Income Tax Declaration Form for the Financial Year 2006-07

Name:

Karthikeyan T

Location:

Emp No:

1056

PAN No:

DOJ:

2/6/2003

Gender:

Male

Employee's Declaration

Value of Proof / Bills Produced

Exemptions under Section 10 & 17

Chennai

House Rent Paid (Sec 10 (13A))

12,000.00

Medical Bills Exemption (Sec 17(2))

15,000.00

Children's Education Allowance Exemption (Sec 10 (14))

LTA Exemption (Sec 10(5))
Vehicle Maintenance (Petrol / Maint. Bills) (Sec 10 (14))
Total

27,000.00

Other Income
House / Property Income or Loss (Enter Loss as Negative)
Interest on Housing Loan (for Tax Exemption)
Other Income (Interest, etc.)
Deductions under Chapter VI-A

Medical Insurance Premium (Sec 80D)

Medical for Handicapped Dependents (Sec 80DD)
Medical for Specified Diseases (Sec 80DDB)
Higher Education Loan Interest Repayment (Sec 80E)
Donation to Approved Fund and Charities (Sec 80G)
Rent Deduction (Sec 80GG) only if HRA Not Received
Deduction for Permanent Disability (80U)
Any Other Deductions
Total
Deductions under Chapter VI (Sec 80C)
Deduction under Pension Scheme (Sec 80C)
NSC (Sec 80C)
Public Provident Fund (Sec 80C)
Employees Provident Fund & Voluntary PF (Sec 80C)
Children's Education (Sec 80C)
Housing Loan Principal Repayment (Sec 80C)
Insurance Premium (Sec 80C)

6,060.00

Infrastructure Bonds & others (MF, ULIP, etc.) (Sec 80C)

Total Investments

6,060.00

I _______________________________________________ do hereby declare that what is stated above is true to the best of my
knowledge and belief.

Date:

Signature:

Employee's Income Tax Declaration Form for the Financial Year 2012-13
Name:

PAN No:

Designation

Gender:

Department

DOB

DOJ:

Email

Work Permit
No.

Contact No.

S. No.

DESCRIPTION

Particulars of Income from sources other than salary from the NIT Raipur
(optional)

1
2
3

Dividends
Interest
Other Incomes (specify)

Proposed
Investment Date

Rs.

Total Earnings
Income from House Property
Annual Value of House Property (As Per Income Tax Act)
Less:
(I) Standard Deduction (as per Section 24(1)

(II) Interest on Housing Loan - as per Section 24(2) (for Tax Exemption - Self
Occupied Property acquired /constructed before 01-04-1999 - Rs.30,000 elgible & Self Occupied
Property acquired /constructed after 01-04-1999 - Rs.150,000 eligble)

a. Amount of Interest for the F.Y. 2012-13

b. Amount of Interest for Pre-Contruction Period (as per Income Tax Rule)
Total Income from House Property
HRA: RENT PAID PER MONTH ( Please mention the starting and ending month)

0
Rent (p.m.)

Period:

Total Rent Paid (per annum)

D
1
2
3
4
5
6
7
8
9
10
11
E
1
2
3
4
5
6
7
F

INVESTMENTS U/S 80C, 80CCC, 80CCD capped at Rs 1 Lac

Provident Fund (PF)
Employees Contribution under New Pension Scheme
Public Provident Fund
Contribution to Certain Pension Funds
Housing Loan Repayment Principal (payable in F.Y. 2012-13)
Insurance Premium (including GIS contribtuion)
Term Deposit with Schedule Bank
National Saving Scheme / Certificate
Mutual Fund
Children Education Expenses / Tuition Fees
Others, (Please specify if any)
Total Investments U/S 80C - limited to Rs 1,00,000/- only
OTHER PERMITTED DEDUCTIONS
80D - Medical Insurance Premium (Maximum Rs. 15,000

(Rs. 20,000 for senior citizens

80DDB - Expenditure on Medical Treatment for specified disease

80E - Repayment of Interest against Educational Loan
80G - Donations (only for Prime Ministers National Relief Fund, the Chief
Ministers Relief Fund or the Lieutenant Governors Relief Fund)
80GG - Rent Paid but not in Receipt of HRA
80U-Permanent Physical Disability (Normal Rs. 50000/- and Severe
Rs.1,00,000/-)
Others - (Please specify if any)
Total Deductions
PREVIOUS EMPLOYMENT SALARY
If Yes, Form 16 from previous employer or Form 12 B attached

0
Salary Paid

TDS (in Rs.)

