UNDERTAKING/SELF DECLARATION

I s/o Sh.

Resident of

employed in G.T.Road, Dhandari Kalan, Ludhiana, hereby confirm and declare

that I will make the following savings or investments with regard to tax deducted at sources on salary during financia

year 2020-21.

Savings or Investments under Section 80c, 80d or 80ccc etc.

SNo. Heads Amount Remarks if Any

1 Contribution to PF

2 Fixed Deposits not less than 5 Years

3 Housing loan - Interest

4 Housing loan - Principal

5 Investment in Approved Mutual Funds

6 Investment in Public Provident Fund

7 Investments in NSC Bonds

8 Life Insurance Paid/SIP/ELSS

9 Medical Insurance Premium

10 Physically Handicapped/Blind Individual Income:

[General/Severe Disability] [80U]
11 Post Office Savings not less than 5 Years

12 Rent Paid per month (with PAN No. of Landlord)

Tuition fees Paid
13 [Only Tuition Fee excl development fees,
donation,etc
14 National Pension Scheme

15 Rent Slips in case of HRA Claiming

16 Other ( )

17 Other ( )

TOTAL:

I(Name) do here declare that what is stated above is true to the best of my

information and belief. I further undertake I shall be responsible for any default in any payments.

(Signature of the employee)

Pan Number:
Date:
 UNDERTAKING/SELF DECLARATION
I s/o Sh.
Resident of
employed in G.T.Road, Dhandari Kalan, Ludhiana, her
that I will make the following savings or investments with regard to tax deducted at sources
financial year 2012-13.
Savings or Investments under Section 80c, 80d or 80ccc etc.
SNo. Heads Amount Remarks if Any
1 Contribution to PF
2 Fixed Deposits not less
3 Housing loan - Interes
4 Housing loan - Princip
5 Investment in Approv
6 Investment in Public
7 Investments in NSC B
8 Life Insurance Paid
9 Medical Insurance Pr
Handicapped/Blind
10 Individual Income:
[General/Severe
Post Office Savings not
11
12 Rent Paid per month
[Only Tuition Fee
13 excl development
14 Infrastructure Bonds
15 Rent Slips in case of
HRA Claiming
16 Other (
)
17
I(Name) do here declare that what is stated above is true to the best of my
information and belief. I further undertake I shall be responsible for any default in any payme

(Signature of the employee)

Pan Number:
Date: