Your Company Name

TAX SAVINGS DECLARATION FOR THE FINANCIAL YEAR 2010-11 (Assessment Year 2011- 12)

Employee Name
Emp. ID#
E - Mail ID
PAN #

I will make the following payments/ investments during April 2010 to March 2011. The same may be considered in
computing my tax liability for the financial year 2010-11.
Proofs for the same will be submitted as and when required by Your Company Name.
SI.No SECTION
1
2
3 80 C
4 80D
5 80DD
6 80 E
7 80 U
DETAILS AMOUNT (Rs.)
House Rent paid
-rent receipt as given by the house owner to be submitted as
proof
-rent receipt to be duly affixed with revenue stamp
-rent receipt can be given consolidated / monthly
-receipts to be dated between 1.4.2010 to 31.3.2011
Loss from House property
-Form 12C to be submitted
-Certificate from Financing Institutions(Ex. Bank/LIC/HDFC)
showing the projected interest payable should be submitted as
proof
INVESTMENT UNDER SECTION 80C and 80CCC
(subject to a max. of Rs. 1,00,000/- only from a to n)
a. Life insurance premium
b. Contribution / Deposits in Public provident fund
c. Investments in postal savings 10/15 years Account
d. Investments in N.S.C
e. Investment in infrastructure bonds.
f. Contribution to notified pension plans
g. Contribution to Mutual funds as notified u/s 10(23D)
h. Tution fee for education of children.
i. Repayment of Housing loan principal amount
j. Investment in unit linked Insurance plan( ULIP)
k. Term Deposit (for a fixed period of not less than five years with
a scheduled bank).
l. Deposit in an Account under the senior citizen saving scheme
Rules, 2004.
m. Deposit in an account under the post office Time Deposit
Rules 1981.
n. Others
o. investment in long-term infrastructure bonds as notified by the
Central Government (Max.Rs.20,000/- addition to Rs.1,00,000/-)
Expenditure u/s. 80 D to 80 U
Premium paid for Medical insurance (Max of Rs.20,000/-)
Amount incurred towards maintenance (including medical
treatment of Handicapped dependants ( max.allowed Rs.
75,000/-) (Necessary proofs of expenditure incurred to be
submitted)
Payment of Interest on Education loan.
Certificate from Bank / Financial Institution showing the projected
Payment of interest should be submitted as proof.
Permanent physical disability/ handicapped employees
(Max.allowed Rs. 50,000/-)(Necessary proofs to be submitted)

VERIFICATION

I __________________________ Emp.ID.No. _________ do hereby declare that what is stated above is true to the best of my
knowledge and belief. I further confirm that there will be no shortfall in the above payments/ investment and that the
documentary proof will be submitted as mentioned above.

Verified today the _______________ Day of _____________ 2010

Place:
Date: Signature of the Employee