Accounting /Payroll Process

COMPANY NAME: _____________________________________________

Investment Declaration for Income Tax / Form 12BB (See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
For the Financial Year 2019-20
Instructions for submitting this form.
1. Employees are requested to read the form carefully before submitting the same.
2. All the fields are compulsory. (please enter Zero if not applicable don’t leave any field blank)
3. You have to send the proofs of the investment latest by 15th January 2020.
4. Please keep the submitted copy, for your record & reference.

Full Name of Employee

Father’s / Husband’s Name (Full)
Employee No
Location
Residential Address

Employee’s PAN (10 Characters)

Please attach copy of PAN CARD for verification

A. (I) Investment proposal under Section 80C ,80CCC & 80CCD(1) (Maximum limit is Rs.1.50 lac)

S. No. Particulars Amount Paid (Rs.) Proof Required Latest by

15th January 2020.
1 Life Insurance Premium Copy of premium receipts no proposal
Premium Paid for Self / Spouse/ Children receipts will be accepted
2 Post Office Time Deposit Scheme (CTD) Copy of the Pass Book
3 Public Provident Fund (PPF) Deposit Receipt for PPF Account /Copy
Subscriptions for Self / Spouse/ Children of PPF Pass Book (MAX. Rs.1,50,000)
4 National Savings Certificates (NSC) Copy of NSC’s
5 Interest Accrued on NSC Copy of NSC Certificate along with
calculations
6 Tax Saving Bonds / Fixed deposits with banks Copy of Bond / Fixed deposit receipt
having locking period of 5 year’s
7 Children Educational Expenses (Tuition Fees Only) Proof of expenses incurred
8 Mutual Funds (ELSS) Copy of Mutual Fund Statement
9 Unit Linked Insurance Plan (ULIP) Copy required
10 Stamp Duty & Registration charges paid during Copy of Index II /stamp duty &
the year towards new House Purchase registration fees paid receipt
11 Other Investments Copy of passbook showing investment
a) Sukanya Samriddhi Scheme done
b)
C)

B. Housing Loan Repayment

a. Number of House Properties owned by Employee -
b. If employee owns more than one property, mention annual rent income of other property -

1 Principal - Part of Section 80C deduction Provisional Certificate from Bank

2 Interest Paid – Section 24, over and above 80 C Provisional Certificate from Bank
deduction

Mention the date of possession of the house : -

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C. HRA Exemption under Sec .10(13A) – Original Rent Receipts for all the months and if rent is above Rs. 5,000 per month,
it should also be supported with the copy of rent agreement with the land-lord (If Rent is above Rs. 8,333/-pm then
Land-lord’s PAN Copy also required).
1 April 2019 Name of the Landlord:-
2 May 2019
3 June2019
4 July 2019
5 August 2019 Address of the Landlord:-
6 September 2019
7 October 2019
8 November 2019
9 December 2019 PAN of the Landlord:-
10 January 2020
11 February 2020
12 March 2020
D. Chapter VIA

1 Sec 80CCD (1B) National Pension System-NPS Copy of Pension Premium Receipt
(Maximum deduction of Rs.50,000)
2 Sec 80 D Medical Insurance Premium (Covering Copy of Premium Receipt
self, spouse, children and dependent parents)
3 Sec 80 DD Specified expense on disabled Certificate from certified medical
dependent. practitioner
4 Sec 80 DDB Exp for medical treatment Certificate from certified medical
practitioner
5 Sec 80 U Deduction to person with disability Certificate from certified medical
practitioner
6 Sec 80 E Repayment of loan for higher studies Certificate from bank, showing
(Only Interest portion will be considered). repayment of loan with interest.
7 Sec 80 EEA Repayment of Home loan interest, if Provisional Interest paid certificate from
applicable as per provisions of this section bank.
8 Sec 80EEB Repayment of Electric Car loan Provisional Interest paid certificate from
interest, if applicable as per provisions of this bank.
section.

E. Leave Travel Allowance Exemption under Se.10 (5)

1 Exempt in 2 years out of 4 calendar years. Block
period starts from 01.01.2018 to 31.12.2021
from his employer for himself and his family, in
connection with his proceeding on leave to any
place in India:
Original tickets required, in case of travel
by air, boarding pass will be required as
proof of travel.

