DECLARATION FORM FOR INVESTMENTS TO BE MADE BY AN EMPLOYEE IN TAX SAVING SCHEMES FOR THE FINANCIAL YEAR 2012-13 To:

I wish to declare that I shall invest the following amounts in tax saving schemes during the financial year 2012-13 in addition to the Provident Fund deduction being made by the company for the purpose of computation and deduction of tax at source from my salary. (Amount in Rs.) Whether you will be claiming Deduction for HRA IF Yes Give the amount of Monthly Rent payable during various month of the year 2012-2013 U/S 80D ______________ Premium to be paid for Medical Insurance (Deduction allowed up to maximum of Rs. 15,000/-) U/S 80DD ______________ Expenditures incurred for permanent physical disability (Deduction allowed up to maximum of Rs. 1,00,000/-) U/S 80C 1. LIC Premium 2. Deposits in Public Provident Fund 3. Contribution to UTI in ULIP Scheme 4. Deposit in National Savings Certificate 5. Interest on National Saving Certificate (Attach photocopy of NSC purchased) 6. Payment made for construction/purchase of House/ Repayment of housing loan (Only Principal Amount) 7. Tution Fee (maximum upto 2 Children) 8. Others (Please Specify) _____________ _____________ _____________ _____________ _____________ _______________ _____________ _____________

(Deduction allowed 80C and 80CCC up to maximum of Rs. 100,000/- incl. PF Ded.)

Exemption from House Property Income Payment made for construction/purchase of House/ Repayment of housing loan (Only Interest amount) (Deduction allowed up to maximum of Rs. 150,000/- ) Name of the Employee Signature Emp. ID Date PAN No. ______________________________ _______________________________(Mandatory) ______________________________ _____________________________ (Mandatory) (Please attach self attested photocopies of all the certificates) __________________

DECLARATION FORM FOR RENT PAYMENT BY AN EMPLOYEE FOR THE FINANCIAL YEAR 2012-13

To:

This is to inform you that, I am paying a rent of Rs. ______ per month from my salary. My residential address is __________ _____________ _______________________________ You are requested to consider this rent payment when you calculate tax on my salary income. I declare that I shall immediately inform the company about any change in my address or the amount of rent paid. I further declare that, I shall submit the proof of payment of the rent at the end of every quarter. I undertake that the above statement is correct and any Income tax liability arising due to my failure in submitting the rent receipts or due to any misdeclaration will be my responsibility and the company will be authorized to deduct tax on my income as if I am not paying any rent.
Name of the Employee Signature Emp. ID Date PAN No. ______________________________ _______________________________ ______________________________ _____________________________

(Please attach self attested photocopies of Rent receipts)

DECLARATION IN FORM NO. 12 C (VOLUNTARY) [See rule 26B] Form for sending particulars of income under section 192(2B) for the year ending 31st March, 2013 1. Name and address of the employee ___________________ ___________________

2. 3. 4.

(i) (ii) (iii) (iv)

Permanent Account Number Residential status Particulars of income under any head of income other than salaries (not being a loss under any such head other than the the loss under the head Income from house property) received in the F.Y Income from house property __________________ (In case of loss, enclose computation thereof) Profits and gain of business or profession __________________ Capital gains __________________ Income from other sources (a) Dividends ______________ (b) Interest ______________ (c) Others (specify) ______________ ________________ Aggregate of sub-items (i) to (iv) of item 4 ________________ Tax deducted at source [enclose certificate(s) issued under section 203] Signature of the employee Verification

___________________ ___________________ ___________________ ___________________

5. 6.

Place ____________________ Date ____________________

I, _____________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the ___________day of ______________ 2012 Place ________________ Date ________________