INCOME TAX DECLARATION FORM - F.Y.

2018-19
(To be used to declare investment that will be made during the period from 01/04/2018 to 31/03/2019 for Income Tax purpose)

Company Name Emp ID

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%

ITEMS PARTICULARS MAXIMUM LIMIT DECLARED AMOUNT

DEDUCTION U/S 10

I am staying in a rented house and I agree to submit Leave &

METRO /
HOUSE RENT Licence A'ment when required.The Rent Paid is (Rs.
NON METRO
_____________ X _______ months) & the house is located in
a METRO / NON METRO (Tick whichever is applicable)
Max Limit Declared Amount
Sec 80D - Medical Insurance Premium (If the policy covers a
senior citizen then exemption is Rs.30,000/-)
Sec 80DD - Handicapped Dependent

Sec 80E - Repayment of Loan for higher education (only Interest)

DEDUCTION UNDER Sec 80GG - Rent Paid
CHAPTER - VI A 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