4/1/2014

3/31/2015

STREAMVECTOR Technology Private Limited

<<Emp ID
<< Name
Declaration of Proof of Investments & Others for the purpose of deduction of Tax
from Salary u/s 192 for the Period 1-4-2015 to 31-3-2016 (A.Y.:2016-2017)
I.

Details of Contributions/Payments (Chapter VIA)

Mediclaim Policy Premium paid directly [u/s 80D]-upto Rs. 35,000/-

Indicate if the premium paid includes coverage for Parents / Senior Citizen>>>>>>>
N- Parents (No)
Y- Parents (Yes) S- Parents (Yes, age > 60 years)
Medical treatment of handicapped dependent [u/s 80DD]- Rs. 50,000/-

Medical treatment - specified diseases [u/s 80DDB]-Actuals upto Rs. 40,000/-

Deduction in case of self being totally blind or physically handicapped [u/s 80U]- Rs 50,000/-

Payment of interest on loan taken for higher education for a full time course [u/s 80E]

Additional deduction in respect of interest of Housing loan [u/s 80EE] - Actuals upto Rs 100000/-

Investment made under notified equity savings scheme [U/s 80CCG] - upto Rs. 50,000/-

Medical Bills/Expenses(Upto Rs.15,000)

Investments for Deduction u/s 80C & 80CCC (Item 1 TO 10 Maxm Limit is Rs.1.5 Lakh p.a. )

Contribution to Pension Plans

Payment of Life Insurance Premium (For self ,spouse & children ) mention details below

Deposit in Public Provident Fund (For self ,spouse & children )

Purchase of National Saving Certificates (VIII Issue)

Contribution to Unit Linked Insurance Scheme (ULIP) mention details below

Contribution to Equity Linked Savings Scheme (ELSS)

Payment of Tution fees to any School, College, University or Educational Institution

Repayment of Principal Amount of Housing Loan

Fixed Deposit for 5 years with a Scheduled Bank

10

Amount (Rs.)

PROOF CODE

<< N/Y/S

Amount (Rs.)

PROOF CODE

TUTION
FEES
HSG.LN.
PRIN.

Others (Please provide details)

HSG.LN.
INT.

IIA.
Self Occupied Property - Interest on Housing Loan

Date of Loan Sanctioned :

Date of Possession Taken :

IIB.Let out / Deemed Let Out Property (Income / Loss on Housing Property) [u/s 24(2)]
Rent receivable on Property
Municipal Taxes

Interest on Housing Loan

Standard Deduction Repairs @ 30%

Date of Loan Sanctioned :

Date of Possession Taken :
I undertake that Interest on Housing Loan as claimed above is in respect of House Property, for which construction has been
completed and the possession has already been taken by me OR is due to be taken in the current financial year. (Refer note below)

III.House Rent Allowance

Name & Address of the Landlord

Rent Amount
p.m

PAN of Landlord

*mandatory, if rent>
Rs.100,000 p.a. / Rs 8333
p.m.

IV.Statement provided - Income from Previous Employer during FY 2015-16 (Yes / No) >>>>

Period of Lease

From :
Upto :
From :
Upto :

No

Declaration:
I hereby confirm that I have invested/contributed the above amounts for the purpose of rebate/deduction to be considered in calculating my
income tax for the F.Y. 2015-2016. I further undertake that wherever eligible investments are made in the name of spouse/children/dependent
parents, the same have been made out of my income and claim thereof shall not be made elsewhere to get Income Tax benefit. I will produce
the tenancy/lease agreement in respect of rents paid, or any other supporting documentation requested by the Company, in support of my claim.
I hereby declare that all the information given by me is true and correct and I undertake to notify you immediately of any change in the above
facts. I also confirm my understanding that I may be subject to disciplinary action, up to and including termination of my employment, for any
false or tampered submission.
Any Income Tax liability arising out of a wrong declaration will be my responsibility, and I undertake to indemnify the Company and its officers
from all consequences, monetary and otherwise, arising out of any incorrect and/or incomplete information provided in this declaration.
Place :
Signature >>
Dated :

NOTES TO DECLARATION OF INVESTMENTS FROM 1.4.2015 TO 31.3.2016

I

A-1

Mediclaim Policy - Premium [u/s 80D]

Deduction u/s 80D for Premium on Mediclaim Policy is allowable only in case of coverage to self, spouse, dependant parents and
dependant children.

The deduction u/s 80D is limited to an amount of Rs 15000 (Rs 20000 in case any beneficiary under the scheme is a Senior Citizen i.e
age >= 60 years). Additional benefit is available to the extent of Rs 15000/- in case the coverage under the Health Policy includes
any of the parents of the employee.

