ADITYA

Employee Investment BIRLA MONEY

Declaration LIMITED
Form for the Year 2010-2011

1. Declaration of proposed investments can be furnished at any time during a financial year and Tax would be deducted during the FY based on latest declaration.
2. Final Declaration alongwith proof of actual investments made till JANUARY are to be submitted by 31stJANUARY 2011 for finalising TDS for the Financial Year.

Emp_Name Emp_ID
Gender No of Children
Pan NO.(Md) No of Children Staying in Hostel

Date of Joining
Add. of rental house

percentage for claiming loss/profit

Location/Branch from house property

Following are the investment declaration for the financila year 2010-2011.
A. Rent paid details for claiming HRA exemption Location
Month Start Month Last Month Rent paid per month Metro/Non Metro
Apr 2010
May 2010
Jun 2010
Jul 2010
Aug 2010
Sep 2010
Oct 2010
Nov 2010
Dec 2010
Jan 2011
Feb 2011
Mar 2011
Section B. Deductions from Total Income AMOUNT REMARK
U/S 80D Mediclaim Premium - Upto Rs. 15,000 (premium on the health of Self, Spouse & Children)
Additional Premium - Upto Rs. 15,000 (for premium on the health of parent / parents)
Upto Rs. 20,000 (if parent / parents is/are Senior Citizen)

U/S 80DD Expenditure on Handicapped Dependents / Deposits made with LIC, etc. for maintenance of
handicapped Dependents - Adhoc Amount of Rs. 50,000 (in case of disability exceeding 80%
the deduction will be Rs.100000/-). Attach certificates as applicable per Annex
U/S 80DDB Exp. likely to be incurred on specified disease or ailment (Cancer/AIDS etc.) - bills to be
submitted by 31.01.10 Maximum Rs.40000/- (Rs. 60,000/- in case of exps. on or by
senior citizen aged above 65 years) (Attach certificate in Form 10-I - Annexure
U/S 80U Permanent Disability benefit (self) - adhoc amount of Rs. 50,000 (in case of disability exceeding
80% the deduction will be Rs.100000/-) Attach certificates as applicable per Annex

U/S 80E Interest on Education Loan (for self/spouse/Children education) from Charitiable or Financial
Institution. (No Limit)

C. Chapter-VIA - Total amount of deduction allowed is Rs. 1,20,000 ( 20000 is for

U/S 80 C infrastructure bond ) AMOUNT REMARK
Contribution To Pension Fund
Life Insurance Premium
Public Provident Fund (PPF)
National Savings Certificate (NSC)
Children Education Fee
Mutual Funds
Nischint
ULIP
Deposit In Post Office Tax Saving Scheme
Equity Linked Savings Scheme (ELSS)
Housing Loan - Principal amount repayment only
Infrastructure Bonds
Fixed Depost with Scheduled Bank for a period of 5 years or more
 U/S 24 (I) D. Loss from House Property
AMOUNT REMARK
Residential Status - Self - Occupied / Letout
Please write "S" for if the property is Self Occupied and "L" if it is Let Out
Total amount of interest paid (post construction / possession) during the financial year (April 06 to March 07)
Limited to Rs.30000.00 if loan was availed before 01/04/1999
Limited to Rs.150000.00 if loan was availed after 01/04/1999

E. Other Income
Other Income declaration to be accounted for tax calculation

F. PREVIOUS EMPLOYER INCOME DETAILS - FORM 16 or Signed tax computation sheet from
12 B the Previous Employer along with Form 12B is mandatory AMOUNT REMARK
Salary paid by the Previous Employer after sec 10 exemptions
Profession Tax deducted by the Previous Employer
Provident Fund deducted by the Previous Employer
Income Tax deducted by the Previous Employer
G. EXEMPTION UNDER SECTION 10 & EQUIVALENT
23 Medical Allowance/Reimbursement

Declaration
I undertake that the above investments will be made not later than above mentioned date and proof will be submitted for finalising computation of income tax deduction at source for current FY.
Based on the documentary evidence of actual investments furnished by me, any shortfall of actual investments made against the investments proposed, I hereby authorise
Finance Department to deduct income tax from my salary for January 11 to March 11 towards the balance TDS Liability.

Date:

Place

EMPLOYEE SIGNATURE