I, do hereby declare that the proof of fresh investments will be submitted by 31st December, 2012. Further, incase of any
change in above declaration, I would revise it and inform the insitute immediately. I shall indemnify the institute for all cost and
consequences if any information is found to be incorrect.

Date:

Page 3 of 6

Name with Signature of Employee

FORM NO. 12B

[See rule 26A]
Form for furnishing details of income under section 192(2) for the year ending 31st March,_______
Name and address of the employee
Permanent Account No.
Residential status
Particulars of salary as defined in section 17, paid or due to be paid to the
employee during the year

S.No

Name and
address of
employer(s)

TAN of the
employer(s) as
allotted by the
ITO

Permanent
Account
Number of the
employer(s)

Period of
employment

Amount deducted in
respect of life
Total amount of house rent
Total of
insurance premium,
allowance, conveyance
Value of perquisites columns 6,
provident fund
Total amount of
allowance and other
and amount of
7, and 8
contribution, etc., to
salary excluding
allowances to the extent
accretion to employee's
which sec. 80C
amounts required chargeable to tax[See section provident fund account
applies (Give details)
to be shown in 10(13A) read with rule 2A and
(give details in the
columns 7 and 8
section 10(14)]
details in the
6
7
8
9
10

Total amount
of tax
deducted
during the
year (enclose
certificate
issued under
section 203)

Remarks

11

12

With effect from 1-4-1991, section 80C has been replaced by section 88.

Signature of the employee

Verification
I,______________________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the_____________________day of______________________
Place

Signature of the employee

ANNEXURE
[See column 8 of Form No. 12B]
Particulars of value of perquisites and amount of accretion to employee's provident fund account
Name and address of the employee
Permanent Account No.
Period : Year ending 31st March,_______________
Value of rent-free accommodation or value of any concession in rent for the accommodation provided by the employer (give basis of computation)[See rules 3(a) and 3(b)]
Where accommodation is furnished

Name of
the
employee

TAN/PAN of
the employer

Where
Value as if
accommodation accommodation
is unfurnished is unfurnished

Cost of furniture (including television sets, radio sets, refrigerators,

other household appliances and air-conditioning
plant or equipment) OR hire charges, if hired from a third party

Perquisite value of furniture (10%

Rent, if any,
Total of columns 4 and
of column 5) OR actual hire
paid by the
6
charges payable
employee

Value of
perquisite
(column 3
minus
column 8
or column
7 minus
column 8
as may be
applicable)
9

ANNEXURE
(Contd.)

Name of
the
employee

Interest
credited to the
Remuneration paid
Estimated value of any other
assessee's
Employer's
Total of
by employer for
Value of free or concessional benefit or amenity provided by the
account in
contribution to
columns 9
Whether any conveyance has been provided by the employer free or domestic and/or
passages on home leave and
employer, free of cost or at
recognised
recognised provident
to 15
at a concessional rate or where the employee is allowed the use of
personal services other travelling to the extent
concessional rate not included in
provident fund
fund in excess of 10%
carried to
one or more motor cars owned or hired by the employer, estimated
provided to the chargeable to tax (give details)
the preceding columns (give
in excess of
of the employee's
column 8
value of perquisite (give details) [See rule 3(c)]
employee (give [See rule 2B read with section
details), e.g., supply of gas,
the rate fixed
salary [See Schedule
of Form
details) [See rule
10(5)(ii)]
electricity or water for household
by the Central
IV - Part A]
No. 12B
3(g)]
consumption, free educational faci
Government
[See Schedule
IV - Part A]

Name of Employee
Place
Signature

10

11

12

13

14

Signature of the employee

15

16