Any payment on account of preventive

health to
check-up
of the employee
family, policy & Premium receipt paid 2014-15
Proof
be Submitted
- Copy oforInsurance
[restricted
to Rs 5000/-;
cashafter
payment
For
the premium
falling due
Jan 15, Pls attach previous year receipt with self declaration.
allowed here]

A-2

Medical treatment of handicapped dependent [u/s 80DD]

Eligible Deduction u/s 80DD is Rs 50,000 from the Gross Total Income of the employee. However, where such person is a dependant
with severe disability (disability exceeding 80%) , the exemption shall stand enhanced to Rs 1,00,000.

Deduction can be provided only for treatment for dependants of the individual i.e. spouse, children, parents, brothers or sisters only.

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Proof to be Submitted - 1. Proof of expenditure incurred OR a duly signed declaration in writing certifying the actual amount of
expenditure incurred AND receipt/ acknowledgment for the amount paid/ deposited into the specified schemes of LIC/ UTI; and
2. Permanent Physical disability certificate from a physician, a surgeon, or a psychiatrist, as the case may be working in a Govt.
hospital. The certificate should contain the employees name. ( i.e 10 I certificate )

I
-

A-3

Medical treatment of specified diseases for self/dependent [u/s 80DDB]

Eligible Deduction is on account of actual expenses, restricted to a maximum Rs 40,000 from the Gross Total Income of the employee.
However, where such person is a Senior Citizen, the limit shall stand enhanced to Rs 60,000.

Deduction can be provided only for treatment for dependants of the individual i.e. spouse, children, parents, brothers or sisters only.
Proof to be Submitted - 1. Proof of expenditure incurred OR a duly signed declaration in writing certifying the actual amount of
expenditure incurred AND receipt/ acknowledgment for the amount paid/ deposited into the specified schemes of LIC/ UTI; and
2. Permanent Physical disability certificate from a physician, a surgeon, or a psychiatrist, as the case may be working in a Govt.
hospital. The certificate should contain the employees name. ( i.e 10 I certificate )

A-4
-

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Deduction can be provided only in case of amount spend on treatment of specified diseases or ailments under Rule 11DD as below :
Neurological Diseases where the disability level has been certified to be of 40% and above, i.e. Dementia, Dystonia Musculorum
Motor Neuron Disease, Ataxia, Chorea, Hemiballismus, Aphasia, Parkinsons Disease etc.: and
Malignant Cancers, Full Blown AIDS, Chronic Renal failure, Hematological disorders, Hemophilia & Thalassaemia.

Deduction in case of self being totally blind or physically handicapped [u/s 80U]

Back

Eligible Deduction u/s 80U is Rs 50,000 from the Gross Total Income of the employee. However, where employee is a person with
severe disability (disability exceeding 80%), the exemption shall stand enhanced to Rs 1,00,000.
Proof to be Submitted - Permanent Physical disability certificate from a physician, a surgeon, or a psychiatrist, as the case may be
working in a Govt. hospital. The certificate should contain the employees name. ( i.e 10 I certificate )

A-5

Payment of interest on loan taken for higher education for a full time course [u/s 80E]

Deduction u/s 80E is eligible only for interest component repaid during the financial year. Deduction on account of Principal
repayment is not eligible for deduction.

Education loan should be from any Financial Institution or any approved charitable institution for the purpose of pursuing his/her
higher education or relative of the individual i.e spouse/children.

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Proof to be Submitted : copy of Certificate issued by the Bank, Financial Institution showing the interest and principle separately.

A-6

Additional deduction in respect of interest of Housing loan [u/s 80EE]

Presently an individual can claim a deduction under section 24(b) of interest payable on loan taken for a house property (self
occupied) upto Rs. 2,00,000. In addition to the same now as per new section 80EE an additional deduction of Rs. 1,00,000 is also
allowed subject to fulfillment of the following conditions mentioned below:

(a) the loan has been sanctioned by the financial institution during the period beginning on the 1st April, 2013 and ending on the 31
March, 2014;
(b) the amount of loan sanctioned for acquisition of the residential house property does not exceed twenty-five lakh rupees;
(c) the value of the residential house property does not exceed forty lakh rupees;
(d) the assessee does not own any residential house property on the date of sanction of the loan
Proofs to be Submitted :1. Copy of Provisional Interest certification from Bank showing clearly the amount of principle and interest
separately.
2.
Date when the loanInvestment
was borrowedmade
&. Dateunder
of completion
of equity
purchase/
construction
of house.
A-7
notified
savings
scheme
[U/s 80CCG]

Newly inserted Section 80CCG provides deduction w.e.f. assessment year 2014-15 in respect of investment made under notified
equity saving scheme

