Annexure 1

SELF-DECLARATION FOR EXISTING INVESTMENT & RENT PAYMENTS

Insurance Premium, Other Investments & Rent due after 1st January, 2018

To,
The Payroll Department
Accenture Solutions Private Limited

Employee Name
Employee SAP ID
(8 Digit – Numeric)
Employee PAN
(10 Character – AlphaNumeric)

I hereby confirm that the following investment(s) / payment(s) are due after the cut- off dates laid out by you for
proof submission; therefore I request you to consider the same for the tax computation purpose for the financial
year 2017-2018. I undertake that I will be making the payment(s) and obtain the valid receipts by 1st March 2018 to
submit to the company.

Particulars Policy / Folio / Amount Remarks

Account No.

Life Insurance Premium:*

MF - ELSS (SIP)

80CCC (Pension plan)*

Tuition Fees

80 D (Medical Insurance)*

80CCD – National Pension

Scheme (NPS)
January’18 February’18 March’18
House Rent payable
Rs. Rs. Rs.

I hereby declare that the above mentioned information is true. I will be solely and wholly responsible to handle any queries
from any competent official and / or to submit all relevant documents to Income Tax / Competent Authorities as and when
st
I am asked for the same. Moreover, I am fully aware that if the above investments / payments are made after 31 March,
2018, the same will be disqualified for tax benefit; this means I have paid short taxes to the Government which may lead to
query from Income Tax Authorities and I will be responsible to handle such queries.

Signature of the employee

Place:

Date:

*Encl: For all investments, please attach the relevant receipt of previous (2016-17) financial year / premium notice
to prove that the policy is in force. Exemption will be provided only in case of the premium receipt provided for
the previous year and not otherwise.