SUMMARY OF PROOF FOR INCOME TAX RELIEF - Y.E. 31.03.

2010

NAME OF COMPANY: LOCATION:

EMPLOYEE CODE NO. PAN:

(As appears on the Pay Slip)
IF PAN NOT AVAILABLE PLEASE TICK ANY ONE BELOW:

NAME OF EMPLOYEE: APPLIED / NOT APPLIED

Rs. (No paise)

RENT PAID BY EMPLOYEE ( FOR HRA COMPUTATION PURPOSE ) For
1 employees who have joined during the year, the rent amount should only be from date of joining
the company till the year end. For Others it should be for the full year.

2 SEC.80D - MEDICLAIM PREMIUM

3 SEC. 80CCC - JEEVAN SURAKSHA / OTHER PENSION SCHEMES

4 LOSS UNDER THE HEAD "INCOME FROM HOUSE PROPERTY"

INTEREST PAID IN RESPECT OF SELF-OCCUPIED PROPERTY

5
a. Interest on Loans taken prior to 31.03.1999 (Max. Rs.30,000)
b. Interest on Loans taken after 01.04.1999 (Max. Rs.1,50,000)

6 UNITS OF MUTUAL FUND [ Section 10(23D) ]

7 FIXED DEPOSIT WITH SCHEDULE BANK MORE THAN 5 YEARS.

8 LIFE INSURANCE PREMIA (by LIC or any other Insurer) - LIP

9 ULIP / DHANRAKSHA

10 PUBLIC PROVIDENT FUND - PPF (Max. Rs.70,000)

11 HOUSING LOAN REPAYMENT - PRINCIPAL AMOUNT

12 NATIONAL SAVINGS CERTIFICATE VIII SERIES - NSC VIII

13 ACCRUED INTEREST ON NSC VIII

(As per
14 TUITION FEES PAID TO UNIVERSITY, COLLEGE, SCHOOL
Rules)
15 INFRASTRUCTURE BONDS
ANY OTHER TAX SAVING SCHEME (Give full details & the relevant section
16 under which relief claimed.)

Signature of Employee: Date:

NAME OF EMPLOYEE: (in block letters)

VERIFIED BY ACCOUNTS / H.R. DEPT.

Cyrus Paymaster
Digitally signed by Cyrus Paymaster
DN: cn=Cyrus Paymaster, o=Paymaster services, ou, email=callcyrus@gmail.com, c=IN
Date: 2009.12.17 12:08:16 +05'30'