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APOLLO INTERNATIONAL LTD

INVESTMENT DECLARATION FORM FOR CLAIMING TAX BENEFITS For the Financial Year 2017-18
PERSONAL INFORMATION (ALL FIELDS ARE MANDATORY)
EMPLOYEE CODE

NAME

FATHER/HUSBAND NAME

DATE OF BIRTH

GENDER

LOCATION

PAN

CONTACT NO.

DATE OF JOINING

SECTION-I (Only original Rent receipts will be considered)


RENT PAID FOR THE PURPOSE OF CLAIMING BENEFIT OF HRA U/S 10(13A) OF THE ITAX ACT, 1961

From date To date Full Address City Rent Paid Per month

Below information is mandatory if rent exceeds Rs. 200000/- annual (16667/- P.M)

PAN OF LANDLORD NAME & ADDRESS OF LANDLORD (IF PAN NOT ISSUED)*

* Please submit hardcopy of declaration from landlord that he/she has not been allotted PAN from Income Tax Department

SECTION-II (Photocopies to be attached)


(DECLARATION OF SAVING ALLOWED U/S 80 OF THE IT ACT, 1961) In respect of Saving allowed under Chapter VI
S.No Description
Amount
U/s 80D- Medical Insurance Premium- Individual, Spouse & Children ( Max Limit - 15,000
1 Additional Rs. 5,000 if any person insured is a senior citizen)
U/s 80D- Medical Insurance Premium- Parents (Max Limit - 15,000, Additional Rs. 5,000 if
any person insured is a senior citizen)
U/s 80D- Preventive Health Check-up- Max 5,000 (Within Overall limit of 15000/20000)

U/s 80DD- Medical treatment for dependent Handicap


2 (If Disability is more than 40% but less than 80%) - Max Limit - 50,000
U/s 80DD- Medical treatment for dependent Handicap
(If Disability is more than or equal to 80%) - Max Limit - 1,00,000
U/s 80DDB- Medical treatment for Specified disease
3 (If patient is not a senior citizen) - Max Limit - 40,000
U/s 80DDB- Medical treatment for Specified disease
(If patient is a senior citizen) - Max Limit - 60,000
U/s 80U- Permanent Physical disability of assessee
4 (If Disability is more than 40% but less than 80%) - Max Limit - 50,000
U/s 80U- Permanent Physical disability of assessee
(If Disability is more than or equal to 80%) - Max Limit - 1,00,000
Section 80E- Payment of interest on loan taken for Higher Education
(No Max limit on Interest Paid during the year 2013-2014). Declaration needs to be
5 submitted.

SECTION-III (saving u/s 80C OF THE IT ACT, 1961) (Photocopies to be attached)


Total Amount of Deduction allowed up to Rs. 1,00,000/- (Including Provident Fund deducted through salary)

S.No Description Amount

1 Accrued Interest on NSC

Public Provident Fund (PPF) - Self, Spouse & Children Only


2

3 LIFE INSURANCE (LIC) - Self, Spouse & Children Only

National Savings Certificate Purchased (NSC)


4

Housing Loan repayment of Principal (Including Stamp Duty, Registration Fees & Other
Expenses incurred for the purpose of Transfer of Property to the Assessee.)
5

Unit Linked Insurance Plan (ULIP) -


6

Mutual Funds notified u/s 10(23D) -


7

Investment u/s.80CCC (Pension Policy) will also qualify under this Sec-Rs.1Lac
8

Investment Declaration Page 1


Children Tuition Fee - Only Tuition fee for Two Children only
9
Term Deposits (Made during April'13-March'14) for a fixed period of not less than 5 years with
10 a Scheduled Bank

Senior Citizens Savings Scheme


11

ELSS (Equity Linked Saving's Scheme)


12

Bonds, issued by national bank of agriculture and rural development.


13

5 year Post Office deposits & Senior Citizen Scheme


14

SECTION-IV (Saving U/S-80CCG & 80TTA)


1. Equity Saving Scheme(U/S 80CCG)-50% of the Amount Invested or 25000 whichever is less

.
2 Deduction I.R.O. Interest in Saving A/C(80TTA) (Interest earned from saving bank account up to Rs.
10000/- is exempt from tax)

SECTION-V (DEDUCTION U/S 24 OF THE IT ACT, 1961 INTEREST ON HOUSING LOAN)


With respect of the amount of any interest payable on borrowed capital for acquiring, constructing , renewal, repairing or re-constructing property.

1. Address of the Property against which Loan taken : ________________________________________________________


_____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

2. Status of Property (Self-Occupied/Rented and vacant :________________________(if Rented/Vacant, details must be submitted in attached
Annexure-B For any other income)
3. Amount of Loan issued, Date of loan availed and Name and the address of the lender (loan Provider): - _________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________

4. Purpose of the Loan (construction / Acquiring property) _______________________________________________________

5. Construction of Property will be completed on or before (expected date)__________________________________________________

6. Date on which Construction has Completed:__________________________________________________________________

7. Date of Possession of Property : _________________________

8. Proof of Possession of Property (Builder Certificate/Registry copy): _________________________

Amount
9. Total amount of interest paid (post construction/possession) during the financial year (April
2013 to March 2014)

10. Specify amount of interest paid for pre-construction/possession period.

11. Ownership ( Joint or Sole)

12. If Joint Ownership Name and Relationship with Owner(s)

Share of Joint Owner(s) in Property

Whether any sum Contributed by Joint Owner in Acquiring Property (if Joint Owner, Declaration must be
submitted )
Name(s) of Joint Owner(s) (Apart from the Employee) Who are Repaying
Aforesaid Housing Loan
Whether Joint Owner(s) is/are claiming Deduction Under Income Tax Act , 1961
On Account of Housing Loan Taken for Aforesaid Property

SECTION-VI (DEDUCTION U/S 80EE OF THE IT ACT, 1961 INTEREST ON HOUSING LOAN)
With respect of the amount of any interest payable on loan sanctioned during the F.Y. 2013-14 for the purpose of acquiring property. (Max limit-
100000)

1. Amount of Loan sanctioned : ________________________________________________________

2. Value of Property : _______________________________________________________

3. Any property owned by employee at the date of sanction of loan (Yes/No) : ____________________________
Amount
4. Total amount of interest paid during the financial year (April 2013 to March 2014)

SECTION-VII
Other Income details to be accounted for tax calculation

SECTION-VIII
I, ___________________________, do hereby declare that the aforesaid information is true and correct to the best of my information

and belief and I shall indemnify the company against all costs and consequences if any information is later on found to be incorrect.

Signature of Employee :______________________

Date :______________________

Place :______________________

Note: Please read & understand the guidelines provided in Instruction for filling Investment proof form before submitting

Investment Declaration Page 2