Employees may kindly send proposed investment details sureshj@gvrinfra.

com

GVR INFRA PROJECTS LIMITED

INCOME TAX INVESTMENT DECLARATION FORM FOR THE FINANCIAL YEAR 2010-11 (For Income Tax Computation Purposes) From Name of the Employee Employee Code Location PAN (Mandatory) Contact No (Mandatory) To Mr.S.CHANDRASEKHAR GM(F&A) Accounts Department Corporate Office Chennai

S.NO

INVESTMENT DESCRIPTION INVESTMENT OVERALL LIMIT OF Rs.1 LAKH UNDER SECTION 80C & 80CC

SECTION

AMT(IN RS)

1 A B C D E F G H I J K L M N 2 A B

LIC- LIFE INSURANCE PREMIUM DIRECTLY PAID BY EMPLOYEE (refer Note 1) HOUSING LOAN PRINCIPAL REPAYMENT (refer Note 2) PPF- PUBLIC PROVIDENT FUND (refer Note 3) PENSION SCHEME INVESTMENTS (refer Note 4) NSC NATIONAL SAVING CERTIFICATE (refer Note 5) DEPOSIT UNDER POST OFFICE SAVING BANK(CTD)RULES,1959 NSS NATIONAL SAVING SCHEME INFRASTRUCTURE INVESTMENT- NOTIFIED U/s 10(23D) ELSS EQUITY LINK SAVING SCHEME OF MUTUAL FUNDS TUITION FEES FOR FULL TIME EDUCATION TO SCHOOL,UNIVERSITY (refer Note 9) 5 YEARS TERM DEPOSIT AN ACCOUNT UNDER POST OFFICE TERM DEPOSIT RULES FIXED DEPOSITS IN SCHEDULE BANKS(TERM PERIOD NOT LESS THAN 5 YEARS) ULIP UNIT LINKED INSURANCE PLAN

MEDICLAIM PREMIUM (Max.Rs.15,000/-) ( refer Note 10) EXPENDITURE ON HANDICAPPED DEPENDENTS/ Deposits made for maintenance of Handicapped Dependents (LIC,UTI or other approved insurer) - (refer Note 11) MEDICAL EXPENSES: Proposed to be incurred ON SPECIFIED DISEASES (AIDS,

80 C 80 C 80 C 80 CCC 80 C 80 C 80 C 80 C 80 C 80 C 80 C 80 C 80 C 80 C 80 D 80 DD 80 DDB

Cancer, Hemophilia, Chroni Renal Failure,Chronic Neurological Diseases..etc) Maximum Rs 40000/- & Rs.60000/- in case aged above 65 years (Certificate of Form 10 IA - Proof of actual expenditure) PERMANENT DISABILITY BENEFIT (SELF) Fixed deduction amount of Rs.50000/- & Rs.100000/-(Suffering from severe physical disability) (Attach Govt.Hospital Medical Certificate) (refer Note 12) INTEREST PAID ON HOUSING LOAN - Maximum Limit for Self-Occupied Properfty Rs.150000/- & if it is let out no ceiling limit (Certificate received from financial institution/Banks) ( refer Note 2) INTEREST ON EDUCATION LOAN (for education)- No Maximum Limit - (refer Note 13) HOUSE RENT PAYMENT: If Rent Lease Agreement is not available, please

80 U

24(1)(vi)

E F G

80 E 10(13A)

Attach Rent Receipts along with Self Declaration

3 a b c 4

INCOME FROM OTHER SOURCES with Form 12C (Optional if you want add to taxable income) Bank Interest Dividend Any Other Income (attached details) Applicable to employees Joining after April 01,2010 Please Submit the Form 16 from Previous employer/Salary Certificate/Form 12B

Declaration I hereby understand and declare that I shall be solely responsible for any false and misleading information disclosed here above in this declaration and also for any financial consequences, resulting due to this declaration.

Date:

Employee Signature THIS FILLED FORM HAS TO BE RETURNED ON OR BEFORE

Note:

1.

