SINCLUS

41 & 43, Navketan Industrial Estate,

Mahakali Caves Road,
Andheri (East)
Mumbai - 400 093

INCOME TAX INVESTMENT ACTUAL DECLARATION FORM FOR THE YEAR 2019-2020

Emp.Code Employee name

PAN Department Name Designation

Mobile No. E-Mail Id

S. No. Investment Description Section Amount (Rs.)

MEDICLAIM PREMIUM Self
(a) For Self, Spouse, Dependent Children
1 80D
& Parents - Maximum Limit Rs. 25000/- & Rs. 30000/-in case of premium on the health of Parents Parents
(Senior Citizen)
EXPENDITURE ON HANDICAPPED DEPENDENTS/ Deposits made for maintenance of Handicapped
2 Dependents -& disability the deduction will be Rs. 1,25,000 (Attach Latest Govt. Hospital Medical 80DD
Certificate )
PERMANENT DISABILITY BENEFIT (SELF) -Adhoc deduction amount of Rs. 75000/-& Rs.1,25,000
3 in case of disability exceeding 80%. (Attach Latest Govt. Hospital Medical Certificate - Form 80U
10ia).
INTEREST ON LOAN TAKEN FOR HIGHER EDUCATION - The deduction will be allowed for a
4 Maximum Period of 8 Years beginning from the year in which payment of interest on the loan begings 80E
or till the interest is paid if full,whichever is earlier.
INTEREST PAID ON HOUSING LOAN. No Maximum limit for let out property. Maximum Limit for
5 Self Occupied Property Rs. 200000/-(from 01-04-1999) (Submit Certificate received fom Financial 24(1)(vi)
Institution/ Banks, Occupation Certificate)

6 INVESTMENT UNDER OVERALL LIMIT OF Rs. 1.5 LAKH UNDER SECTION 80C VIA
(A) HOUSING LOAN PRINCIPAL REPAYMENT 80 C
(B) Provident Fund Contribution (Employee's Portion) 80 C
(C) PPF -PUBLIC PROVIDENT FUND - 15 Years 80 C
(D) LIC -LIFE INSURANCE PREMIUM DIRECTLY PAID BY EMPLOYEE 80 C
(E) NSC -NATIONAL SAVING CERTIFICATE 80 C
(F) NSC -INTEREST (PURCHASED PRIOR TO 31.03.2018) 80 C
(G) DEPOSIT UNDER POST OFFICE SAVING BANK 80 C
(H) MUTUAL FUNDS / ULIP 80 C
(I) ELSS -EQUITY LINK SAVING SCHEME OF MUTUAL FUNDS 80 C
(J) TUITION FEES FOR FULL TIME EDUCATION TO INDIAN SCHOOL, UNIVERSITY 80 C
(K) SUKANYA SAMRUDHI YOJANA / RAJEEV GANDHI MUTUAL FUND. 80 C
(L) INVESTMENT IN TERM DEPOSIT ( PERIOD OF 5 YEARS OR MORE) IN A SCHEDULED BANK 80 C
(M) 5 YEARS TERM DEPOSIT AN ACCOUNT UNDER POST OFFICE TERM DEPOSIT RULES 80 C
Grand Total of Column 7 for rebate under section 80 C -
7 INVESTMENT IN PENSION FUND U/S 80CCD (1B) ( ADDITIONAL DEDUCTION OF RS.50,00/-) 80 CCC
0
HOUSE RENT PAYMENT (Relief provided against submission of Lease agreement, PAN Number of
8 10 (13A)
Owner).

Previous Employer Income :(If Joined after 01.04.2019 ) -Form 16 or signed Tax
9
Computation Sheet from employer along with Form 12 BA is mandatory.
ANY OTHER INCOME -(ATTACH DETAIL)
10
Amount of Interest on Housing Loan May change, hence you are requested to obtain final certificate in the month of January'2020 and submit before 25th
January'2020.Please Note - Interest accrued on NSC is your income for the financial Year.If you claim any such amount as investment U/S.80C,than it will
also be considered as your income and the same will be added while calculating your income tax liability.
I undertake that, the proposed investment mentioned above will be completed on or before 25th January'2020 for final computation of Income Tax for
the financial year 2019-2020

Date: Employee Signature:

PLEASE SUBMIT THE PROOFS OF INVESTMENTS (Hard Copies OR Soft Copies) TO LOCAL HR/PAYROLL ON OR BEFORE LAST DATE : 25th January'2020.