Investment proof submission form FY 20-21

Emp Code
Emp Name
Company Name

Current Address

Date of Joining
Mobile Number
E Mail Id
PANNo. (Compulsory)
Pan no. is compulsory.In case It is not available then apply for the same immediately and attach copy of acknowledgement.
Please fill your Employee code and Name on every document being sent.
1. Please note that all payments shall be made between 01-April 2020 to 31-March 2021
2. Please go through the Investment proofs submission guidelines before filing up this coversheet
1. Rent Receipt (please submit the same in original- atleast three)

Sr No. MONTH RENT P.M ONLY Name, Address and Pan No. of Landlord
1 Apr-20
2 May-20
3 Jun-20
4 Jul-20
5 Aug-20
6 Sep-20
7 Oct-20
8 Nov-20
9 Dec-20
10 Jan-21
11 Feb-21
12 Mar-21
Total (Rs.) 0
Total No. of Receipts Attached:

If annual rent paid by the employee exceeds Rs 1,00,000 per annum, it is mandatory for the employee to report PAN of the landlord to the employer.
2. LIC Premium ( Detail Individual Premium wise)
Sr No. Policy No Payment Date Premium Self/ Dependent

Total (Rs.) 0
Total No. of Receipts Attached:
Please Note : Only for Self, Spouse and Children
If the premium is payable at any time in current financial year after the date falling due for submission of proofs with us then please submit currently copy of the
premium paid in previous financial year along with a request duly signed stating that the proof for current premium due would be provided immediately on
payment of premium.
3. Pension Plan under Section 80CCC (the same would be clubbed with Rs. 1.5 Lac allowed u/sec. 80C)
Sr No. Policy No Payment Date Premium Self/ Dependent

Total (Rs.) 0
Total No. of Receipts Attached:

4. Repayment of Housing Loan along with Interest u/s 24 ( i.e. Interest on on housing loan and Principle )
PAN of the lender. Name of the lender. Date of Possession of Property Int on hsg loan Amount of Principle Own/Rented
Total (Rs.) 0 0
Documents to be attached: -
1. In case of Joint Ownership, the declaration of Joint Ownership
2. Bank Certificate for loan repayment including interest
3. Declaration where rent benefit is claimed in respect of one property and interest benefit for other property
4. Proof for possession of Property/Electicity bills/Property tax/Telephone bill
5. Required Bank Pan & Bank Name.
5.1 Mediclaim is admissible for Self,Spouse and Children–Upto Rs. 25000.( Inclusive- Preventive Health checkup upto Rs. 5000/-)
2 For Parents (if not senior citizen) – Upto Rs. 25000
3: Parents (if senior citizen) – Upto Rs. 50000
•SrMedical
No. Expenses for Super Senior Citizens up to Rs Policy
50,000:Holder
Individuals
Namewho are morePayment
than 80 years
Date old shall be allowed a deduction
Premium Self for medical
expenses of up to Rs 50,000 from their total income. Family/PARENT

Total (Rs.) 0
Total No. of Receipts Attached:

6. National Saving Certificates (NSC) for investment during 2020-21

Sr No. Certificate No Purchase Date Amount Self/ Dependent

Total (Rs.) 0

Note: NSC purchased in current financial year ( i.e. 2020-21) only in self name or Minor Child is eligible for deduction under Section 80C.

7. Interest on National Saving certificate (Investment prior to 01-04-2020)

Sr No. Certificate No Purchase Date Amount Self/ Dependent

Total (Rs.) 0
Note: For interest accrual on NSC purchased in previous financial years(i.e. before 01/04/2020) please provide copy of all NSC certificates for
computation of interest on the same as per Income Tax Rules.

8. Children Education Fees (for a maximum of 2 Children)- Tution Fees only

Sr No. School Name Month of Payment Amount Child Name

Total (Rs.) 0
Total No. of Receipts Attached:

Tuition fees paid for the financial year 2019-20 for the purpose of full time education with any university, college, school and other educational institute in India
(i.e., Apr’20–Mar’21) will be considered for deduction.
9. Equity Linked Insurance Scheme (ELSS)- Units of Mutual Fund
Sr No. Name of Mutual Fund Date of Payment Amount Certificate No.

