Smartivity Labs Pvt Ltd

Employee's Income Tax Declaration Form for the Financial Year 2016-17
Name:

Date of Birth

Father's Name

PAN No:

DOJ:

Gender:
Designation

Address
I undertake to make the following investments qualifying under the provisions of The Income Tax Act, 1961 during the financial year 2016-17 and submit the
investment proof thereof alongwith Rent Receipts (if applicable) by January 10, 2017.
DESCRIPTION
S.No

INVESTMENTS U/S 80C+ 80CCC+ 80CCD(1) capped at Rs 1.5 Lac

Provident Fund (PF)

Public Provident Fund (PPF)

Employees Contribution under New Pension Scheme 80CCD(1)

Employees Contribution under New Pension Scheme 80CCD(1B)

(Max Rs.50000.00 In Addition to u/s 80C)

5
6
7
8
9
10
11
12
13
14
15
16

Life Insurance Premium Paid (Policy wise details as per annex)

National Savings Scheme/Certificate (NSC)
Approved Superannuation Fund
Interest accrued on NSC
Investment in Tax Saving Fixed Deposit (at least for 5 Yrs)
Children Education Expenses / Tuition Fees (Original receipt to be attached)
Housing Loan - Principal Payment (Payable in 2016-17)
Post Office Monthly Savings Schemes
Investment in Tax Saving Mutual Funds
Contribution to Pension Fund (80CCC)
Sukanya Schemes
Others, if any
Total Investments U/S 80C - limited to Rs 1,50,000/- only
OTHER PERMITTED DEDUCTIONS
80D - Medical Insurance Premium Maximum Rs. 25,000

80DDB - Expenditure on Medical Treatment for specified disease

80E - Repayment of Interest against Educational Loan

80G - Donations (Only for Prime Minister's National Relief Fund, the Chief Minister's
Relief Fund or the Lieutenant Governor's Relief Fund)
80U - Permanent Physical Disability- Normal Rs. 75000/- and Severe Rs. 1,25,000/-

B.

4
5

AMOUNT

Proposed Date of Date of Actual

value of Proof
Investment
Produce

0.00
AMOUNT

(Rs. 30,000 in case of premium on the health of Dependents above 65 years old)
(Certificate from Prescribed Authority Required)

(Certificate from Prescribed Authority Required)

Others -Please specify if any

Total Deductions
C
Exemptions under Section 24
Interest on Housing Loan (for Tax Exemption)
HRA: RENT PAID PER MONTH ( Please mention the starting and ending month)
D

0.00
AMOUNT
Rent per month

Amount

From: 01/04/16 To: 31/03/2017

(If rent amount changes during the financial year please specify the amount and the
period separately) If p.a. Rent is more than Rs.1 Lac then PAN Card of the Land Lord
is mandatory

From:

To:

(Submission of copies of rent receipts, L&L Agreement etc are essential for considering the exemption).

E
F
1
2
3

Rent Per Annum

PREVIOUS EMPLOYMENT SALARY
If Yes, Form 16 from previous employer or Form 12 B attached
INCOME FROM OTHER SOURCES
Pension Income
Interest on Fixed Deposit and on bank deposits.
Any other income

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 10th January 2017 for final computation of Income Tax for the year 2016-17.
Further, incase of any change in above declaration, I would revise it and inform immediately.
Signature:

Date:

Notes:
1. The declaration is for the Financial Year 2016-17 (Assessment Year 2017-18)
2. Whenever Employee submits proof or change in the declared value, the above format need to be filled and send to Finance Dept.
3. The date of Investments must be between 01-04-2016 - 31-03-2017.
4.Deduction under section 80C+80CCC+80CCD(1) cant excedds Rs 150,000/- ( Section 80CCE)
5. No Deduction under section 80CCD(1B) shall be allowed in respect of the amount on which a deduction has been claimed and allowed u/s 80CCD(1).
Deduction u/s 80CCD(1B) of Rs.50000.00 in addition to Rs. 150000 u/s 80C
6. Deduction u/s 80D shall be allowed only if the payment is made by any mode other than cash.
7. Maximum Deduction u/s 80D shall be allowed only upto Rs 30,000/- in case of dependent parents (Senior Citizen) & Rs 25,000/- for himself,
dependent children & dependent parents (Non-Senior Citizen).

spouse,

8. For renewal of Investments like Life Insurance Policy already taken, the dates on which the amount are payable are to be mentioned
9. Deduction u/s 10(13A) for HRA is available only where employees have actually paid the rent. Original rent receipts may be retained at your end while
xerox copies can be provided to Finance Dept. Deduction w.e.f April will be considered against declaration only if copy of lease agreement / Rent Agreement
is attached.
10. Kindly submit original Medical Bills of Rs.15000/- in a year towards availing Tax exemption.
11. Declaration should have PAN Number. Those who do not have PAN are requested to apply for it immediately and mention 'NOT FURNISHED'
In case of "NO PAN" or "Wrong PAN" tax will be deducted at a higher rate as per Income Tax Act.
12. Income Tax Slabs for the Financial Year 2016-17 (Assessment Year 2017-18):
I.
II.

Slab (General)
Upto 2,50,000
2,50,001 to 5,00,000

Rate
Nil
10%

III.

5,00,001 to 10,00,000

20%

IV.

Above 10,00,000

30%

I.

Slab (Senior Citizen: 60 to 79 years)

Upto 3,00,000

Rate
Nil