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EQUINOX Software & Services Pvt Ltd.

Proposed Investment Declaration Form for FY 2013 - 14 Full Name of Employee : Emp. No. PAN : Date of Joining : RAVINDRA MANOHAR BIDWAIK 1054 AQQPB7565B 15/10/2012

These figures will be considered for working of employee TDS for the current financial year and tax will be deducted evenly till January 14 Form, completed in all respects, should be submitted latest by 25th April 2013, failing which tax will be worked out & deducted from April 13 salary as applicable. Sr.No. Particulars

Part I : Qualified U/s 80C, 80CCC ( Maximum Rs.1 Lac) 1 Life Insurance premium - self, spouse and any child 2 Employee Contribution to Recognized / Statutory Provident Fund 3 Contribution to PPF - self, spouse & any child 4 Employee contribution to Approved Superannuation Fund 5 NSC (VIII issue) - New Purchase 6 Contribution to ULIP of UTI or LIC Mutual Fund (Dhanraksha plan) - self, spouse and child 7 Subscription to Equity Linked Saving Schemes Tuition fees (excluding development fees or donation or payment of similar nature), to any university, college, school or other educational institution situated within India for the purpose of full-time education of any two children of individual. Repayment of Housing Loan - Principal Componant (Including stamp duty, registration fees ) Contribution to Approved Pension Fund (80 CCC) Any Other (give details) ( Tax Saving Fixed Deposit)

8 9 10 11

Part II : Other Items Qualified U/c VI A 1 Medical Insurance Premium (U/s 80D) - Max Amount Rs 15,000 2 Any Other (give details)

Part III : Other Details 1 2 3 4 5 6

House Rent paid from to Interest on Housing Loan LTA Bills (Exemption Minimum of LTA or Actual expenses on travel) The benefit is available once in 2 years (Current Block 2006-09) and the employee should ensure the compliance with the provisions of the Act Medical Bills (exemption is min.of Rs.15,000 or actual medical reimbursement or actual bills) Claim should be from date of joining or 1 April 08, whichever is later. Books & Periodicals Bills (Exemption Minimum of the allowance or Actual expenses incurred) Telephone Bills (Exemption Minimum of the allowance or Actual expenses incurred)

I hereby undertake to produce the actual proofs of such spending / investments latest by 10th February 2014

Signature of the employee Date : Place :

Ravindra Bidwaik 22/04/2013 Pune

Amount Rs.