FORM FOR HOUSE LOAN IN JOINT NAME

(For House Loan in joint name of spouse or other person)

I Mr. / Ms Janmejaya Panda Emp No. __50026655

Declare that, I have taken Housing loan in the joint name of

Mr. / Ms _ Narayan Panda who is my Father,

and the Income Tax Exemption on the same is claimed only by me and not by Father.

Details of Benefit Claimed (FINANCIAL YEAR 2017-2018)

Sl No. INTEREST/PRINCIPAL REPAYMENT AMOUNT (In Rs.)

1. intrest paid 1,60,000

2. Principal paid 48,000

3.
s
4.

5.

6.

2,08000
Total
Two lakhs and eight thousand rupees

I also undertake to reimburse to the Company, any liability arising out of dis-allowance
of any of the above exemption by the Income tax authorities on account of error in
claim.

Place :Bangalore
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Date :15/01/2018
(SIGNATURE OF THE EMPLOYEE)

I, NAME OF SPOUSE/OTHER PERSON, do declare that what is stated above is true to

the best of my information & belief

Place :Bhubaneswar

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Date :15/01/2018 (SIGNATURE OF THE SPOUSE/OTHER

PERSON)