Copy of Insurance Premium paid receipt of all the periods in this financial year 2010-2011 taken in the name of Self/Spouse/Children.(Late fee cannot be considered) 2. Copy of Certificate from Financial Institution for the principal paid/payable on housing loan giving the break up of prinicipel & Interest repayment for the F.Y.2010-11. (Online Statement will NOT be considered).In case of Joint loan- To avail 100% benefit a declaration should be submitted. 3. Copy of PPF Contribution paid receipt (Bank Challan) or copy of the pass book which contains the transaction after 1st April 2009 onwards along with Pass book covering page which contains account holder details for the F.Y 2010-11 deposited in the name of only Self/Spouse/Children. 4. Copy of Pension Scheme Investments Premium paid receipt of all the periods in this F.Y. 2010-11 taken in the name of Self/Spouse/Children(Late fee cannot be considered) 5. Copy of NSC Certificate(s)(VIII issue only) invested during the financial year 2010-11 in the name of Self. 6. Copy of the Tax Saving fixed deposit certificate for the amount deposited in the name of Self during the F.Y.2010-11 with tenure of 5 years and above duly confirmed by the bank/post office that the investment qualifies for exemption U/s 80C. (Any other type of fixed deposit with tenure of less than 5 years will not be considered under this section for deduction. 7. Copy of the eligible Infrastructure Investment Bonds Certificate/Allotment Letter/Paid receipt on or after 1st April 2010 for self for the F.Y.2010-11 8. Copy of the unit statement issued by Mutual Fund for the amount invested in the eligible schemes on or after 1st April10 in the name of Self/Spouse/Children.If the investments are made through Systematic Investment Plan (SIP) route,attach copy of the SIP registration letter, unit statement provided by the mutual fund. 9. Copy of the School Fees paid Receipt (only Tuition Fees will be considered) for the F.Y.2010-11 for the purpose full time education of any two children. Amount paid towards Donation, Administration Fees, Books,Amenities..etc will not be considered. 10. Copy of premium paid receipt towards of Medical insurance premium during this financial year 2010-11 for Self/Spouse/Children/Dependent parents.Deduction allowable is Rs.15000/- or actuals whichever is lower. If the insurance is taken for dependent parents then additional deduction allowable shall be Rs.15000/- and if the parents are senior citizen(aged 65 years and above) then deduction allowable shall be Rs.20000/-.To avail the exemption dependent Name, relationship & age should be specified on copy of the receipt.Premium paid through cash is not eligible for deduction. 11. Recent Doctors Certificate working in Government hospital and the medical bill spend in this F.Y.2009-10 for Spouse/Children/Dependent/Parents/Brother/Sister Maximum limit is Rs 50000/-(40% and above) and in case of severe disability Rs 100000(80% and above). Form 10-IA need to be submitted.

12. Doctors Certificate working in Government Hospital for self. Maximum limit is Rs.50000/-(40% and above) and in case of severe disability Rs.100000/- (80% and above) Form 10 IA need to be submitted. 13. Education loan taken for the purpose of pursuing full time higher education in any field including vocational education. Loan taken for self/Spouse/Children and legal guardian of the student and loan repaid to be out of your income chargeable to tax. Copy of Banker certificate giving the break up of Interest and principal repayment to be submitted.Only interest payment is eligible for deduction.

RENT RECEIPT NAME OF THE OWNER ADDRESS OF THE OWNER : :

Received with thanks from_________________________________________________ a sum of Rs._____________(Rupees ______________________________only) per month being Rent payable for the House situated at No._____________________________________

(FULL ADDRESS)

Revenue Stamp Rs.1/-

Note : 1. Get the signature from the Landlord only across the Revenue Stamp. 2. Please note that no Exemption will be given under this Section in absence of a valid Rent Receipt duly signed by the landlord.

TO WHOMSOEVER IT MAY CONCERN I, ______________________________<<name of joint owner>>, being joint owner to the extent of ____% in property ________________________________________________________________ _______________________________________________________<< Address >> , do hereby declare that I am not paying EMI on housing loan taken against the aforesaid property. I am not claiming any deduction on account of interest or principal repayment under any provisions of the Income Tax Act, 1961. Name & Signature of Joint Owner Date : I, __________________________________________<<name of the employee>>,do hereby declare that the above mentioned statement is true and correct and request you to give me the deduction for the entire amount of interest and principle (subject to the limit prescribed under the Act). Further, I also undertake to pay the amount of Income Tax, interest and penalty as may be levied by the tax authorities, in case if a different view is taken by the tax officers with respect to the deduction granted to me on account of Income from House property for any year for which I have claimed such deduction.

Name & Signature of the Employee Date :