Instructions and Guidelines for Filling the EPS(employee proof submission) form

BASIC DETAILS

1) Please fill in your Employee code as mentioned in payslip.

2) Please provide
3) Please enter your name
your as This
PAN. per what is given and
is a mandatory appears
field in your
and your paywill
proofs slip.not be accepted if the PAN is not mentioned or if PAN is Invalid

RENT RECEIPTS
1) Please submit the rent receipts for every quarter/month as the case may be. (Apr - Jun, Jul - Sept, Oct - Dec & Jan -Mar)
2) Please specify only the Rent per month you are paying. (Please don't add maint charges/water/electricity in rent amount)
3) Kindly mention the number of receipts you are submitting. This will help us to avoid any issues arising out missing receipts

4) Rent Receipt -REQUIRED DETAILS is provided in the second sheet (Sheet EPS Form_12BB). Please ensure that rent receipt should have
all the details. Also please affix the Revenue Stamp and get the signature from the owner over revenue stamp.
5) If annual rent paid by the employee exceeds Rs 8,333/- PM or Rs 1,00,000/- per annum, it is mandatory for the employee to provide PAN
of the landlord.
6) Rent Receipt must be original and should have all details/particulars as given in the format.

LOSS/INCOME FROM HOUSE PROPERTY

If your house is Self Occupied
1) Incase the property is a self occupied property, then you can claim upto a maximum of Rs.2,00,000 pertaining to the Interest amount paid as
Loss on Income from House Property.
2) The Loss from Self Occupied Property sheet (Sheet Loss from Self Occupied Prop) must be duly filled and must accompany
the EPS form while submitting the proofs.
3) If you are the joint owner of property then Declaration for Joint owner must be duly filled and must accompany the EPS
form while submitting the proofs.
4) A Bank certificate/statement (duly signed) showing the interest and principal paid (alongwith PAN and name of lender
bank) during the period towards the Housing Loan from the bank must accompany the EPS form.
5) Incase you are claiming the Loss of Income from House Property, the above documents must accompany your EPS form.
Without which it will not be valid.

PREVIOUS EMPLOYER INCOME

1) Please fill in the Form 12B( Sheet FORM NO 12B - PREV EMP DETAILS). The highlighted columns needs to be filled with
out fail (Column 6, 7, 9, 10)
2) Column 6 - Salary after deduction U/S 10 exemption; from the previous employer from April 2022 till the last working day
with the Previous employer (s).
3) Column 7 - Tax on employment i.e.., Professional Tax deducted from April 2022 till the last working day with the Previous
employer(s).
4) Column 9 - Provident Fund contribution deducted from the salary from April 2022 till the last working day with the
Previous employer(s).
5) Column 10 - Income Tax deducted from the salary from April 20222 till the last working day with the Previous employer (s).
6) The Form 16 / Tax Computation Sheet (for the earning from April 22 till LWD) from the previous employer (s)(Duly
signed and stamped) for the current FY needs to be provided along with Form 12B
DEDUCTION UNDER CHAPTER VI A
1) 80D (Mediclaim) - The premium amount paid towards the mediclaim for Self, Spouse, and children can be provided to
avail the exemption up to Rs 25000.
2) Further exemption to the extent of Rs 25000 can be availed under this section if the premium is paid towards mediclaim for
your parents (subject to proof submitted).
3) If you or your parents are senior citizens; exemption to the extent of Rs 50000 can be availed (subject to proof Submitted).
4) Kindly fill in the declaration stating the relationship with self,(Sheet Declaration ON Relationship) only then the full
benefit on the tax exemption can be availed. Else the exemption will restrict to Rs 25000 (subject to proof submitted)

5) 80DD ( For dependent disability) - To avail the exemption under this section; the doctor's certificate stating the percentage
of disability is required without which the exemption can not be given
6) 80 U ( For self disability) - To avail the exemption under this section; the doctor's certificate stating the percentage of
disability is required. without which the exemption can not be given

7) 80E ( Educational Loan taken for Self, Spouse, Children) - To avail the exemption under this section; a bank statement
stating the interest repayment on the educational loan taken is required. There should be evidences that the interest deducted
is only towards educational loan.

