You are on page 1of 11

Income Tax Declaration Form for the Financial Year 2006-07

Name: Karthikeyan T Location: Chennai

Emp No: 1056 PAN No:

DOJ: 2/6/2003 Gender: Male

Exemptions under Section 10 & 17 Employee's Declaration Value of Proof / Bills Produced

House Rent Paid (Sec 10 (13A)) 12,000.00

Medical Bills Exemption (Sec 17(2)) 15,000.00

Children's Education Allowance Exemption (Sec 10 (14))

LTA Exemption (Sec 10(5))

Vehicle Maintenance (Petrol / Maint. Bills) (Sec 10 (14))

Total 27,000.00 -

Other Income

House / Property Income or Loss (Enter Loss as Negative)

Interest on Housing Loan (for Tax Exemption)

Other Income (Interest, etc.)

Deductions under Chapter VI-A - -

Medical Insurance Premium (Sec 80D)

Medical for Handicapped Dependents (Sec 80DD)

Medical for Specified Diseases (Sec 80DDB)

Higher Education Loan Interest Repayment (Sec 80E)

Donation to Approved Fund and Charities (Sec 80G)

Rent Deduction (Sec 80GG) only if HRA Not Received

Deduction for Permanent Disability (80U)

Any Other Deductions

Total - -

Deductions under Chapter VI (Sec 80C)

Deduction under Pension Scheme (Sec 80C)

NSC (Sec 80C)

Public Provident Fund (Sec 80C)

Employees Provident Fund & Voluntary PF (Sec 80C)

Children's Education (Sec 80C)

Housing Loan Principal Repayment (Sec 80C)

Insurance Premium (Sec 80C) 6,060.00

Infrastructure Bonds & others (MF, ULIP, etc.) (Sec 80C)

Total Investments 6,060.00 -

I _______________________________________________ do hereby declare that what is stated above is true to the best of my
knowledge and belief.
Date: Signature:
Employee's Income Tax Declaration Form for the Financial Year 2016-17

Name PAN No
Designation Gender
Department DOB
DOJ Email
Work Permit No. Contact No.
S. No. DESCRIPTION
Amount (Rs.)
A Particulars of Income from sources other than salary (optional)
1 Dividends
2 Interest
3 Other Incomes (specify)
Total Earnings -
B Income/(Loss) from House Property
C HRA: Rent Paid/Payable ( Please mention the starting and ending period) Monthly Rent

Total Rent Paid/Payable


D INVESTMENTS U/S 80C, 80CCC, 80CCD
1 Provident Fund (PF)
2 Employees Contribution under New Pension Scheme
3 Public Provident Fund
4 Contribution to Certain Pension Funds
5 Housing Loan Repayment Principal (payable in F.Y. 2016-17)
6 Insurance Premium (including GIS contribtuion)
7 Term Deposit with Schedule Bank- Tax Saving Scheme
8 National Saving Scheme / Certificate
9 Mutual Fund
10 Children Education Expenses / Tuition Fees
11 Others, (Please specify if any)
Total Investments U/S 80C - limited to Rs 1,50,000/- only -
E OTHER PERMITTED DEDUCTIONS
1 80D - Medical Insurance Premium
2 80DDB - Expenditure on Medical Treatment for specified disease
3 80E - Repayment of Interest against Educational Loan
4 80G - Donations
5 80GG - Rent Paid but not in Receipt of HRA
6 80U - Permanent Physical Disability
7 Others - (Please specify if any)
Total Deductions -
F PREVIOUS EMPLOYMENT SALARY Salary Paid
If Yes, Form 16 from previous employer or Form 12 B attached

I, do hereby declare that investment(s) proposed will be completed on or before the proposed date and proof of investme
submitted by 05th January, 2017. Further, incase of any change in above declaration, I would revise it and inform
immediately. I shall indemnify the company for all cost and consequences if any information is found to be incorrect.

Date: Page 3 of 11 Name with Signature of Employee


eclaration Form for the Financial Year 2016-17

Male

Proposed Investment
Date

Metro

TDS (in Rs.)

be completed on or before the proposed date and proof of investment(s) will be


of any change in above declaration, I would revise it and inform the insitute
and consequences if any information is found to be incorrect.

Date: Page 4 of 11 Name with Signature of Employee


FORM NO. 12B
[See rule 26A]
Form for furnishing details of income under section 192(2) for the year ending 31st March,_______
Name and address of the employee
Permanent Account No.
Residential status
Particulars of salary as defined in section 17, paid or due to be paid to the
employee during the year

TAN of the Permanent


Name and Total amount of house rent Total of
employer(s) as Account Period of
S.No address of allowance, conveyance Value of perquisites columns 6,
allotted by the Number of the employment
employer(s) Total amount of allowance and other and amount of 7, and 8
ITO employer(s)
salary excluding allowances to the extent accretion to employee's
amounts required chargeable to tax[See section provident fund account
to be shown in 10(13A) read with rule 2A and (give details in the
columns 7 and 8 section 10(14)] details in the
1 2 3 4 5 6 7 8 9

† With effect from 1-4-1991, section 80C has been replaced by section 88.

Verification
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
ANNEXURE
[See column 8 of Form No. 12B]
Particulars of value of perquisites and amount of accretion to employee's provident fund account
Name and address of the employee
Permanent Account No.
Period : Year ending 31st March,_______________
Value of rent-free accommodation or value of any concession in rent for the accommodation provided by the employer (give basis of computation)[See rules
Where accommodation is furnished

Name of
TAN/PAN of
the Where Value as if Cost of furniture (including television sets, radio sets, refrigerators, Perquisite value of furniture (10%
the employer
employee accommodation accommodation other household appliances and air-conditioning of column 5) OR actual hire
is unfurnished is unfurnished plant or equipment) OR hire charges, if hired from a third party charges payable

1 2 3 4 5 6
ANNEXURE
(Contd.)

Remuneration paid Estimated value of any other


by employer for Value of free or concessional benefit or amenity provided by the
Whether any conveyance has been provided by the employer free or domestic and/or passages on home leave and employer, free of cost or at
Name of
at a concessional rate or where the employee is allowed the use of personal services other travelling to the extent concessional rate not included in
the
one or more motor cars owned or hired by the employer, estimated provided to the chargeable to tax (give details) the preceding columns (give
employee
value of perquisite (give details) [See rule 3(c)] employee (give [See rule 2B read with section details), e.g., supply of gas,
details) [See rule 10(5)(ii)] electricity or water for household
3(g)] consumption, free educational faci

1 10 11 12 13

Name of Employee
Place
Signature
Total amount
Amount deducted in
of tax
respect of life
deducted
insurance premium,
during the
provident fund Remarks
year (enclose
contribution, etc., to
certificate
which sec. 80C †
issued under
applies (Give details)
section 203)

10 11 12

Signature of the employee

Signature of the employee


count

er (give basis of computation)[See rules 3(a) and 3(b)]

Value of
perquisite
(column 3
minus
Rent, if any,
Total of columns 4 and column 8
paid by the
6 or column
employee
7 minus
column 8
as may be
applicable)

7 8 9
Interest
credited to the
assessee's
Employer's Total of
account in
contribution to columns 9
recognised
recognised provident to 15
provident fund
fund in excess of 10% carried to
in excess of
of the employee's column 8
the rate fixed
salary [See Schedule of Form
by the Central
IV - Part A] No. 12B
Government
[See Schedule
IV - Part A]

14 15 16

Signature of the employee