EmpIoyee's Income Tax DecIaration Form for the FinanciaI Year 2012-13

Name: PAN No:

Designation Gender:
Department DOB
DOJ: EmaiI
Work Permit
No.
Contact No.
S. No. DESCRIPTION Rs.
Proposed
Investment Date
Proof Document Required
A
ParticuIars of Income from sources other than saIary from the NIT Raipur
(optionaI)
1 Dividends Certificate
2 nterest Certificate
3 Other ncomes (specify) Appropriate Certification
TotaI Earnings 0
B Income from House Property
Annual Value of House Property (As Per ncome Tax Act) Certificate & Receipts
Less:
() Standard Deduction (as per Section 24(1)
() nterest on Housing Loan - as per Section 24(2)(for Tax Exemption - Self
Occupied Property acquired /constructed before 01-04-1999 - Rs.30,000 elgible & Self Occupied
Property acquired /constructed after 01-04-1999 - Rs.150,000 eligble)
a. Amount of nterest for the F.Y. 2012-13 Bank Certificate
b. Amount of nterest for Pre-Contruction Period (as per ncome Tax Rule) Certificate
TotaI Income from House Property 0
C HRA: RENT PAID PER MONTH ( Please mention the starting and ending month) Rent (p.m.)
Period: copies of rent receipts / L&L Agreement
TotaI Rent Paid (per annum)
D INVESTMENTS U/S 80C, 80CCC, 80CCD capped at Rs 1 Lac
1 Provident Fund (PF) No proof document required
2 Employees Contribution under New Pension Scheme No proof document required
3 Public Provident Fund Receipts / Statement
4 Contribution to Certain Pension Funds Certificate
5 Housing Loan Repayment Principal (payable in F.Y. 2012-13) Bank Certificate
6 nsurance Premium (including GS contribtuion) Receipts / Statement, No Proof submission required for GS
7 Term Deposit with Schedule Bank Certificate
8 National Saving Scheme / Certificate Certificate
9 Mutual Fund Certificate / Acknoledgement
10 Children Education Expenses / Tuition Fees Certificate / Copy of vouchers
11 Others, (Please specify if any) Certificate / Receipts
0
E OTHER PERMITTED DEDUCTIONS
1
80D - Medical nsurance Premium (Maximum Rs. 15,000
(Rs. 20,000 for senior citizens
Receipt / Statement
2 80DDB - Expenditure on Medical Treatment for specified disease Form 10- + expense vouchers
3 80E - Repayment of nterest against Educational Loan Bank Certificate
4
80G - Donations (only for Prime Minister's National Relief Fund, the Chief
Minister's Relief Fund or the Lieutenant Governor's Relief Fund)
Receipts
5 80GG - Rent Paid but not in Receipt of HRA Form No.10BA + Receipts
6
80U-Permanent Physical Disability (Normal Rs. 50000/- and Severe
Rs.1,00,000/-)
Certificate
7 Others - (Please specify if any)
0
F PREVIOUS EMPLOYMENT SALARY SaIary Paid TDS (in Rs.)
f Yes, Form 16 from previous employer or Form 12 B attached Form 12 B from previous employer
Notes:
1. The date of nvestments must be between 01-04-2012-31.03.2013.
2. Deduction u/s 10(13A) for HRA is available only where employees have actually paid the rent. Original rent receipts may be retained at your end while xerox copies can be provided to Main Office
3. Declaration should have PAN Number. Those who do not have PAN are requested to apply for it immediately and mention'NOT FURNISHED'
4. ncome Tax Slabs for the Year 2012-13 (Assessment Year 2013-14)
Slab Rate
.
Rs. Nil to 2 Lacs (For Woman below 65 years limit is 2 Lacs
For Senior Citizens limit is 2.50 Lacs)
Nil
. Above 2.00 Lacs to Rs. 5.00 Lacs 10%
. Above 5.00 Lacs to 10.00 Lacs 20%
V. Above 10.00 Lacs 30%
, do hereby declare that the proof of fresh investments will be submitted by 31st December, 2012. Further, incase of any change
in above declaration, would revise it and inform the insitute immediately. shall indemnify the institute for all cost and
consequences if any information is found to be incorrect.
TotaI Deductions
TotaI Investments U/S 80C - Iimited to Rs 1,00,000/- onIy
Date: Page 1 of 1 Name with Signature of Employee