Please fill in the Declaration form provided to declare the relationship with self (Sheet Declaration ON Relationship)

DEDUCTION UNDER SECTION 80C

1) Life Insurance Premium ( LIC ) - Receipts for the current financial year needs to be provided, if the premium is yet to be paid
with in the FY a declaration is required that this will be paid by the end of FY - The investment in the name of self, spouse and
children can be provided for exemption. Kindly fill in the declaration stating the relationship with self.
2) Pension Plans u/s 80CCC - Receipts for the current financial year needs to be provided, only if the receipts that is being
provided has a statement stating that the exemption can be availed U/S 80ccc, the exemption will be provided.
3) Public Provident Fund ( PPF ) - A copy of the Pass-Book is required. The investment in the name of self, spouse and children
can be provided for exemption. Kindly fill in the declaration stating the relationship with self.
4) Equity Linked Saving Scheme (ELSS) - A copy of it is required. This can be given only for self.
5) Housing Loan Principal Repayment/(Stamp Duty & Reg. Charges) can be given only if it pertains to current FY - A
statement showing the interest and principal paid towards the Housing Loan from the bank must accompany the EPS form.
6) Deposit in NSC - The copy of the NSC certificates needs to be provided. This should be for the current FY Only.

7) Deposit in ULIP of UTI/LIC - Receipts of (investment/premium paid ) Unit Linked Insurance Plans for the current FY needs
to be provided. The investment in the name of self, spouse and children can be provided for exemption. Kindly fill in the
declaration stating the relationship with self.
8) Tax Saving Mutual Funds eligible for deduction u/s 80 C - Only if there is a statement stating that the exemption can be
availed U/S 80C, the exemption will be provided
09) Infrastructure Bonds / Tax saving bonds - Only if there is a statement stating that the exemption can be availed U/S 80C,
the exemption will be provided.
10) Fixed Deposit in Banks eligible for Tax Saving u/s 80C - Only if there is a statement stating that the exemption can be
availed U/S 80C, the exemption will be provided.
11) Children Education expenditure towards tution fee - A copy of the fee receipts from the school, college, and educational
institution can be provided. Only the Tuition Fee will be give exemption under this section
12) Tax Saving Systematic Investment Plan (SIP) - Separate statement will be provided by bank with regard to this investment
(There will be a lock in period of 3 year for each deposit).
13) Post Office Time Deposit Account - the copy of the pass book should to provided to avail the exemption ( Only 5 year tax
saving deposit will be accepted).
 Employees Proofs Submission Form FY 2022-23
NAME OF COMPANY IOMEDIA INDIA PRIVATE LIMITED
EMPLOYEE CODE * IOM-637
DATE OF JOINING ( If after 31st March 2022)
NAME AND ADDRESS OF THE EMPLOYEE * Masood Ahmad-22A/1R/1,Pura Madari-Allahabad-211016
PAN NUMBER OR AADHAAR NUMBER OF THE EMPLOYEE * BMFPA7365G
FINANCIAL YEAR 2022-23
GENDER (MALE OR FEMALE) * MALE
MOBILE NO 8447972192
PAYROLL TO
* Mandatory WHETHER T
NUMBER OF
Proofs Submitted Evidence /particulars (No ENTERED TA
Checklist for
Amount (to be filled by of Receipts/Bills ACTUAL BILL
Payroll Team
S. No. Nature of claim employee) ( Rs. ) attached) SUBMITTED
IN THIS COL
House Rent Allowance:
A Rent Receipts ( Pls mention the no. of months to be claimed)
420000
Mohammad
Ashraf Rent Receipt from
(i) Rent paid to the landlord
22A/1R/1, Pura Apr 22 to Mar 23
(ii) Name of the landlord
(iii) Address of the landlord Madari-Allahabad
(iv) Permanent Account Number or Aadhaar number of the landlord MIEPS2947C
Note: PAN shall be furnished if the aggregate rent paid during the previous year exceeds one lakh 1
rupees (exceeds 8333/- pm)
From Date 1st April 2022 till March 2023 Rent P.M. with RESIDENTIAL LOCATION
1 Mar 2022 to May 2022 105,000 1
2 June 2022 to Aug 2022 105,000 1
3 Spt 2022 to Dec 2022 105,000 1
4 jan 2023 to march 2023
Loss / Income from House Property (attach "Rule 26B Declaration" / Computation Satement -
105,000 1
B Mandatory)
Housing Loan Interest Amount (upto 30k or 200k)
Pl. mention whether loan was taken
before 01/04/99 or after 01/04/99
Note: Name/PAN of the lender bank required to be furnished

C Income from Other Sources, if any ( FILL IN THE "Rule 26B Declaration" GIVEN)

