Submission of Investment Declaration / Proof - Financial Year 2016-17

U/S 24
1
Housing Loan Repayment of Interest

Rs.

Under Construction [ ] / Self Occupied

[ ]
U/S 80 C
2
Housing Loan Repayment of Principal

Max. upto Rs.2,00,000/- Only

for self occupied property
Claimed only after occupation
of flat

Rs.

Max. upto Rs.1,50,000/

Public Provident Fund/ National Savings

Certificates
SukanyaSamriddhi Scheme

Rs.

,,

Rs.

,,

Rs.

,,

ELSS / Mutual Fund ( Tax savings exempt u/s

80C only)
Unit Linked Insurance Scheme

Rs.

,,

Payment of Life Insurance Premium

Rs.

,,

Children Education Fees (Only Tuition Fees)

Rs.

,,

Five Years Tax Savings Fixed Deposit

Rs.

,,

10

Pension Plan (80CCC)

Rs.

,,

11

Investment in NPS (80CCD

Rs.

Max. upto Rs.50,000/

4
5

Aggregate amt of investments u/s 80C, 80CCC Rs.1,50,000/-+ u/s 80CCD(1b)Additional deduction of Rs.
50,000
Other deductions under Chapter VI-A
11
Mediclaim U/S 80D
Rs.
Max. up to Rs.25,000/- for
individual. Max. up to
Rs.30,000/- for Senior
Citizen.
1
Payment of Education Loan Interest U/S 80E
Rs.
No limit on Interest paid on
Loan (Max.
2
for 7 yrs from the date
repayment)
1
Handicapped Dependant 80DD (Pls. submit
Rs.
Max.Rs.75,000/3
Form 10-IA)
(Rs.1,25,000/- in case of
severe disability)
1
Physically Handicapped 80U (Pls. submit
Rs.
,,
4
Form 10-IA)
1
Treatment of Specified diseases 80DDB (Pls.
Rs.
Actual expense incurred or
5
submit Form 10-IA)
Max Rs. 40,000 (Rs.60,000
for Senior citizen or
Rs.80,000 for very senior
citizen).
U/S 10

1
6
1
7

Rent Paid (Monthly)

Number of School going
Children, if any ( No.)

HRA
Exemption
Rs.100/exempted per
child(Max.2
children)

I hereby declare that what is stated above is correct. I undertake to inform any change in the
above facts. I hereby confirm that I shall submit necessary proof of investment details &
Rent receipts by February 15th2017 failing which the tax relief computed may be withdrawn.
Employee No.:
Name:
Location
PAN
(Mandatory)
Signature
Date