FORM I

SAVINGS FOR CLAIMING INCOME TAX REBATE

FINANCIAL YEAR 2014-15 ( ASSESSMENT YEAR 2015-16)
NAME :
STAFF NO :
PAN NO. :

DEPARTMENT
DIRECT

INTERCOM / MOBILE NO. :

1. Savings U/S 80C

a) PPF
b) LIC
c) NSCs
d) ULIP
e) Childrn Tuition Fees
f) Repayment Housing Loan (Principle)
g) any other item not covered
2) Savings u/s 80CCC- Jeevan Suraksha etc.
Total
3) Outside Income
a) Income from other sources -As per Form 12C
b) Income from house property( attach working as per Form II enclosed)

4) To claim HRA Rebate:Attach original rent receipts for Apr.2014, Aug.2014 and Dec.2014
Specify: Rent paid by individual p.m
5a . Expenditure on disabled dependents (u/s 80DD)
5b. Deduction to a person with disability (u/s 80U)
(attach valid medical certificate from Govt. Hospital FOR 5a. And 5b. )
6. Deduction in repsect of interest on repayment of loan of higher education u/s 80E
7.Deduction U/s 80TTA (for interest on saving account upto Rs.10000/-)
8. Exemption of income tax on cafeteria item of " reimbursement of expenditure on helper
at residence office" will be given only on production of receipt for the same
This is certified that the above mentioned savings are made by me and no other person will claim rebate of
Income Tax for the same.

Note: 1) Deduction u/s 80C and Sec 80CCC shall not exceed Rs. 1.50 lakh.
2) There is no sectoral caps in the investments made u/s 80C and the assessee is free to invest in
any one or more of the eligible instruments within the overall ceiling specified.
3) Deduction for interest for housing loan u/s 24 for self occupied house has been increased to
Rs.2 Lakhs form Rs.1.5 Lakhs
4) In case of HRA rebate , kindly attach original rent receipts of April 2014, August 2014 and Dec
2014 alongwith PAN of Landlord if Annual rent is more than Rs. 100000(or monthly rent is more
than Rs.8333/-)
5) Tax at higher of the prescribed rate or 20% will be deducted where PAN No. of the deductee is
not available.
6) Kindly verify the PAN No. in SAP Payslip. If there is any discrepancy in PAN, inform to
Aastha Madan / Mr. Amarchand of Finance Deptt.

SIGNATURE

Form No. 12C

[ See rule 26B]
Form for sending particulars of income under section 192(2B) for the year
ending 31st March, 2015

Name

Staff No

3
4

Permanent Account Number

Residential status

Particulars of income (not being loss ) under any head other

than "Salaries" received in the financial year
1

Income/Loss from house property

(in case of loss, enclose Computation thereof. Format
attached "Com of House property loss")

Profits and gains of business or profession

Capital gains

Income from other sources

(a)

Dividends

(b)

Interest (including interest from saving bank a/c for

claiming deductions u/s 80TTA)

(c)

5
6

Rs.

Rs.

Other incomes (Specify)

Total (a) + (b) + ( c)

Aggregate of sub-items (1) to (4) of item 4

Tax deducted at source [ enclose certificate(s) issued under
section 203]

Loss

Place :
Date :

Signature of the employee

Verification

This is to certify that I am in legal possession of the property for which rebate u/s 24 is claimed.
I, ______________, do hereby declare that what is stated above is true to the best of my knowledge and belief
Verified today, the __________day of __________
Place .................
Date ....................

Signature of the employee

Staff no.

COMPUTATION OF LOSS/ INCOME FROM HOUSE PROPERTY

NAME :
FINANCIAL YEAR :
STAFF NO. :
PAN :

2014-2015

1.

Address (es) of the property (ies)

2.

Self - Occupied

3.

Annual letable value/ Annual rent received or receivable, whichever is higher

4.

Less : Taxes paid to local authorities (attach proof)

Annual value (3-4)

6.

Less : Deductions claimed u/s 24

Yes

No

Rs.
Rs. 0

a) Repairs and collection of rent (30% of Annual Value at 5)

b) Interest on borrowed capital

Rs. 0
Rs. 0

Total - 6(a) + 6(b)

7.

Rs.

INCOME CHARGEABLE UNDER THE HEAD

"INCOME(LOSS) FROM HOUSE PROPERTY." [ 5 - 6 ]

Rs. 0

Verification

I,

Date :

certify that the above particulars are true and correct to the best of my knowledge and belief.

( Signature of the employee)