Axcend Automation and Software Solutions Pvt. Ltd.

Declaration for Investments / Other Income / Losses

Employee Name:- P.SRIVATSAN
Employee No:-0297
Designation:- Technical Consultant HR Grade:- D
Sex:- Male
Declared Amount
REMARKS
Sl. No. Particulars of Income / Investments / Losses per Annum
In case of home loan interest on self occupied
1
Income from House Property/Loss from house property(Indicate Loss within property to be declared in this section. Limit for
exemption Rs.1,50,000 p.a. for interest paid.
brackets in the declaration)
Declare any other income you would like the
2 Income from Other Sources during April 12 to March 13
company to consider for tax deductions. No
proof needed for this.
3 Rent Paid per month
Give 3 months receipt as proof
As per details given
Savings u/s 80 C of Income Tax Act like LIC premium, Tuition Fees, PPF, NSC, below subject to a
4
Recognised Mutual Funds, 5 years Fixed Deposit, Home loan principal payment limit of Rs. 1 Lakh
etc. U/s 80C
a Life Insurance premium paid on self / spouse / children Insurance Policy on Parents not allowed u/s 80 C
b Contribution to Public Provident Fund ( Max Rs 1,00,000) Self, Spouse and Children allowed
c Investment in NSC
d Contribution to UTI for participating in ULIP Self, Spouse and Children allowed
e Repayment of Housing Loan (principal amount)
f Accrued interest on NSC (Please state the amount of accrued interest)
g Education expenses/Tution fees of children, for two children Tution fees to College/University/Institute paid
h Approved Mutual Fund/bonds
i Fixed deposit with Scheduled Bank (for a period of 5years or more)
j Contribution to Pension Scheme of LIC or any other approved Insurance Co.
k National Pension Scheme
5 Long Term Infrastructure bond u/s 80 CCF (Max Rs.20,000)
For Self max Rs.15,000/- and dependents
Rs.5,000/- Allowed on policy taken on a Senior
6
Medical Insurance Premium for Self and dependents u/s 80 D including cost of Citizen of 65 years or older. Cost of helath check
health check up plans (Rs.5000 limit) up for Rs.5000/- allowed
Only Interest for self for higher education
7 Interest paid on Education loan for self only u/s 80 E
allowed.
Proof as required under Income Tax Rules to be
8 Any Claim for Permanent Physical Disability u/s 80 U
provided
Proof by means of an attested statement of
9 Income from Previous employer to be considered for employees joining after
1st April 2012 salary and deduction or Form 16 to be provided
Any Other Details Specific relating to Tax deduction 10
Declaration :
I am aware that I shall submit the proof for the above on or before the due dates failing which the
Company will deduct tax at source from my Salary without considering the declaration for those items
for which proofs are not given.
Signature ___________________
Name _P.SRIVATSAN_ Date _16-04-2012
Due Date for submission : 16 Apr 2012 (For New employees, before first salary cycle)
Rs 5500/ Month
Rs 66000/Year
Policy No.719916814- 8.5 - 179-12, Amt-11788
Policy No.719916813- Plan - 149-15,Amt-15852
Period From APR 2012
Period To MAR 2013
HR Grade:- D
PAN:-CVCPS2747B