COLLEGE OF ENGINEERING, PUNE , Wellealy Road, Shivaji Nagar, Pune #77005 INCOME TAX DECLARATION FORM - F.Y. 2014-15. a Based To aeeara Tavestmant Thal WIT Be made Gurag he period Wom OT UMLOTE To BOIS Tor TACome TAX BUFO) PERSONAL INFORMATION (ALL FIELDS ARE MANDATORY) INAME (Capital Letters) IGeNDeR JDesicnation DEPARTMENT DATE OF voINING lDATE OF BIATH JPAN NO (Attach Photo Copy) IMoBiLeNO A INCOME FROM OTHER SOURCES ‘SR NO[PARTICULARS AMOUNT/ RS. interest earned on Saving Bank Account interest earned on Fixed Deposit lother Income (Please specify) lother Income (Please specify) Total B HOUSE RENT PAID (For Staff receiving "HRA" Exempted as per Rule) SR NO RENT PAID FROM MONTH TO MONTH FETT | ROOF | TOTAL © HOUSE RENT PAID (For Staff not receiving "HRA") RENT PATUPER TiO OF TOTAL ‘SR NOJRENT PAID FROM MONTH TO MONTH MONTH. montis | amounties | D HOUSING LOAN INTEREST - (Limit upto 2,00,000/ -) HOUSING DATE OF INTEREST ‘SR NO|NAME OF THE FINANCIAL INSTITUTE Peon joan | ‘noun E INVESTMENTS U/ S 80C, 80CCC & BOCCD (Limit upto - 1,50,000/ -) ‘SR NO[PARTICULARS. AMOUNT/ RS. [Accrued Interest on NSC lPublic Provident Fund (PPF) lite insurance (L1C)[National Savings Certificate (NSC) |Repayment of Principal Housing Loan Instalment (Excluding Salary Deduction} lunit Linked Insurance Plan (ULIP) lMutual Funds notitied u/ s 10(23D) [children Tuition Fee - Only Tuition fee for Two Children only [Term Deposits (for minimum § years with a Scheduled Bank) 19] lEquity Linked Saving’s Scheme - (ELSS) 4 12] 13] Total F OTHER INVESTMENTS / DEDUCTIONS ‘SR No| PARTICULARS. AMOUNT/ RS. IMediciaim Policy - Individual, Spouse & Children lPreventive Health Check-up- Max 5,000 lMediciaim Policy - Parents lRepayment of Interest on Higher Education Loan |Permanent Physical Disability - Self (Attach copy of Ce ficate) |Permanent Physical Disability - Dependant (Attach copy of Certtica Total G PREVIOUS EMPLOYMENT DETAILS (LPC DETAILS) ‘SR No| 7 TOTAL SALARY TOTAL INCOME TAX INAME OF THE INSTITUTE! EMPLOYER TAL SALA AC TNCOME SELF DECLARATION hereby declare thatthe information given above is correct and true in all espects. | am also aware thatthe inttute wil Je considering the above details in utmost good faith based on the details provided by me and that I am personally liable for lany consequences arising out of errs, i any, in the above nfarmation. [ram also aware thal making a Tals statement dectaration inthe above Torm shall be Table To [277 of the Income Tax Act, 1961 Ted ana prOveOUTTON Us| Te proot of Other Tncome | Tavesiments 1 Deductions or calculation of Income Tax, willbe provided ated by 24th NNovember 2014. if fail to submit the declaration within stipulated period of time. please deduct my balance Income [Tax equally during the remaining months. [wil claim my tax refund from Income Tax Department through my Income [Tax Return, ram also aware that The iivecimente declared Th above Tarm are dVeal invecmants and not reiected in my Monthly ary [The is no possiblity of auplicatan of invesments [ter considering declaration of vestments, balance income Tax payable willbe deducted Wom my Slay payabl Tore 5)month of Dee 2014, Jan 2015 & Feb 2015 equally. Date ‘Signature of the Declarant