INVESTMENT DECLARATION FORM for the period of APRIL 2011 TO MARCH 2012

EMP NAME Fathers name: DOB Item

Abhisek sahu Jagadish sahu : 04-051983 Praticulars Address (Mentioned in PAN card) E-mail id:urabhisek@gmail.com Max Limit Declared Amount plot-96,lane-4,jagannath vihar,bermunda,bhubaneswar

Deduction Under section 10

House Rent

I am staying in a rented house and I agree to submit rent receipts when required. I have taken exemption for LTA in the following years During the year 2009 - Yes / No - Yes / No During the year 2010

Residential property located at Bangalore.(Specify the name of the city)

LTA - IF Applicable

I will produce the travel bills as laid down under the LTA policy to avail the deduction.
MAX BENEFIT PERMISSIBLE (Rs) AMOUNT (RS)

Sec 80D Premium in respect of Medical Insurance 15000 (for self, spouce,dependent childern), Addl 15000 is allowed if parents (not a Sr citizens) are covered. Another Addl 5000 is allowed if the parents are Sr citizens Maximum of Rs. 35000/- is allowed under this sec. Sec 80DD (Medical treatment of handicapped dependents) Certificate from a doctor working in Government Hospital required Declaration by employee of amount incurred during the year
Maximum limit is 50,000 (In case of severe disablity more than 80% maximum limit is Rs.1,00,000)

15000

20000 -

Sec 80DDB (Medical treatment for specified ailments) Government Doctor(not less an MD) certificate in Form 101 40,000/- or 60,000/- (Senior Declaration by employee of amount incurred during the Citizen) year. Please mention if treatment is on Senior Citizen Interest paid on loan availed for higher education Sec 80E Certificate from Financial Institution ( Only Interest part will be given as deduction and not Principal amount)
No Limit

60,000

Sec 80U (Physically handicapped or totally blind employee) Maximum limit is 50,000 (In Certificate from a doctor working in Government Hospital case of severe disablity required maximum limit is
Rs.1,00,000)

100,000

DEDUCTION UNDER SEC 80C

7 8 9 10 11 12 13 14 15 16 17 18 19

Sec 80 CCC Contribution to Pension Fund (Maximum Rs.1,00,000) Life Insurance premium paid Unit Linked Insurance Plan (ULIP) National Savings Certificate (New Purchases) Interest Accrued on NSC (Previous Investments) Public Provident Fund (PPF) (Maximum Rs.70,000) Equity Linked Savings Scheme Principle repayment of Housing Loan Mutual Fund Bonds (Notified or UTI) Tutions fees (Maximum 2 children) Infrastructure Bonds Subscription to the bonds issued by NABARD Fixed Deposits more than 5 years made in Banks
5,713

Maximum Limit u/s 80C is Rs.1,00,000/( including PF deduction from Salary).

Note : The maximum amount of investments qualifying for deducation is Rs. 10,000/- under pension plan - 80CCC

DEDUCTION UNDER SEC 80CCF

20

Long Term Infra Structure Bonds Interest on Housing Loan

20,000 150,000 30,000

Deduction under Interest if the loan is taken before 01/04/99 Section 24

Declaration:

1) I hereby declare that the information given above is correct and true in all respects. 2) I also undertake to indemnify the company for any loss/liability that may arise in 2) I also undertake that the proof for the same would be provided in Feb 2012. the event of the above information being incorrect.
Date : Place:

Signature of the Employee