Investment Declaration Form - F.Y.

2019-20

1 NAME Bharath Babu MD ADDRESS

EMPLOYEE CODE
2 2909 S/O Devendrappa BM, V Bannihatti Channagiri Davanagere-577215
(MANDATORY)
PAN NO.( MANDATORY)
3 BMXPB9347P
*
4 DEPARTMENT Highway
5 DESIGNATION Senior Engineer
6 Date of Joining 17-Apr-19
7 Contact No. 91 81 222 919 45 Internal Off Extn No.

I hereby confirm that I will be investing/ contributing the following amounts for the purpose of rebate/deduction to be considered in calculating my income tax
for the F Y 2019-20 I further undertake that wherever eligible investments are made in the name of spouse/children/dependent parents, the same have been/
will be made out of my income and claim thereof has/shall not be made by anybody else.
I further undertake to submit all the Investment Proofs and Rent Receipts (if any) on or before 15th JANUARY, 2020 failing which the tax may be deducted
accordingly from my salary.

I. A. Deduction to be Claimed U/S 80 D Amount (Rs.)

Mediclaim Policy Premium [u/s 80D]-Max. upto Rs. 25,000/- for self , spouse & children and Rs. 30,000/-
1 for parents ( Rs.50,000 in case employee/parents are senior citizen) 50000
2 Mainetenance/Medical treatment of disabled Dependent [u/s 80DD]- Max. Limit Rs. 75,000/- & Rs. 1,25,000/-in case of Severe disabled ( Medical
Certificate from Specialist Doctor) -
3 Medical treatment of specified diseases for self [u/s 80DDB]-Max. Limit Rs. 40,000/-, Rs. 60,000/-in case of Senior Citizen & Rs. 80,000 for Very
-
Senior Citizen ( Medical Certificate from Specialist Doctor)
4 Deduction in case of person with disability [ u/s 80U]- Max.Limit for Disabled - Rs.75,000 , and in case of Severely Disabled - Rs.1,25,000 ( Medical
Certificate from Specialist Doctor) -

B Deduction U/S 80CCE - Maxi. Limit Rs.1,50,000

1 Life Insurance (Including Unit Linked Insurance Plan - ULIP ) 150000
2 Public Provident Fund ( PPF ) -
3 National Saving Certificates ( NSC ) -
4 Children School fee ( Only Tution Fee for max. two childern) -
Child 1: (Amount in Rs) Child 2: (Amount in Rs) -
5 Housing Loan Principal Payment ( Certificate attached) -
6 Bank FD/Infra Bond ( Tax saving FD for a period of Mini. 5 Years) -
7 Tax Saving Mutual Funds -
8 FD with Post office for a period of min 5 years -
9 Sukanya Samriddhi Account scheme -
10 Contribution to certain pension funds -
11 Any Other Investment pertaining to this Section 80CCE only (Please provide details) -

C Deduction U/S 80CCD -Maxi.Limit Rs.50,000

1 Contribution to National Pension Scheme (NPS) 25000

D Deduction U/S 80E

1 Interest on Loan taken for Higher Education ( Certificate Attached )

II. E Housing Loan Interest for Self Occupied Property - Maxi.Limit Rs.2,00,000
Interest on Housing loan ( Certificate attached)
( Attach provisional certificate from bank / financial institution)

III. House Rent Allowance (H.R.A.) Rent Amount p.m.

Name & Address of the Address of accommodation Pan no. of Copy of a Rent Receipt to be Yes/No
Landlord Landlord attached
Manadatory
(Rent PA >
1 Lacs)
Mr Veerabhadran, No 298
Saraswathi nagar Main 99600 8,300.00 99,600.00
Road Vijayanagar-566040
IV. LTA DECLARATION ATTACHED Yes/No AMOUNT CLAIMED
25000

I hereby declare that all the information given by me is true and correct & that the investments declared above,
will not be used anywhere else to get income tax benefit.

Place : Bangalore
Dated : 5/31/2019 Signature