Year 2010-11

Name: Location:
Emp No: PAN No:
DOJ: Gender:
Designation
Address

I undertake to make the following investments qualifying under the provisions of The Income Tax Act, 1961 during the financial year
2010-11 and submit the investment proof thereof alongwith Rent Receipts (if applicable) by February 10, 2011.
DESCRIPTION
Proposed Date of Actual value
AMOUNT Investment of Proof
S.No INVESTMENTS U/S 80C, 80CCC capped at Rs 1 Lac or submission Produced

1 Provident Fund (PF)

2 Public Provident Fund (PPF)
3 Life Insurance Premium Paid (Policy wise details as per annex)
4 National Savings Certificate (NSC)
5 Approved Superannuation Fund
6 Interest accrued on NSC
7 Units purchased from a recognised mutual fund
8 Children Education Expenses / Tuition Fees
9 Housing Loan - Principal Payment (payable in 2010-11)
10 Post Office Monthly Savings Schemes
11 Kisan Vikas Patra
12 Investment in Tax Saving Mutual Funds
13 Infrastructure Bonds, ELSS
14 Contribution to Pension Fund (80CCC)
15 Others, if any
Total Investments U/S 80C - limited to Rs 1,00,000/- only 0.00
B. OTHER PERMITTED DEDUCTIONS AMOUNT
1 80D - Medical Insurance Premium Maximum Rs. 15,000
(Rs. 20,000 in case of premium on the health of Dependents above 65 years old)

2 80DDB - Expenditure on Medical Treatment for specified disease

(Certificate from Prescribed Authority Required)
3 80E - Repayment of Interest against Educational Loan
4 80G - Donations (Only against actual recipt and not on declaration)
5 80U - Permanent Physical Disability
(Certificate from Prescribed Authority Required)
6 80CCF - Notified Long Term Infrastructure Bond (Inserted by Finance Bill 2010)
7 Others - if any
Total Deductions 0.00
C Exemptions under Section 24 AMOUNT
Interest on Housing Loan (for Tax Exemption)
- Property acquired /constructed before 01-04-1999 - Rs.30,000 elgible
- Property acquired /constructed after 01-04-1999 - Rs.150,000 eligble
D HRA: RENT PAID PER MONTH ( Please mention the starting and ending month) Rent per month
(IF the rent amount changes during the financial year please specify From: To:
the amount and the period separately)
(Submission of copies of rent receipts, L&L Agreement etc are essential for considering the From: To:
exemption).
Rent Per Annum
E PREVIOUS EMPLOYMENT SALARY
If Yes, Form 16 from previous employer or Form 12 B attached

I, _______________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief,
the proposed investment mentioned above will be completed on or before 10th February 2011 for final computation of Income Tax for
the year 2010-11. Further, incase of any change in above declaration, I would revise it and inform immediately.

Financial Year 2010-11 CA. Parag S. Thorat

Signature: Date

Financial Year 2010-11 CA. Parag S. Thorat

Notes:
1. The declaration is for the Year 2010-11 (Assessment Year 2011-12)
2. Whenever Employee submits proof or change in the declared value, the above format need to be filled and send to Finance Dept.
3. The date of Investments must be between 01-04-2010-31.03.2011.
4. For renewal of Investments like Life Insurance premium already taken, the dates on which the amount are payable are to be mentioned

5. Deduction u/s 10(13A) for HRA is available only where employees have actually paid the rent. Original rent receipts may be retained
at your end while xerox copies can be provided to Finance Dept. Deduction wef April will be considered against declaration only if copy
of lease agreement / land lord's ownership declaration is attached.
6. Declaration should have PAN Number. Those who do not have PAN are requested to apply for it immediately and mention 'NOT
FURNISHED'
7. Income Tax Slabs for the Year 2010-11 (Assessment Year 2011-12)
Slab Rate
Rs. Nil to 1.60 Lacs (For Woman below 65 years limit is 1.90 Lacs
I. Nil
For Senior Citizens limit is 2.40 Lacs)
II. Above 1.60 Lacs to Rs. 5.00 Lacs 10%
III. Above 5.00 Lacs to 8.00 Lacs 20%
IV. Above 8.00 Lacs 30%

Financial Year 2010-11 CA. Parag S. Thorat

 Annexure to Investment Declaration
Details of Life Insurance Premium Paid/Payable
For the year 2010-11
Policy From Policy No. Amount Premium Qtrly/HLY Total
InsuredPaid/Payable Yearly Premium

CA. Parag S. Thorat

 FORM NO. 12B
[See rule 26A]
Form for furnishing details of income under section 192(2) for the year ending 31st March,_______
Name and address of the employee
Permanent Account No.
Residential status
Particulars of salary as defined in section 17, paid or due to be paid to the
employee during the year Total amount
Amount deducted in
of tax
respect of life
TAN of the Permanent deducted
Name and Total amount of house rent Total of insurance premium,
employer(s) as Account Period of during the year
S.No address of allowance, conveyance Value of perquisites columns 6, provident fund Remarks
allotted by the Number of the employment (enclose
employer(s) Total amount of allowance and other and amount of 7, and 8 contribution, etc., to
ITO employer(s) certificate
salary excluding allowances to the extent accretion to employee's which sec. 80C †
issued under
amounts required chargeable to tax[See section provident fund account applies (Give details)
section 203)
to be shown in 10(13A) read with rule 2A and (give details in the
columns 7 and 8 section 10(14)] details in the
1 2 3 4 5 6 7 8 9 10 11 12

† With effect from 1-4-1991, section 80C has been replaced by section 88. Signature of the employee

Verification
I,______________________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the_____________________day of______________________
Place Signature of the employee
 ANNEXURE
[See column 8 of Form No. 12B]
Particulars of value of perquisites and amount of accretion to employee's provident fund account
Name and address of the employee
Permanent Account No.
Period : Year ending 31st March,_______________
Value of rent-free accommodation or value of any concession in rent for the accommodation provided by the employer (give basis of computation)[See rules 3(a) and 3(b)]
Where accommodation is furnished

Value of
perquisite
Name of (column 3
TAN/PAN of minus
the Where Value as if Cost of furniture (including television sets, radio sets, refrigerators, Perquisite value of furniture (10% Rent, if any,
the employer Total of columns 4 and column 8 or
employee accommodation accommodation other household appliances and air-conditioning of column 5) OR actual hire charges paid by the
6 column 7
is unfurnished is unfurnished plant or equipment) OR hire charges, if hired from a third party payable employee
minus
column 8 as
may be
applicable)

1 2 3 4 5 6 7 8 9
 ANNEXURE
(Contd.)

Interest
credited to the
Remuneration paid Estimated value of any other benefit assessee's
Employer's Total of
by employer for Value of free or concessional or amenity provided by the account in
contribution to columns 9
Whether any conveyance has been provided by the employer free or domestic and/or passages on home leave and employer, free of cost or at recognised
Name of recognised provident to 15
at a concessional rate or where the employee is allowed the use of personal services other travelling to the extent concessional rate not included in the provident fund
the fund in excess of 10% carried to
one or more motor cars owned or hired by the employer, estimated provided to the chargeable to tax (give details) preceding columns (give details), in excess of
employee of the employee's column 8 of
value of perquisite (give details) [See rule 3(c)] employee (give [See rule 2B read with section e.g., supply of gas, electricity or the rate fixed
salary [See Schedule Form No.
details) [See rule 10(5)(ii)] water for household consumption, by the Central
IV - Part A] 12B
3(g)] free educational faci Government
[See Schedule
IV - Part A]

1 10 11 12 13 14 15 16

Signature of the employee