Form of declaration & verification of Other Income For the year ending 31st March 2014 (See rule

26B) Form of declaration 1. Name and address of the employee : 2. Permanent Account Number : . !esidential Status : ". Particulars of #ncome$not bein% loss) under any head other than &Salaries' recei(ed in the financial year $i) #nterest on securities $ii) #ncome from house property $in case of loss* enclosed computation thereof) #ncome +ess : #nterest Paid +oss from ,ouse Property $iii) Profits and %ains of business or profession $i() -apital %ains $() #ncome from other sources $a) .i(idends $b) #nterest $c) /ther incomes $specify) !s. )))))) !s. )))))) !s. )))))) TOTAL Rs. !s. )))))) !s. )))))) !s !s. !s. !s. ))))) !s. )))))) !s. ))))))

0. A%%re%ate of sub1items $#) to $() of item " 6. 2a3 deducted at source4enclose certificate$s) issued under section 25 6 Form of (erification #* 777777777777777777777777777 do hereby declare that 8hat is stated abo(e is true to the best of my 9no8led%e and belief. Place Bangalore. Date .. Signature of the Employee

OTHER DETAILS (COMPULSORY)

1. Address of the property in respect of 8hich the housin% loan has been a(ailed. 2. .ate of a(ailin% of housin% loan. . .ate of possession of house $Attach possession -ertificate). ". Name of the company: institution: ban9: from 8here the housin% loan has been a(ailed. 0. Amount of interest accrued durin% the F.;.25) < 25) $attach ban9er=s certificate for accrued amount) 6. Principal amount repaid in actual durin% the F.;.25) < 25) $attach ban9ers certificate for repaid amount ) >. #f house ac?uired: constructed durin% F.;.25) < 25) the amount of total interest paid for the period prior to 1st April of that financial year $same 8ill also be allo8ed in fi(e yearly e?ual installments) attach ban9er=s certificate for the same @. #n case of Aoint property 8ith Aoint loan proportion of principal loan amount repaid out of employees income B. #n case of Aoint property 8ith Aoint loan proportion of interest accrued :paid out of employeesC income for the F.;.25) < 25).

15. 2hat the house is in occupation of employee i.e. o8ner. 11. 2hat the house in not actually let durin% any part of the pre(ious year and no other benefit there from has been deri(ed. 12. 2hat in case of interest on housin% loan for the period prior to the pre(ious year in 8hich the property has been ac?uired: constructed* if the same is to be a(ailed in fi(e e?ual yearly installments* the amount of interest 8as not allo8ed as a deduction under any other pro(ision of the act. 1 . 2hat the property consists of one house only and it could not actually be occupied by the reason of the fact that o8in% to his employment carried on at other place. 2he employee had to reside at any other place #n a house not belon%in% to him and further pro(ided that such house 8as not actually let out and no other benefit there from is deri(ed by the o8ner. # further declare that # am only claimin% the amount mentioned in this declaration D my spouse is not claimin% this amount for her 2a3 benefit.

Form of (erification
#* 777777777777777777777777777 do hereby declare that 8hat is stated abo(e is true to the best of my 9no8led%e and belief.

Eerified today* the 7777777777day of 77777777 25)

Place Ban%alore .ate

)))))))))) Si%nature of the employee

Note: Please attach this form alon% 8ith the #ncome 2a3 proof submission form before submittin% to the finance des9.