Declaration:

I _________________________________, hereby declare that what is stated above is true to the best of my
information & belief. I also certify that payments listed in Para’s A, B, C, D, E & F have been made by me. I also
undertake that any income tax liability arising out of wrong declaration will be my responsibility.

Employees Signature & Date

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Declaration for claiming deductions under section 24(b) & 80 C (2)(xvii)

of the Income Tax Act, 1961

I __________________________ hereby declare that I have taken a Home loan from

________________Bank, Branch _____________, City ________________ and PAN
No _____________ for a house property located at (Give complete address of the
property)_____________________________________________________________
____________________________.

I hereby declare that possession of the above property has been taken by myself
from Date _____________(Month / Year).

I also undertake that any income tax liability arising out of wrong declaration will be
my responsibility.
(If the loan is in the joint name please specify the portion of
loan & interest paid by you and Joint Borrower)

1. Mr./Mrs._____________________________________ Share______________%
2. Mr./Mrs._____________________________________ Share______________%
3. Mr./Mrs._____________________________________ Share______________%

(Employee Signature)
Place : ____________
Date : ____________

Note:
As per Income tax Act 1961 deduction under section 24(b), interest can be availed in the
year of actual possession and onwards till the complete payment of loan. House rent deduction
till the date of possession of property only will be allowed, if located in the same City.

The acquisition or construction of the house should be completed within 5 years from
the end of the FY in which the amount was borrowed. Hence, it is necessary for the Company to
have the completion certificate of the house property against which deduction is claimed either
from the builder or through self-declaration from the employee.

Maximum deduction limit under 80EEA:-

Up to Rs 1.50 lacs can be claimed towards interest payable on home loan in the financial year
2019-20. The deduction under sub-section (1) shall be subject to the following conditions,
namely:

1. The loan has been sanctioned by the financial institution during the period beginning on the
1st day of April, 2019 and ending on the 31st day of March, 2020.
2. The stamp duty value of residential house property does not exceed forty-five lacs rupees.
3. The assesse does not own any residential house property on the date of sanction of loan.
4. Possession letter require for claiming the interest under this section.

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LEAVE TRAVEL ALLOWANCE CLAIM FORM

(To be filled by the employee after the journey)

Employee Name: ________________________ Date of Joining:__________________

I. Journey Details:
Start date of journey: ____________________ End date of journey: ______________

Place visited: From: _____________ to: _____________

Mode of journey (Air / Train /Road)

Air / train / Car hire charges paid: Rs. ________________

II. Leave availed: From: __________________ to: _______________

III. Dependent members travelled along with self

S. No: Name Relation Age

1.

2.

3.

(Please attach original tickets. If the journey is by road, please submit original bill. If journey
is by air, original boarding passes is a must, as supporting for travel done, without which
exemption will not be allowed)

Restriction on Children – The exemption will not be available to more than 2 surviving
children of an individual born after 01.10.1998. This restriction shall not apply in respect of
children born before 01.10.1998 and also in case of multiple births after one child. It may be
noted that section 2 (15B) of the Act defines a child as includes a step child and an adopted
child of the individual.

Note: Maximum allowable exemption will be equal to -

1. Where the journey is performed, by air, an amount not exceeding the air economy
fare of the national carrier by the shortest route to the place of destination.

2. Where places of origin of journey and destination are connected by rail and the journey is
performed by Public transport system, an amount not exceeding the air-conditioned first
class rail fare / first class fare by the shortest route to the place of destination;

Employee signature: _____________ Date: ____________

Accounts Department
1. LTA eligible for F Y ________Rs. __________ 2. LTA payable Rs.______________
3. Amount of exemption ______________ 4. Amount taxable ______________

Signature
(Authorized Person)

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 Accounting /Payroll Process

EXEMPTION ON ACCOUNT OF CHILDREN EDUCATION ALLOWANCE,

APPLICABLE ONLY IN CASES WHERE CTC HAS THIS COMPONENT

Requirements –

1. One of the salary components should be Children Education Allowance.

2. Will need self-declaration in below format.
3. Maximum exemption allowed for only 2 children.

Declaration for claiming Children Education Allowance – Exemption

I ______________________, Father / Mother of Son / Daughter _____________________

&_________________________ hereby declare that he / she is attending school and we

have been paying fees regularly.

Name of Son / Daughter Date of Birth Standard in which studying

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