Declaration of Loss on Housing Property & Income from Other Source.

(Please submit property wise forms)

FORM NO 12C
(See Rule 26B)
Form for sending particulars of Income Tax under section 192(2B) for the year ending 31st March 2011.

1.Name & address of the employee

2.Permanent Account No. 3.Residential status

________________________________ ________________________________ ________________________________ ________________________________ Resident or 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. (Rupees) a. Income from House Property __________ (In case of loss, enclose computation thereof) b. Profit & gains of business or profession c. Capital gains d. Income from other sources -Net Taxable Interest -Other incomes (specify) 5.Aggregate of sub-items (a) to (d) of item 4 6.Tax deducted at source [enclose certificate(s) issued under section 203] Place Date : __________ : __________ ______________________ (Signature of the employee) I, ______________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the __________ day of __________. Place Date : __________ : __________ _____________________ (Signature of the employee) Employee No. : __________ __________ __________ ========== __________ __________

Property-wise Computation sheet and Provisional Interest Certificate for Year Ended 31.03.11 should be attached with this form.

COMPUTATION OF LOSS FROM HOUSE PROPERTY : 2010-11 Form 12C Annexure Particular Address of the premises Property 1 Self-occupied Property 2 (Let-out) Property 3 (Let-out) Total (Property 1, 2 & 3)

House Property is complete House Property is Self Occupied House Property is Deemed to be self occupied House Property is rented out & the annual rent received A. Fair market annual rent in case there is no actual receipt of rent. B. LESS: Property (Municipal) tax actually paid during the financial year as per receipt attached. C. Balance rental income (A B) D. LESS: Repairs & Maintenance (30% of above) E. LESS: Interest on Housing Loan i) Company Loan ii) Outside institution/Agency

NA NA NA NA

- Prior to 1/04/99 (max. 30000/-) After 1/04/99 (max. 1.5 lakhs for self occupied house only) Total Interest on Housing Loan (i + ii) INCOME / (LOSS) PROPERTY (C D - E) FROM HOUSE

*For all loans availed after 1/04/1999, please attach copy of loan sanction letter as proof to get higher rebate. Without such proof, the exemption will be restricted to RS 30,000/-. * Attach provisional interest certificate year ended 31/03/2011 to be attached for company loan / Outside financial institution. Without such proof, no exemptions will be allowed.

DATE___________

SIGNATURE NAME EMP.NO

___________________________ ___________________________ ___________________________