Income Tax Declaration Form For Financial Year 2012-13

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INCOME DECLARATION FORM FOR 2012-13

(To be used to declare investment for income Tax that will be made during the period 2012-2013)

Company Name Employee Name DOJ PAN Number (Mandatory)


Item Particulars
EXT. Mobile

Contat Details

Max. Limit As per Rules Max.Limit 1,50,000.00 30,000.00 15,000 50,000

Declared Amount

Deduction Under House Rent Section 10


Item

I am staying in a rented house and I agree to submit rent receipts when required. The actual Rent paid is declared here :
Particulars

Declared Amount

Deduction under Section 24

Interest on Housing Loan after 01/04/99 Interest if the loan is taken before 01/04/99

Sec.80D - Medical Insurance Premium (If the policy covers a senior Citizen then deduction of Rs.20,000/- is available) Sec. 80DD - Medical treatment of Handicapped Dependant A higher deduction of Rs. 100,000 is available, where such dependent is with severe disability of > 80% (Form 10-IA should be submitted) Deduction Under Sec 80DDB - Medical treatment (specified diseases only) Medical treatment in respect of a senior Citizen then deduction of Rs.60,000/Chapter VI A is available (Form 10-IA should be submitted) Sec 80E - Repayment of Loan for higher education (only interest)

40,000

Item

Sec 80DDB - Handicapped 50,000 higher deduction of Rs. 100,000 is available,where severe disability is > 80% (Form 10-IA should be submitted) Particulars Max. Limit Public Provident Fund Sec 80CCC - Contribution to Pension Fund Life Insurance Premium National Savings Certificates
100,000

Declared Amount

Deduction Under United Link Insurance Plan (ULIP) Section 80C Repayment of Housing Loan (Principal Loan) (Maximum Units of Approved Mutual Funds Rs 1,00,000)
Fixed Deposit with Banks (made for a period of 5 years) Children- Tution Fee restricted to max.of 2 children Equity Linked Savings Scheme (ELSS) Others (please specify)
Declaration:
1) I hereby declare that the information given above is correct and true in all respects. 2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information being incorrect.

_______________________________________

Date: Place: Employee Signature

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