Rayat Educational & Research Trust

Railmajra, Distt. SBS Nagar Phones: 01881-270500, 270691, Fax: 01881-270501

INCOME TAX DECLARATION FORM 01.04.2012 TO 31.03.2013 Part I (Personal Information) Name of the Employee Date of Birth (Mandatory) Gender (Mandatory) Contact No. (Mandatory) Permanent Account Number (Mandatory) Employee Code (Mandatory) Department Date of Joining Designation Pay Scale Total Emoluments drawn Part II (Investment profile) Amount likely to be invested during the year under review. S. No. 1. Description Section 80-C LIC Premium PPF NSCs Interest on NSCs ULIP Notified Mutual Funds Principal on Housing Loan Children Education Fee Term deposit for a period of not less than 5 years with a Scheduled Bank/Post Office. (as per Income Tax scheme) Amount

S. No. 3. 4. 5.

Description Section 80CCC Pension Scheme Investment Section 80D Medical/Health Insurance Premium Section 80DD Maintenance including Medical Treatment of Handicapped dependent.

Amount

6. 7. Part III

Section 80E Interest on Education Loan Section 80U Deduction in respect of disability Declaration of Rent for the purpose of Exemption u/s 10(13A) i) Location of property taken on lease/rent. ii) Rent being paid per month.

Part IV Declaration for the purpose of deduction u/s 24 i.e. property income. i) Part V
(To be filled in only if the employee wishes to furnish an other income (including loss unde house property) other than salary income). Form for sending particulars of income u/s 192(2B) read with rule 26B for the year ending March 2011. Particulars of income under any head of income other than salaries (not being loss under any such head other than the loss under the head Income from House Property) received in the F.Y. (Amount in Rupees)

Interest on housing loan repaid during the year.

Part IV Income from other sources i) ii) iii) DECLARATION

I do hereby declare that the aforesaid information is true and correct to the best of my information and belief and I shall indemnify the society against all costs and consequences if any information is later on found to be incorrect. Signed __________________________ (NAME) Place ______________________ Date _______________________

Dividend Interest Other Income