Employees Proofs Submission Form 2013 -14

( Please read the instructions / guidelines attached carefully before filling up the form )
NAME OF COMPANY

GYANSYS INFOTECH PRIVATE LIMITED

EMPLOYEE CODE *
NAME *
PAN NUMBER*
LOCATION
No of Children *
*

Mandatory

S. No.
A

Proofs Submitted
Amount (to be filled Amount ( to be filled
by employee) ( Rs. )
by Finance)

Particulars

Rent Receipts ( Pls mention the no. of months to be claimed)

From Date

To Date

Rent P.M.

1
2
3
4
B

Loss / Income from House Property (attach Computation Statement( Auditor Certificate - Mandatory for let
Housing Loan Interest Amount (upto 30k or 150k)

Income from Other Sources, if any

D
1

Deduction under Chapter VI A

80D (Mediclaim- upto Rs. 15000 for Self, Spouse and Children)

Pl. mention whether loan was taken before 01/04/99 or after 01/04/99

(upto Rs.15000 for Parents & Addl. Rs.5000 for Senior Citizen Parents)

2
3

80DD - Medical treatment for handicapped dependent

(with < 80% disability or > 80% disability, pl. specify)
80 E - Repayment of Interest on Education loan taken for
Higher Education for SELF, SPOUSE AND CHILDREN

E
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Deduction under section 80C

Life Insurance Premim ( LIC )
Pension Plans u/s 80CCC
(Jeevan Suraksha / Pension schemes of any other insurer)
Public Provident Fund ( PPF )
Equity Linked Saving Scheme (ELSS)
Housing Loan Principal Repayment/Stamp Duty & Reg. Charges
Deposit in NSC
Interest on NSC - Accrued
Deposit in ULIP of UTI/LIC
Tax Saving Mutual Funds eligible for deduction u/s 80 C
Infrastructure Bonds / Tax saving bonds
Fixed Deposit in Banks eligible for Tax Saving u/s 80C
Children Education expenditure
- Pl.mention number of children studying in School/College
Tax Saving Systematic Investment Plan (SIP)
Deposit in Senior Citizen Saving / 5 year Time Deposit Scheme
TOTAL

G
Previous Employment Salary ( Salary Earned from 01/04/2013 till Date of Joining)
( Applicable only if you have joined Gyansys Infotech after 01/04/2013 )
If you have joined Gyansys Infotech Private Limited after 1st April 2013, and you were working with some other organisations
Pl. enclose the copy of Form 16 / Statement Certifying Earnings and Deductions from your previous employer's, which is manda

1) I hereby declare that what is stated above is true to the best of my knowledge and belief.
2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information
being incorrect.
Date :
Place:

Signature of the Employee

GYANSYS INFOTECH PRIVATE LIMITED

Remarks

PAN of the landlord /

house owner is
mandatory, if the
annual rent paid
exceeds Rs.100000.
Self decl form in case
PAN not available.

ation Statement( Auditor Certificate - Mandatory for let out properties)

pril 2013, and you were working with some other organisations before joining.
and Deductions from your previous employer's, which is mandatory.

s/liability that may arise in the event of the above information

Signature of the Employee

FORMAT OF RENT RECEIPT

RENT RECEIPT
Received from Mr. Anil Ganduri of GyanSys Infotech Pvt. Ltd.[Name of the company]
a sum of Rs. 1,20,000/-( Rs. One Lakh Twenty Thousand Only)
towards rent for the period From April 2014 To Jan 2014 for the
property situated at No. 41, Flat No.105, 1st Floor, Deeksha Blossom, 15th Cross, Green Garden
Layout, Next to Church, Shirdi Sai Nagar, Munnekolala, Marathahalli(post), Bangalore
560037(Address of the property)

Name of the owner

: LATHA M REDDY

PAN of the owner

Address of the owner

: No.17, 5th Cross, 1st Main, A Block, Vinayaka Nagar, Konena Agrahara,
HAL Post, Bangalore - 560017.

( SIGNATURE OF THE OWNER )

Note:
PAN of the landlord / house owner is mandatory, if the annual rent paid exceed Rs.100000.
In case PAN is not available, self declaration of the house owner is mandatory as per the enclosed format.

Document

nclosed format.

Computation of Loss from Self Occupied Property:

Name of the employee
Employee Code
Address of the Self Occupied House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction
Date of Occupation (Taken Possession)
Interest paid during the period Apr 13 to Mar 14
(Should match with the amount appearing in the certificate given by
the Bank / Financial Institution)
1/5th of pre-construction interest, if any
(Should also mention the year of instalment)
Total Interest paid for the year 2013-14

I am the registered sole owner of the property situated at the above address.
I hereby declare that what is stated above is true to the best of my knowledge and belief.
Please considered the above Loss from Self Occupied House Property
while computing the tax on salary income.

Employee Signature:
Date:
Note:

If it is a joint property, please sign the attached declaration along with computation

Computation of Income / (Loss) from Let Out Property - Rented property

(Do not disturb the formulas)
Name of the employee
Employee Code
Address of the Let Out House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction
Date of Occupation (Taken Possession)

COMPUTATION OF INCOME / LOSS FROM HOUSE PROPERTY ( RENTED OUT)

Annual Rental Income
Less: Municipal Tax paid during the financial year 2013-14
Net Annual Rental Income
Less: 30% for Repairs & Maintenance on Net Annual Income

0
0
0

Less:
Interest paid on borrowed Loan (From Apr 13 To Mar 14)
(Should match with the amount appearing in the certificate given by
the Bank / Financial Institution)
1/5 th of Pre-Contruction Interest (if any)
(Should also mention the year of instalment)
Net Income / (Loss) from House Property

I am the registered sole owner of the property situated at the above address.
I hereby declare that what is stated above is true to the best of my knowledge and belief.
Please considered the above Income / (Loss) from Let Out House Property
while computing the tax on salary income.

Employee Signature:
Date:

Note:

If it is a joint property, please sign the attached declaration along with computation

Document

FORM No. 12C

[See rule 26 B]

Form for sending particulars of income under section 192 (2B) for the year
ending 31st March, 2014
1. Name and address of the employee

2. Permanent Account Number

3. Residential status

RESIDENT / NON RESIDENT

4. Particulars of income under any head of income other than "salaries" (not being a loss
under any such head other than the loss under the head "Income from house property")
received in the financial year.
Rs.
(i) Income from house property
(in case of loss, enclose computation thereof)
(ii) Profits and gains of business or profession
(iii) Capital Gains
(iv) Income from other sources
(a) Dividends
Rs.
(b) Interest
Rs.
(c) Other Income (specify) Rs.
Total

Rs.

5. Aggregate of sub-items (i) to (iv) of item 4.

6. Tax deducted at source [enclose certificate(s) issued

under section 203]
Place _______________________________
Date ________________________________
Signature of the employee

Verfication

I, _______________________________________________________________________________
do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the __________________ day of _____________________ 20________.

Place _______________________________
Date ________________________________
Signature of the employee