Employee No
Name
Gender
Male       Female
PAN no
Date Of Birth
Date Of Joining

1.      Please enter your Monthly Rent details as per the Rent Receipt / Lease Deed.
Note :   If the Employee is paying the rent below Rs.3000/- per month, he/she need not furnish the Rent Receipts (Circular No:8/2007 Dt: 05.Dec.2007).
1
April 2016
Metro       Non-Metro
2
May 2016
Metro       Non-Metro
3
June 2016
Metro       Non-Metro
4
July 2016
Metro       Non-Metro
5
August 2016
Metro       Non-Metro
6
September 2016
Metro       Non-Metro
7
October 2016
Metro       Non-Metro
8
November 2016
Metro       Non-Metro
9
December 2016
Metro       Non-Metro
10
January 2017
Metro       Non-Metro
11
February 2017
Metro       Non-Metro
12
March 2017
Metro       Non-Metro

2.
Interest on Housing Loan u/s 24 (If the house is self occupied and the loan was taken before April 1999).Bankers Certificate to be submitted
Upto Rs. 30000/-(If Self Occupied)
Provisional Certificate issued by the Banker showing the Interest Part
Interest on Housing Loan u/s 24(If the house is self occupied and the loan was taken on or after April 1999).Bankers Certificate to be submitted
Max Limit - Rs. 1,50,000/- (If Self Occupied)
Provisional Certificate issued by the Banker showing the Interest Part
Interest on Housing Loan u/s 24(Let out/ Deemed to be let out)Bankers Certificate to be submitted[if the property is LET OUT - Rental Income need to be specified]
- No Limit -(If Let Out)


Rental Income for the Period April 2014 - March 2014


Municipal Taxes PAID by the owner (employee) during the financial year

3.  Medical Allowance
Rs.15,000/- per annum
Medical expenses incurred for family: (Family includes spouse, children and dependent parents, brothers and sisters )
4.  Sec 80D (Medi Claim Policy & Preventive health check up)
Rs. 25,000/
Medical Insurance Premium PAID by Employee: - on the health of employee, spouse, and dependent children.[Rs.20,000/- In case employee is a Senior Citizen] (i.e., 60 years or more).
Payment made by an employee for preventive health check-up of self, spouse, dependent children during the financial year is eligible for maximum deduction of Rs 5000.
Note:The amount paid is within the overall limits ( Rs. 15000/Rs. 20000).
Rs. 15,000/- (or) Rs.20,000/-
Additional Amount of Rs.15,000/- Medical Insurance Premium PAID by Employee on the health of parents (even not dependent on employee) . [Rs.20,000/- In the case parents are Senior Citizen]i.e., 60 years or more payment made by an employee for preventive health check-up of parents during the financial year is eligible for maximum deduction of Rs 5000. Note: The amount paid is within the overall limits ( Rs. 15000/Rs. 20000).
5.  Sec 80DD (Maintenance including Medical treatment of dependant person with disability)
Rs. 50,000/- (Rs.1,00,000/- for Severe disability)
Here Employee gets fixed amount of deduction.If employee has incurred any expenditure / deposited in specified policy. (Form 10-IA obtained from Medical Authority has to be submitted)
6.  Sec 80DDB (Medical treatment for specified diseases or ailments) - Self / Dependents
Rs. 40,000/- (Rs. 60,000/- for Senior Citizen )
Here Employee gets deduction: Lower of the following: i). Amount incurred orii). Rs.40,000/- (or Rs.60,000/- if expenses incurred for senior citizen i.e,60 years or more )(Form 10-I obtained from Medical Authority has to be submitted)
7.  Sec 80E (Education Loan)
No limit(only Interest Portion)
Interest on Loan taken for Higher Education:Amount paid by employee during the financial year on loan taken for higher education of - Employee, spouse or children of employee or students for whom employee is a legal guardianBenefit Period:Current Period + Next 7 years
8.  Sec 80U (For person with a disability)
Rs.50,000/- (Rs.1,00,000/- for Severe disability)
Here Employee gets fixed amount of deduction.(Form 10-IA obtained from Medical Authority has to be submitted)

Maximum amount eligible for Deduction under section 80C & 80CCC Categories is Rs.1,50,000/-
9.
Life Insurance Premium
Self , Spouse & Children only
10.
Public Provident Fund (PPF)
Self , Spouse & Children only
11.
Voluntary Provident Fund (VPF)
will be additionally deducted from salary
12.
Pension Fund Contribution
Self only
13.
National Savings Certificate (NSC)
Self only
14.
Interest Accrued on NSC (Reinvested)
Self only
15.
Unit Linked Insurance Policy (ULIP)
Self , Spouse & Children only
16.
Equity Linked Savings Schemes (ELSS) - Mutual Funds
Self only
17.
Payment of Tuition fees for Children (Max 2 Children)
Two children only
18.
Principal repayment of Housing Loan
Self & Joint a/c holder
19.
Registration charges incurred for Buying House (I year Only)
Self only
20.
Infrastructure Bonds
Self only
21.
Bank Fixed Deposit for 5 Years & above
Self only
22.
Post office Term Deposit for 5years & above
Self only

23.
a) Interest Income from Savings A.c (Banks & Post office only)
b)Any Other

c)Any Other

d)Any Other


24.
Income From Previous Employer (Joined after 01/04/2016)
(a)
Income after exemptions
(b)
Provident Fund (PF)
(c)
Professional Tax (PT)
(d)
Tax deducted at source (TDS)
Form 16 or Tax computation from previous employer should be furnished

25.   
a) Date of actual possession of property
[which can be validated by 'Possession Certificate' issued by builder/municipal authorities etc.]
b) Amortisation of pre-construction period interest (if any) incurred
[which needs to be considered during Current FY 2016 - 17]


c) Information towards the House Property (LET OUT ) - In case of more than 1 Let out House Property

% of Owner Ship House Property Rental Income Per Annum Muncipal Taxes Per Annum Principal portion paid in the Financial Year
i) House Property 1
ii) House Property 2
iii) House Property 3
iv) House Property 4
26.   
     I here by declare that Information as stated above is true and correct. I also authorize the company to recover tax (TDS) from my salary based on the PROOFS Submitted by me. I am personally liable to Income Tax proceedings for any misstatements in the declaration or proofs submitted herewith if they are inconsistent with the requirement of Income Tax Act, 1961.




GuideLines To Fill
  1. Metro City : Mumbai / Delhi / Calcutta / Chennai
  2. Non Metro City : All Other Cities
  3. Please fill in and submit the same along with the Supporting documents
  4. All the HRA Bills / Medical Bills / LTA Bills / Provisional Loan Certificate for House from Banker - should be ORIGINAL
  5. Provisional Loan Certificate for House from Banker - should be submitted in respect All the properties declared by employee in the above table
  6. As per the provisions of the Income Tax Act 1961 - HRA Exemption will not be provided, if the Employee is staying at his SELF OCCUPIED House Property
    [if the Employee has claimed BOTH HRA & Interest on Self Occupied HP - For Tax Declaration ONLY one among them will be considered]
  7. In case of Self Occupied / Let Out House Property the Employee has to mention the "Interest on Housing Loan" / "Principal repaid Amount"
    Please mention - Full amount of "Interest" / "Principal" along with the % of Owner ship