Employee's Income Tax Declaration Form for the Financial Year 2008-09

Name: Location:

Emp No: PAN No:

DOJ: Gender:

Company

Address

I undertake to make the following investments qualifying under the provisions of Income Tax Act, 1961 during the financial year 2008-09 and submit the

investment proof thereof alongwith Rent Receipts (if applicable) by January 15, 2009.
A DESCRIPTION
Proposed Date of Actual value of
AMOUNT Investment Proof
S.No INVESTMENTS U/S 80C capped at Rs 1 Lac or submission Produced

1 Provident Fund (PF)

2 Public Provident Fund (PPF)
3 Life Insurance Premium Paid (Like LIC,ICICI Prudential, TATA AIG etc..)
4 National Savings Certificate (NSC)
5 Approved Superannuation Fund
6 Interest accrued on NSC
7 Units purchased from a recognised mutual fund
8 Children Education Expenses / Tuition Fees
9 Housing Loan - Principal Payment (payable 2008-09)
10 Post Office Monthly Savings Schemes
11 Kisan Vikas Patra
12 NHB Scheme
13 Investment in Mutual Funds / equity shares of Companies engaged in
14 Infrastructure Bonds, ELSS
15 Contribution to Pension Fund
16 Others if any
Total Investments U/S 80C - limited to Rs 1,00,000/- only 0.00
B. OTHER PERMITTED DEDUCTIONS AMOUNT
1 80D - Medical Insurance Premium
2 80DDB - Expenditure on Medical Treatment for specified disease
3 80E - Repayment of Interest against Educational Loan
4 80G - Donations (Only against actual recipt and not on declaration)
5 80U - Permanent Physical Disability
6 Others - if any
Total Deductions 0.00

C Exemptions under Section 24 AMOUNT

Interest on Housing Loan (for Tax Exemption) 233.00
- Property acquired /constructed before 01-04-1999 - Rs.30,000 elgible 1,220.23
- Property acquired /constructed after 01-04-1999 - Rs.150,000 eligble 145.00
D RENT PAID PER MONTH ( Please mention the starting and ending month) Rent per month

(IF the rent amount changes during the financial year please specify the From: To:

amount and the period separately) From: To:

Rent Per Annum

E PREVIOUS EMPLOYMENT SALARY

If Yes, Form 16 from previous employer or Form 12 B attached

I, _________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief, the proposed investment
mentioned above will be completed on or before 15th JAN 2009 for final computation of Income Tax for the year 2008-2009. Further, incase of any
change in rent of the above permise I would revise declaration & inform immediately.

Signature: Date

Note:
1. The declaration is for the Year 2008-09 (Assessment Year 2009/10)

2. Whenever Employee submits proof or change in the declared value, the above format need to be filled and send to Finance Department.

3. The date of Investments must be between 01-04-2008 to 31-03-2009

4. For renewal of Investments like Life Insurance premium already taken, the dates on which the amount are payable are to be mentioned
5. Declaration should have PAN Number. Those who do not have PAN are requested to apply for it immediately and mention 'NOT FURNISHED'