D Deduction under Chapter VI A

1 80D (Mediclaim- upto Rs. 25000 for Self, Spouse and Children) 24252 1
(upto Rs.25000 for Parents & Addt Rs.50000 for Senior Citizen Parents)
2 80DD - Medical treatment for handicapped dependent
(with < 80% disability or > 80% disability, pl. specify)
3 80U - Medical treatment for handicapped -Self
(with < 80% disability or > 80% disability, pl. specify)
4 80 E - Repayment of Interest on Education loan taken for
Higher Education for SELF, SPOUSE AND CHILDREN
E DEDUCTION UNDER SECTION 80CCE
1 Life Insurance Premium ( LIC )
2 Pension Plans u/s 80CCC
(Jeevan Suraksha / Pension schemes of any other insurer)
3 Public Provident Fund ( PPF )
4 Equity Linked Saving Scheme (ELSS) 150000 1
5 Housing Loan Principal Repayment/Stamp Duty & Reg. Charges
6 Deposit in NSC
7 Deposit in ULIP of UTI/LIC
8 Tax Saving Mutual Funds eligible for deduction u/s 80 C
9 Infrastructure Bonds / Tax saving bonds
10 Fixed Deposit in Banks eligible for Tax Saving u/s 80C
11 Children Education expenditure
12 Tax Saving Systematic Investment Plan (SIP)
13 Post Office Time Deposit Account
14 Section 80 CCD - National Pension Scheme (NPS) or the Atal Pension Yojana (APY) 50000 1
F PREVIOUS EMPLOYER INCOME ( FILL IN THE FORM 12B GIVEN) & Copy of FORM 16
G BILLS SUBMITTED FOR EXEMPTION U/S 10
1) LTA BILLS - ( attach sheet as per format- mandatory)

Verification/Declaration
1) I, Masood Ahmad Son of Shamshad Ahmad do hearby certify that the information given above is complete and correct.
2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information
being incorrect.
3) I also undertake to prove the genuineness of the above statement before the Incoem Tax Authorities and/ or IOMEDIA INDIA PRIVATE LIMITED
if called for. I shall also be responsible for payment of / reimbursement to IOMEDIA INDIA PRIVATE LIMITED (even after employment)
of any tax, interest and penalty payable to / charged by the Income Tax Authorities on account of any fraudulent claim submitted by me.
Date : 1/30/2023 Masood Ahmad
Place: Allahabad Signature of the Employee
Designat Senior Engineer 1-Quality Full name: Masood Ahmad
 Declaration on the relationship with self to avail the tax exemption under various heads
Name Age
Spouse Gulafshan Siddiqui 27
Father Shamshad Ahmad 52
Mother Shaira begam 48
Dependent
Children
1 Ashar Siddiqui 1
2

DECLARATION
1) I hereby declare that what is stated above is true to the best of my knowledge and belief.
2) I also undertake to indemnify the company for any loss/liability that may arise
in the event of the above information being incorrect.

Date : 1/30/2023
Masood Ahmad
Place: Allahabad Signature of the Employee
 Statement of particulars of income under heads of income other than "Salaries" for
deduction of tax at source.
[See rule 26 B]

Form for sending particulars of income under section 192 (2B) for the year
ending 31st March, 2023

1 Name and address of the employee Masood Ahmad

22A/1R/1, Pura Madari,
Karamat Ki Chowki
Prayagraj-211016
2 Permanent Account Number BMFPA7365G

3 Residential status RESIDENT / NON RESIDENT

4 Particulars of income under any head of income other than "salaries" (not being a loss
under any such head other than the loss under the head "Income from house property")
received in the financial year.
Rs.
(i) Income from house property
(in case of loss, enclose computation thereof)

(ii) Profits and gains of business or profession

(iii) Capital Gains

(iv) Income from other sources

(a) Dividends Rs.
(b) Interest Rs. 1617
(c) Other Income (specify) Rs.

Total Rs. 1617

5 Aggregate of sub-items (i) to (iv) of item 4. 1617

6 Tax deducted at source [enclose certificate(s) issued

under section 203]

Place ____ Allahabad

Date _____ 1/30/2023 Masood Ahmad

Signature of the employee

Verfication

I, ________________________________________________(Name of the assessee)

do declare that what is stated above is true to the best of my Information and belief.

Verified today, the __________________ day of _____________________ 20________.

Place _______________________________

Date ________________________________
Signature of the assessee