Avineon India Pvt Ltd Declaration for computation of Income Tax on Salaries for the Financial Year 2012-2013.

Name of the Employee: ID Number: 1. 2. Rent paid per month Deductions u/s 80C a) Life Insurance Premium b) National Savings Certificates Division / Department: IT PAN No: Rs. ______________

Rs. ______________ Rs. ______________

c) Mutual Funds Investment Rs.______________ d) Public Provident Fund (PPF) Rs.______________ e) Tuition & Term Fee of Children Education (Other than Donations) Rs._______________ f) Repayment of Principal of Housing Loan (Including Property Tax) Rs.______________ (Principal and interest portions should be mentioned clearly) g) Interest on NSC VIII Issue Rs.______________ h) Contribution to Pension Fund Rs.______________ i) Contribution to Employees Provident Fund Rs.______________ 3. 4. Repayment of Interest on Housing u/s 24 Deductions u/s 80D to 80 U a) Contribution to Medical Insurance Premium & Preventive health check up Expenses b) Medical Treatment of Handicapped Dependants c) Medical Treatment towards specific diseases Donations to approved national funds (please mention 50% or 100% eligibility) Number of school going children Rs.______________

5.

Rs.______________ Rs.______________ Rs.______________ Rs.______________ ________

6. Note:

1. The above declaration is provisional and all the supporting documents related to this 2. 3.
declaration need to be submitted by 20th Jan 2013. Proof documents need not to be submitted now only provisional amounts need to be provided. In the case of Housing Loan availed during the year, number of months for which house rent is expected to be paid need to be mentioned clearly in the point (1). Principal and Interest break-up need to be provided in the case of housing loans.

Signature of the employee

Date: