KOYAMA Precision Works INDIA Pvt Ltd

Employee's Income Tax Declaration Form for the Financial Year 2016-17
Name : C.Kumaravel PAN No : ATVPK8664L

Designation : Deputy Manager - Quality DOB : 18.07.1977

Department : Quality Assurance

S. No. DESCRIPTION Proposed Investment

A Particulars of Income other than salary from Koyama (optional)

1 Other Incomes (specify)

DETAIL OF HOUSE PROPERTY FOR CLAIMING REBATE UNDER SECTION

B
24 OF THE I.T ACT :

Address of house property :

Whether self occupied : (Yes /No)

If no , Net annual income of house property

Amount of housing loan Interest for the F.Y. 2016-17 148,642.00

Amount of Interest for Pre-Contruction Period (as per Income Tax Rule)

C HRA: RENT PAID PER MONTH 180,000.00

D INVESTMENTS U/S 80C, 80CCC, 80CCD

1 Public Provident Fund

2 Contribution to Certain Pension Funds

3 Housing Loan Principal Repayment 84302

4 Insurance Premium 25230

109,532.00

5 Term Deposit with Schedule Bank

6 National Saving Scheme / Certificate

7 Mutual Fund

8 Children Tuition Fees

9 Others, (Please specify if any)

Total Investments U/S 80C - limited to Rs 1,50,000/-

only

ADDITIONAL BENEFIT -Section 80CCD - National Pension Scheme (NPS)

Rs 50000

E OTHER PERMITTED DEDUCTIONS

80D - Medical Insurance Premium (Maximum Rs. 25,000

1
(Rs. 30,000 for senior citizens)

2 80G - Donations

4 Others - (Please specify if any) Medical 15000 15000

Kindly Submit this form before 24 Feb 2017

I, do hereby declare that the proof of investments will be submitted by 24th February , 2017. Further, in case of any change in
above declaration, I would inform the company . I shall indemnify Koyama for all cost and consequences if any information is
found to be incorrect.

I further declare that company can deduct Rs. ---------- P.M as TDS from my salary w.e.f 24-02-2017

Signature with date