Total (Rs.) 0
Total No. of Units/Systematic Investment Statement Attached:

10. Unit Linked Insurance Plan (ULIP)

Sr No. Policy No. Date of Payment Amount Relation
Total (Rs.) 0
Total No. of Units Attached:

11. Public Provident Fund Account (PPF)

Sr No. PPF Account No. Date of Payment Amount Relation with Emp

Total (Rs.) 0
Total No. of Receipts Attached (alongwith Passbook copy):
Note :In the name of Tax Payer

12. Sukanya Samriddhi Account Deposit Scheme

Sr No. Post office Account No. Date of Payment Amount Relation with Emp

Total (Rs.) 0
Copy of Passbook ( which contain transaction and 1st page images)

13. Fixed Deposits with Scheduled Bank (5 Years or more)

Sr No. Name of FD Holder Date of Payment Amount No. of Years

Total (Rs.) 0
Total No. of Certificates of FDR Attached:

14.National Pension Scheme Employee Contribution -80CCD (1b)

Sr No. Scheme Name Date of Payment Amount

Total (Rs.) 0
Total No. of Documents Attached:
INR 50,000 is allowed as deduction u/s 80CCD(1b) for employee contribution towards NPS.
Copy of transaction statement or Account statement as a proof of payment.

15. 80E for Repayment of Education Loan (only Interest Payment)

Sr No. Scheme Name Date of Payment Amount Relation with Emp

Total (Rs.) 0
Total No. of Documents Attached:
Certificate of Payment from Bank
16. Medical treatment of a Disabled Dependent -DEDU_80DD
Sr No. Scheme Name Under Section Amount Relation with Emp

Total (Rs.) 0
Following are the documents to be attached for availing the deduction u/s 80DD
• Certificate from the government hospital mentioning the disability; and
• Receipts for the expenditure incurred by the employee.
17.Medical treatment for specified illness/diseases -DEDU_80DDB
Sr No. Scheme Name Under Section Amount Relation with Emp

Total (Rs.) 0
Following are the documents to be attached for availing the deduction u/s 80DDB
• Certificate from the government hospital mentioning the specified illness / disease; and
• Receipts for the expenditure incurred by the employee.
18.80U for Handicapped self
Sr No. Scheme Name Under Section Amount Relation with Emp

Total (Rs.) 0
•Certificate issued by physician, Surgeon, psychiatrist working in Govt Hospital
19. 80EE Additional benefit for interest paid on housing loan
PAN of the lender. Name of the lender. Date of Possession of Property Int on hsg loan Amount of Principle Own/Rented
Total (Rs.) 0 0
Documents to be attached: -
1. In case of Joint Ownership, the declaration of Joint Ownership
2. Bank Certificate for loan repayment including interest
3. Declaration must be taken from employee for being the 1st time buyer
4. Proof for possession of Property/Electicity bills/Property tax/Telephone bill
5. Required Bank Pan & Bank Name.
20. 80EEA Deduction for first time home buyers
PAN of the lender. Name of the lender. Date of Possession of Property Int on hsg loan Amount of Principle Own/Rented

Total (Rs.) 0 0
Documents to be attached: -
1. In case of Joint Ownership, the declaration of Joint Ownership
2. Bank Certificate for loan repayment including interest
3. Declaration from employee for not owning any house as on date of loan
4. Copy of possession letter/ completion certificate / sale deed or self-declaration
5. Required Bank Pan & Bank Name.
21. 80EEB Deduction for Interest on Loan taken to Buy Electric Vehicles
PAN of the lender. Name of the lender. Int on Vehicles loan

Total (Rs.) 0
Documents to be attached: -
1. Certificate from bank specifying the interest amount
2. Loan Sanction date
3. Type of vehicle must be an electric vehicle
4. Details of vehicle purchased
5. Required Bank Pan & Bank Name.
22. 80TTA Interest on Savings Account
Sr No. Amount

Total (Rs.) 0
1. Bank, Post Office or Co-operative Society
2. Passbook or Bank Statement

23. 80TTB Interest on Savings Account (For Senior Citizen)

Sr No. Amount

Total (Rs.) 0
1. Bank, Post Office or Co-operative Society
2. Passbook or Bank Statement
24. ANY OTHER SAVING SCHEME
Sr No. Scheme Name Under Section Amount Relation with Emp

Total (Rs.) 0
Total No. of Documents Attached:

CERTIFICATE

I hereby declare that the information given above is correct and true in all respects. In case any of the statements are found to be untrue, I am fully responsible
for the consequences and undertake to indemnify my employer for any loss sustained as a result thereof.
I request the Company to allow me the appropriate Income-tax rebate / relief.

I also certify that conveyance paid to me has been spent by me in commuting between my residence and office.

Signature of Employee ___________________________

Name (in block letters): ___________________________

Date: