Investment Proof Submission Form - EPSF for the year 2023-2024

Company COLLABERA TECHNOLOGIES Client :

Name
Code Name Gend
DOJ PAN er
Sl No Description Maximu Amount for Which Amount for Which No of Docs
No m proof is Submitted proof is approved Submitted
Amount
Allowed
A INVESTMENTS U/S 80C capped at Rs 1.5 Lac
1 Public Provident Fund (PPF)
2 Life Insurance Premium Paid (Like LIC,ICICI Prudential, TATA AIG etc..)
3 National Savings Certificate (NSC)
4 Approved Superannuation Fund
5 Interest accrued on NSC
6 Units purchased from a recognised mutual fund
7 National Saving Scheme (NSS)
8 Children Education Expenses / Tuition Fees
9 Housing Loan - Principal Payment
10 Registration / Stamp Duty charges paid for registration of house property
11 Post Office Monthly Savings Schemes
12 NHB Scheme
13 Investment in Mutual Funds / equity shares of Companies engaged in
14 Infrastructure Bonds
15 Others
16 Contribution to Pension / Annuity Fund

Total Investments U/S 80C - limited to Rs 1,50,000/- only

Contribution to NPS NPS contribution
B Long Term Infrastructure Bonds Limited to Rs 20000 ( 80CCF)

C OTHER PERMITTED DEDUCTION

1 80D - Medical Insurance Premium (Rs 15,000/- or Rs 20,000/- (Senior Citizen))

2 80DD - Medical Treatment of Dependent suffering from Permanent Disability

3 80DDB - Expenditure on Medical Treatment for specified disease (up to Rs. 40,000)

4 80E - Repayment of Interest against Educational Loan - Interest paid on loan only

5 80U - Permanent Physical Disability (Rs.10000/-)

Total Investments under chapter VI A excluding 80C as above
D Exempton Under Section 10& 17
1 Medical (Exemption up to Rs. 15,000/-)
2 Leave Travel Allowance
E RENT PAID
(IF the rent amount changes during the financial year please specify the amount and the
period separately)

(DD/MM/YYYY format) From Date:- 01-Apr-2023 To Date:- 30-Apr-2023

(DD/MM/YYYY format) From Date:- 01-May-2023 To Date:- 31-May-2023
(DD/MM/YYYY format) From Date:-01-Jun-2023 To Date:- 30-Jun-2023
F INCOME OTHER THAN SALARY-
G House Property Income/(Loss), Please Go to Annexure 3
INTEREST PAYMENT ON HOUSING LOAN

(up to Rs.1 .5 Lacs if the loan taken after 1-4-99, 30000 if it is prior to 1-4-1999 and there
is no limit on let out property)
H PREVIOUS EMPLOYMENT SALARY (Salary earned from 01/04/2023 till date of
Joining)
Gross Salary After Section 10 and 17
PT paid
PF deducted
TDS paid
If Yes, Form 16 from previous employer or Form 12 B attached
 No of Docs
Submitted

NPS contribution
 MUTUAL FUNDS
Paid Details from the April 2023 to Jan 2024
Name of the Fund Date of payment Amount paid

Declaration for the MF Dues ( From Feb 23 to March 24)

Name of the Fund Date of payment Amount to bepaid

I here by declare that I will be paying my MF dues for the Feb 14 and March 14 as on time
with out delay and submitting the same , and I would responsible for to the Income tax
authorites and the company would not be liable for the same
Signature of the employee
 LI C Paid Details from the April 2023 to March 2024
Policy No Date of payment Name of the Policy holder Relation ship Mode,y,hly,qtr Amount paid

Total
Declaration for the LiC Dues ( From Feb 23 to March 24)
Policy No Date of payment Name of the Policy holder Relation ship Mode,y,hly,qtr Amount to bepaid

Total
I here by declare that I will be paying my LIC dues for the Feb 14 and March 14 as on time
with out delay and submitting the same , and I would responsible for to the Income tax
authorites and the company would not be liable for the same
Signature
 Annexure 3- Applicable for Employees who have House Property
Self occupied
1 Are you Paying Interest on Housing Loan which is Self - Occupied
0 Interest amount paid in the Current Financial Year
0 Pre EMI interes paid in the Current Financial Year
0 Pre EMI interes paid in the Last Fiver Previous Financial year , 20% Benefit to be claimed
0
2 Is the Loan in the Joint account , what is % you are claiming benefit

Joint Owner Name

PAN NO
Relation ship
3 If the Exemption contribution claimed 100%, then Sign below

This is to inform the concerned authorities that the property mentioned is a joint property
however the other owner of the property is not enjoying any tax benefits on the same and
has granted me permission to avail the tax benefits of the same

Signature of the Employee

Let Out
Rent Received 0 Entere the amount Per annuam
Less Municipal taxes paid 0 Entere the amount if any paid in the Current Year
Standard deduction 30% 0
Net Income 0
Interest paid on the let out property ( 2021-22) 0 Do Enter the amount Here , Enter below
Net Income / loss 0

0 Interest amount paid in the Current Financial Year

0 Pre EMI interes paid in the Current Financial Year
0 Pre EMI interes paid in the Last Fiver Previous Financial year , 20% Benefit to be claimed
0

HRA Declaration:
If you are claiming HRA exemption and interest on Housing loan exemption also
, then you have to fill the below declaration
1 I own a House property which has not been let out nor any benefit has been derived from the
same and is located at

2 Own House is in a different City/Town Yes /No

3 Own House is in the same city but the distance between rented house and own house is more than
35 kms/ Own House though in the same city but could not be occupied by the reason
of the location of office of employment
Yes /No
4 House construction is not completed and same to be completed and occupied by month and year

Month and Year Details