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Emp Name :
Emp Code :
Designation :
Pan No. :
Particulars Projected Total
(-)Exemptions
Medical Allowance
Conveyance Allowance
Professional Allowance
Uniform Allowance
LTA
Vehicle Reimbursement
Other Allowance exemptions
HRA
Total Exemption
Profession Tax
Investments (80CCC-80U)
PAN of Employee
Employee Name
(compulsory)
As per section 206AA, in case PAN is not submitted, TDS will be deducted at flat rate of 20%
DEDUCTION U/S 10
DEDUCTION UNDER Sec 80E - Repayment of Loan for higher education (only Interest)
CHAPTER - VI A Sec 80GG - Rent Paid
Sec 80U - Handicapped
Sec 80CCG - Rajeev Gandhi Equity Saving Scheme
(Investment max upto Rs.50,000, would get a deduction of 50% on
the amount invested)
Sec 80TTA - Interest on saving a/c
Any other Deduction (Please specify)
Max Limit Declared Amount
Contribution to Pension Fund (Jeevan Suraksha)
Life Insurance Premium on life of self/spouse/child only
Deferred Annuity
Public Provident Fund in own name/spouse/child only
ULIP of UTI/LIC in own name or spouse and child only
Repayment of Housing Loan (Only principal)
Contribution to Pension Fund or UTI or Notified Mutual Fund
DEDUCTION U/S 80C
Investment in ELSS made in units of Notified Mutual Fund
Children Tuition Fee: Restricted to a max of 2 Children
Deposit in home loan account scheme of NHB/HDFC
5 yrs. Term deposit in a Sch.Bank
Others (please specify)
Others (please specify)
DEDUCTION U/S 80CCC Annuity/Pension Plan
DEDUCTION U/S 80CCD Notified Pension Scheme
Aggregate Deduction U/S 80C, 80CCC & 80CCD cannot exceed Rs. 150000/-
Additional Deduction U/S 80CCD (1b) of Rs. 50000/-
Max Limit Declared Amount
Interest on Housing Loan on fully constructed accomodation
only
DEDUCTION U/S 24
Interest if the loan is taken before 01/04/99 on fully constructed
accomodation only
DECLARATIONS:
1. I hereby declare that the information given above is correct and true in all respects. I am also aware that the company will be considering
the above details in utmost good faith based on the details provided by me and that I am personally liable for any consequences arising
out of errors, if any, in the above information.
2. I am also aware that any person making a false statement / declaration in the above form shall be liable to be fined and prosecution u/s
277 of the Income Tax Act, 1961
3. The proof of payment / Supportings for claim, will be provided latest by _________________
Note -
Date :
Place: SIGNATURE OF THE EMPLOYEE
Form 12c
Form for sending particulars of income under section 192 (2B) for the year
for the year ending 31 Mar 2019
_____________________
ACTION POINTS
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Form 12c
1 This form is to be used by an assesse-employee when he desires that his income from
sources other than "salaries" may also be taken into account by the employer for purposes of
deduction of tax of source. This form may be submitted by the assessee employee to his
employer.
2 Once the Form is submitted by the assessee employees, the employer has to take into
account the other income disclosed by the assesse and the tax deducted at source thereon
while computing the tax deductible at source from the assessee's salary.
3 From the assessment year 1999-2000, the assessee is permitted to furnish particulars in
respect of any loss under the head 'Income from house property' to his employer. The Form
has consequently been enlarged, so as to enable the assessee-employee to furnish particulars
of such loss. Employees having loss under the head 'Income from house property' will find
it to their advantage to furnish such loss (if any) to the employer, since the tax deductible at
source will get corresponsdingly reduced. This apart, such employees will also be saved from
the botheration of filing a return of income just for the purpose of obtaining tax refund.
4 The assessee-employee cannot however furnish particulars of loss (if any) under any head of
income other than 'Income from house property'.
_____________________
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