Employee Tax Declaration Form

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Sample Income Tax Declaration Form for Financial Year 2012-13, 2013-14, 2014-15 in word/. doc / excel Format for salary persons in India

PRELIMINARY DECLARATION FOR CLAIMING INCOME TAX REBATE
FOR THE FINANCIAL YEAR 2012 – 2013
[ASSESSMENT YEAR 2013-2014]
To       
Accounts Department                                                    Name   :
            Rocket Sales Ltd                                                             PAN No.:
            45/1 Ambani Road                                                        Department:
            Mumbai  – 458 545          

I  give  below  the  necessary  declaration  for  the  payments / investments  to  be  made  by  me  during  the  period  1st April, 2012  to  31st March, 2013  to  enable  me  to  avail  of  the  tax  rebate  as  per  the  provisions  of  the  Income  Tax  Act, 1961  (as  amended  up  to  date).

(A)      FOR CALCULATION OF NON-TAXABLE RENT ALLOWANCE
            MONTHLY RENT PAID TO LANDLORD                                          :  Rs_________
            (The rebate will be allowed only on furnishing
            Copy of original rent receipt)                                                             : 
_________________________________________________________________________

(B)       DEDUCTION ALLOWABLE UNDER SECTION 80 C
           
            N.B.  Total claim for deduction u/s. 80C is restricted upto Rs.1,00,000 for contribution to Life Insurance Premium (LIC & others), ULIP, contribution to EPF, VPF, PPF, investment in NSC, Mutual Funds, schemes of different annuities, payment of tuition fees of children, housing loan principal repayment, investments in debentures / equity shares in a public company engaged in infrastructure including power sector as also in subscription to equity shares and debentures of a public company forming part of eligible issue of capital for the purpose of providing telecommunication services (whether basic or cellular), etc.
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(1)   PREMIUM ON LIFE INSURANCE POLICIES

POLICY                    CAPITAL                            DATE                       ANNUAL     
                         NO.                   SUM ASSURED               OF MATURITY           PREMIUM


                (2)   UNIT LINKED INSURANCE POLICY (ULIP)                         Rs.    __________________________________________________________________________

                (3)   P. O. CUMULATIVE TIME DEPOSITS 10/15 YEARS           Rs.     __________________________________________________________________________

                (4)   PUBLIC PROVIDENT FUND                                                     Rs.    
__________________________________________________________________________


(5)     NATIONAL  SAVINGS  CERTIFICATE  VIII  ISSUE  PURCHASED  BETWEEN
 (01.04.2011   TO 31.03.2012)  Total amount invested as per following details:-         
     
       DATE OF PURCHASE                 CERTIFICATE NO.                                              AMOUNT (Rs.)

__________________________________________________________________________

(6)      INTEREST  ON  NATIONAL  SAVINGS  CERTIFICATE  VIII  ISSUES  (for  existing  holding  up to  31.03.12 for 1st 5 years only)

                    DATE OF PURCHASE          CERTIFICATE  NO.           PRINCIPAL                        INTEREST  
                                                                                                                        AMOUNT (Rs.)                AMOUNT (Rs.)
                    Total Interest Accrued                   
_________________________________________________________________________

            (7)   HOUSING LOAN REPAYMENT (PRINCIPAL ONLY)                      Rs.             


            (8)   TUTION FEES PAYMENT (FOR UPTO 2 CHILDREN ONLY)          Rs.             


(9)   INVESTMENTS MADE UNDER JEEVAN DHARA / JEEVAN AKSHAY PLAN/NSS WHICH WERE MADE PREVIOUSLY UNDER SECTION 80CCA

JEEVAN DHARA                                                                                       Rs.             

JEEVAN AKSHAY                                                                                     Rs.            
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(10)  INVESTMENTS UNDER EQUITY-LINKED SAVINGS SCHEME PREVIOUSLY MADE    
UNDER SECTION 80CCB (ELSS)

Total amount proposed / Invested                                                          Rs.        
_________________________________________________________________________

(11)  INVESTMENTS IN EQUITIES / MUTUAL FUNDS OF COMPANIES FOR DEVELOPING, 
MAINTAINING  AND  OPERATING  AN  INFRASTRUCTURAL  FACILITY  OR  FOR  GENERATING  POWER  AND  TAX  SAVINGS  BONDS  OF  ICICI  /  IDBI  ETC.
                                                            Rs.
________________________________________________________________________

(12) DEDUCTION  UNDER  SECTION  80CCC  IN  RESPECT  OF  CONTRIBUTION  TO  A  PENSION 
FUND WITH LIC / UTI / ANY OTHER INS. CO. Section 80CCC         Rs.

(Subject to a maximum deduction ceiling of Rs. 1, 00,000/- allowable under section 80C)
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(C)       DEDUCTION UNDER SECTION 80D IN RESPECT OF MEDICAL INSURANCE PREMIUM

            (Subject  to  a  maximum  deduction  of  Rs.10,000/-  /  Rs.15,000/-  p.a.)       Rs.   _________________________________________________________________________


(D)      DEDUCTION UNDER SECTION 80DD IN RESPECT OF MEDICAL TREATMENT OF
            HANDICAPPED DEPENDANTS

            (Subject  to  a  maximum  of  Rs.50,000/-  p.a.)                                                    Rs.     _________________________________________________________________________

 (E)      DEDUCTION UNDER SECTION 80DDB IN RESPECT OF MEDICAL TREATMENT OF
            WOHLLY DEPENDANT PARENTS/BROTHERS/SISTERS/SPOUSE/CHILDREN

            (Subject to a maximum of Rs.40,000/-  p.a.)                                                          Rs.     
_________________________________________________________________________

(F)       DEDUCTION  UNDER  SECTION  80E  IN  RESPECT  OF  REPAYMENT  OF  LOAN  FOR  HIGHER EDUCATION 

            (Entire payment of interest is deductible)                                                            Rs.     
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(G)       DEDUCTION  UNDER  SECTION  80G  IN  RESPECT  OF  DONATIONS  TO  CERTAIN  FUNDS,  CHARITABLE  INSTITUTIONS  ETC.

            (Only  in  case  of  100%  relief  like  Prime  Minister’s  Relief  Fund,  etc)      Rs.     ____________________________________________________________________

(H)      DEDUCTION  UNDER  SECTION  80U  IN  CASE  OF  PERMANENT  PHYSICAL  DISABILITY  (INCL.  BLINDNESS)

            (Up to a maximum of Rs.50,000/- p.a. (Rs.75,000/- p.a. for severe disability)  Rs.      
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(I)        DEDUCTION  UNDER  SECTION  24(B)  IN  RESPECT  OF  HOUSING  LOAN  REPAYMENT  (INTEREST  ONLY) (Up  to  a  maximum  of  Rs.1,50,000/- p.a.)                               Rs.


ANY OTHER INCOME AND / OR PREVIOUS SALARY DETAILS                        Rs.

(Please attach Statement of Income and / or Form 16 / Salary Certificate of previous Employer if any)
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THIS  DECLARATION  IS  TRUE  TO  THE  BEST  OF  MY  KNOWLEDGE.  PROOF  OF  ACTUAL INVESTMENTS,  AS  APPLICABLE  SHALL  BE  PROVIDED  WITH  THE  SPECIFIED  TIME.  I  ALSO  DECLARE  THAT  I  WILL  INVEST  THE  AMOUNT  SPECIFIED  ABOVE  WITH  IN  THE  SPECIFIED  TIME.



SIGNATURE…………………………….                                            Date-.…………………

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