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Name:

FORM OF INFORMATION SHOWING INCOME TAX RATES AND MAXIMUM OF PROPOSED SAVING
INVESTMENT MADE/TO BE MADE DURING CURRENT F/Y 01/04/2013 TO 31/03/2014
Emp. No:
Date of Birth:
Date of joining:
Designation:

Sex: Male/Female

Residential Address:
(in BLOCK LETTERS)

PAN

SLAB
MALE

FEMALE

SENIOR CITIZEN
(Age 60 79 years )

SUPER SENIOR CITIZEN


Age 80 years or above

TAX
RATES

Rs.2,00,001/- to
Rs.2,00,001/- to
Rs.2,50,001/- to
Nil
10%
Rs.5,00,000/Rs.5,00,000/Rs.5,00,000/Rs.5,00,001/- to
Rs.5,00,001/- to
Rs.5,00,001/- to
Rs.5,00,001/- to
20%
Rs.10,00,000/Rs.10,00,000/Rs.10,00,000/Rs.10,00,000/30%
Above Rs.10,00,000/Above Rs.10,00,000/Above Rs.10,00,000/Above Rs.10,00,000/Note: 1. Tax rebate of Rs.2000/- is given if the taxable income is less than or equal to 5 lac, or those
under the tax bracket of 10%
2. Surcharge @10% is applicable on tax for those incomes above Rs.1 crore
Instructions:
(1) Completed Form should reach us on or before
/ /2013 positively.
(2) ALL PROOFS OF INVESTMENT MUST BE SUBMITTED EXPEDITIOUSLY BUT NOT LATER THAN
_____________
(3) GIVE DETAILS ON SEPARATE SHEET, IF SPACE PROVIDED IS NOT SUFFICIENT.
(4) Please dont mention As per last year, since the declaration has to be given every year by the assessee.
(5) New joiners to give their previous income details with out fail. Failing which investments will be taken on prorata basis for the current employment.
(6) PAN is compulsory (If there is no PAN, tax @ 20% or higher will be levied on entire earnings, no

exemption is permissible-Refers sec 206AA of Finance Act, 2010 effective 01 Apr 2010 )
Sr.
No.

Under
Sec

10

2
3

4
5
6

7
8
9
10
11

Nature of Investment/Eligible
Expenditure
House Rent Paid
(50% - Metro (Delhi, Mumbai,
Chennai & Kolkotta)
40% - Non-Metro)
Address of Landlord:
Children Education Allowance

80C

Limit

Actual/Proposed
Amount (ANNUAL)

i. 40/50 % of basic (or)


ii. HRA received (or)
iii. Rent paid over 10% of basic
which ever less

Rs.100 per child +


Rs.300 for hostel

Children 1
Children 2

Hostel
Hostel

Day Scholar
Day Scholar

Rs.

INVESTMENTS
01/04/2012 to 31/03/2013
National Saving Certificates
Purchased during the period
PPF(Max 70000 up to Nov 2011)
Unit linked-Insurance Plan (ULIP)
Insurance payable (give annual value
for each existing policies of self,
spouse and children)(This does not
include SSS if any)
(Max 10% of sum assured for the
policy issued on or after 01 Apr 12)
(Policy for parents cannot be
considered)
Total :
Senior Citizens Saving Scheme 2004
Post Office 5 year Term Deposit
Scheme
Home loan Principal for acquisition
or construction of a house
(ANNUAL)
Stamp duty paid
Registration fees Paid
Jeevan Dhara / Jeevan Akshay Policy
premium

Rs.

Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.

Rs.
Rs.
Rs.
Maximum of 1 lac (includes
80C + 80CCC + 80CCD)

Rs.
Rs.
Rs.

Rs.
Rs.
Rs.
Rs.
Rs.

22

Additional deduction allowed on


Interest paid on housing
property(ANNUAL)
80EE

23
80G

24
80TTA
25

26

27

Donations (It involves calculations


like Gross Qualifying Amount, Net
Qualifying Amount and Amount
Deductible) (Donations in kind shall
not be included)
Deduction in respect of interest on
saving account

Physical disability of not less than


40% on blindness or low vision or
80U
hearing impairment or mental
retardation or locomotor disability
Salary received from previous employer
(In case of new employees)
(Form 16 from previous employer is must)

Maximum 1 lac
i) Housing loan taken on or after
01 Apr 13.
ii) The loan sanctioned is less
than or equal to 25 lac.
iii) The registered value of the
property should be less than or
equal to 40 lac.
iv) The assesse is having only
one house property.
NDF, PMs National relief fund
etc 100%

1. To Individual employee
2. Max Rs.10,000/-(Interest
should be shown on other
income)
Fixed Rs.50,000/- or 1 lac for
severe disability of 80% &
above.

Income Chargeable Under the


Head Salaries
(after exempting Sec 10 & 16)
PF deducted by previous
employer
TDS deducted
Details of other income (Please give details for TDS calculation)
(i) Income from house property
(ii) In case of loss, pl. enclose computation there of
(ii) Other Income if any (Pl. specify)

No deduction should be
allowed by the DDO from the
salary income in respect of
any donations made for
charitable purposes. Circular
No. 5/2011, dated 16/8/2011

Rs.

Rs.
Rs.
Rs.
Rs.
Rs.
Rs.

VERIFICATION
I do herby solemnly declare that the details given by me is true and correct. I hereby confirm that
the above investments will be made out of my chargeable income and the proofs will be submitted
in due course.
Date:

Signature of the Employee

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