INVESTMENT DECLARATION FOR YEAR 2012-2013

*NAME (Mr / Ms.) *E.CODE : 525989 *DOJ : 24 Oct 2012 *PAN NO. *Male/Female * Gender: *ADDRESS (for the purposes of HRA ) *Metro/Non-Metro Details of Dependents Ashar Khan AMCPK9678A Male

Non-Metro 2

I undertake to make the following investments qualifying u/s 80C of the Income Tax Act, 1961 during the financial year 2012-2013. and submit the proof thereof alongwith proof under Chapter VI-A and Rent Receipts (if applicable) before Feb- 2013.

S.NO. A. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

DESCRIPTION INVESTMENTS U/S 80C capped at Rs 1 Lac Public Provident Fund (PPF) Life Insurance Premium Paid (Like LIC,ICICI Prudential, TATA AIG etc..) National Savings Certificate (NSC) Interest accrued on NSC Approved Superannuation Fund Units purchased from a recognised mutual fund Any sum Paid as Tution Fees for full time education of any two children of the individual Housing Loan - Principal Payment Registration / Stamp Duty charges paid for registration of house property NHB Scheme Investment in Mutual Funds / equity shares of Companies engaged in Contribution to Pension Fund Senior Citizen Saving Scheme 2004 Fixed Deposit for a period of 5 years or more in accordance with scheme of central Govt. Amount deposited in the 5 years time deposit scheme in post office Infrastructure Bond Total Investments U/S 80C - limited to Rs 1,00,000/- only (Infrastructure Bond) Additional Deduction of Infrastructure Bond Rs 20000 is removed) OTHER PERMITTED DEDUCTIONS 80D - Medical Insurance Premium (up to Rs.15,000/-or Rs 20,000/- as applicable and Additional Deductioon of Rs 15,000/- or Rs.20,000/- allowed in an Individual paying Medical Insurance Premium for His or Her Parent or Parents.Preventive Medical Check ups Rs 5000 is eligible under this section 80DD - Medical Treatment of Dependent suffering from Permanent Disability (up to Rs.50,000/-) 80DDB - Expenditure on Medical Treatment for specified disease (up to Rs. 40,000) 80E - Repayment of Interest against Educational Loan - no limits on interest paid during the year 80U - Permanent Physical Disability (Rs.75000/- disability less than 80% and Rs 1 Lakh for disability more than 80% )

AMOUNT 30,000 50,000.00 20,000.00

Proposed Date of Investment / submission

20,000.00

B. 1 2 3 4 5

C. 1 2 D

E.

0.00 REIMBURSEMENTS Amount of Bills Medical Bills (Exemption up to Rs. 15,000/-) 15000 Leave Travel Allowance ( 2 journeys in a block of four years exempted) Current Bloack 2010-13 12000 If I do not submit the bills the amount of Medical / LTA paid can be taxed as per the rule. Yes/ No INTEREST PAYMENT ON HOUSING LOAN (up to Rs.1 .5 Lacs if the loan taken after 1-4-99, 30000 if it is prior to 1-4-1999 and there is no limit on let out property) RENT PAID PER MONTH ( Please mention the starting and ending month) Rent per month (IF the rent amount changes during the financial year please specify the 5,000.00 To Date: 31 mar 2013 amount and the period separately) From Date: 01 apr 2012 To Date: (DD/MM/YYYY format) From Date: PREVIOUS EMPLOYMENT SALARY (Salary earned from 01/04/12 till date of Joining) If Yes, Form 16 from previous employer or Form 12 B attached or certified IT Computation sheet from previous employer to be attached.

Total Investments under chapter VI A

Rent per month

F.

VERIFICATION I do hereby declare that what is stated above is true to the best of my knowledge and belief. Further, in case of any change in rent and / or occupation of the above premises I would revise the declaration & inform immediately. Note : Please do not attach any proofs to this form . This is only a Declaration.
The Tentative date for submission of income tax proof will be on 10th Feb'13, with in 10 days from the date of resignation which ever is earlier For all your queries please write to info@teamlease.com

*Employees' Signature : * Indicated filled is mandatory

Ritesh Narula

Date: 04 th May 2012