The deduction under this section is available if following conditions are satisfied:
(a) The assessee is a resident individual (may be ordinarily resident or not ordinarily resident)
(b) His gross total income does not exceed Rs. 12 lakhs;
(c) He has acquired listed shares in accordance with a notified scheme;
(d) The assessee is a new retail investor as specified in the above notified scheme;
(e) The investment is locked-in for a period of 3 years from the date of acquisition in accordance with the above scheme
(f) The maximum investment eligible for deduction, under this section, is Rs. 50000/(g) If any deduction is claimed by a taxpayer under this section in any year, he shall not be entitled to any deduction under this
section for any subsequent year

Deduction limited to 50% of amount invested in equity shares. However, the amount of deduction cannot exceed Rs. 25,000

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Proofs to be Submitted :Deduction can be provided only on the basis of acknowledged copy of purchase of shares i.e. Purchase
Invoice / Contract Note. The employee is also required to submit a copy of his demat statement (designated as eligible under the
Scheme by the Depository participant)

B-1
-

Contribution to Pension Plans

Back

Deduction on account of Premium paid to keep in force a Annuity Policy (Pension Plan) is eligible for deduction u/s 80CCC, and subject
to a consolidated maximum limit of Rs 1,50,000 u/s 80C.
Proofs to be Submitted :Copy of Premium receipt.
For the premium falling due after Jan 15, Pls attach previous year receipt with self declaration.

B-2

Payment of Life Insurance Premium (For self ,spouse & children )

The beneficiaries as per the Insurance Policy should either be the self individual, spouse or children of the individual. Premium paid
for parents, brother or sister, even if dependant on the employee, is not eligible. Hence if the Policy Premium receipt bears the name
of a person, other than the individual, relationship of the beneficiary to the individual should be clearly mentioned on the Receipt.

Late Fee / Interest on late payment of Premium is not eligible for deduction u/s 80C

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If the annual premium of life insurance policy, issued before April 1,2012, is more than 20% of the sum assured of the concerned
policy, benefit allowed should be restricted to 20% of the sum assured.

If the annual premium of life insurance policy, issued on or after April 1,2012, is more than 10% of the sum assured of the concerned
policy, benefit allowed should be restricted to 10% of the sum assured.

As a proof we can accept xerox copies of premium paid receipts / policy copies of current financial year
Proofs to be Submitted :Copy of Premium Receipt paid during 2014 2015.
Late payment interest charged will not be included as premium paid & for the premium falling due after Jan 14, Pls attach previous
year receipt with self declaration.

B-3

Deposit in Public Provident Fund (For self ,spouse & children )

Contribution by the employee to PPF Account only in the name of self, spouse or children of the employee is eligible for deduction.

Deposits under PPF is eligible only if the same is paid in the current Financial Year
Proofs to be submitted :1. Copy of passbook along with the cover page showing investors name (OR)
2. Copy of the challan duly acknowledged by the Bank

B-4

Purchase of National Saving Certificates (VIII Issue)

Subscription to NSC is eligible only if the same is purchased in the current Financial Year. Interest on NSC is not eligible for deduction
from Taxable Income u/s 80C.

Subscription to NSC is eligible only if the Certificate is in the name of the employee.
Proofs to be submitted : Copy of the Certificates purchased during the year 2014-15

B-5

Contribution to Unit Linked Insurance Scheme (For self ,spouse & children )

The beneficiaries as per the Insurance Policy should either be the self individual, spouse or children of the individual. Premium paid
for parents, brother or sister, even if dependant on the employee, is not eligible. Hence if the Policy Premium receipt bears the name
of a person, other than the individual, relationship of the beneficiary to the individual should be clearly mentioned on the Receipt.

Late Fee / Interest on late payment of Premium is not eligible for deduction u/s 80C
Proofs to be submitted :Copy of ULIP statement

B-6
-

Contribution to Equity Linked Savings Scheme (ELSS)

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Subscription to ELSS is eligible only if the units are purchased in the current Financial Year and the same is in the name of the
employee only.
Subscription to ELSS is eligible only if the same is a Tax Saver Scheme. All Mutual Fund Schemes are not Tax Saver Schemes and
hence any investment in a Mutual Fund is eligible only if it is a Tax Saver Scheme.
Proofs to be submitted :Copy of statement of current FY

B-7

Payment of tuition fees to any School, College, University or Educational Institution

Tuition Fees is eligible only if the same is with respect to any two children of the employee.

Payment on account of tuition fees, term fees, admission fees etc .only is eligible for Deduction as per Tax Rules. Any and any other
payout like development fees, capitation fees, donation etc. are not eligible.

Payment should be to a University, School, College or other Educational Institution in India for the purpose of full-time education and
includes any payment for play-school, pre-nursery or nursery activities. Exemption will be provided for actual payments only.
Proofs to be submitted : Copy of receipts for Tuition Fees

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B-8

Repayment of Principal Amount of Housing Loan

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Any sum paid on account of purchase or construction of a residential house property is eligible for deduction, wherein such payment
is made by way of instalment or part/full repayment towards principal loan due to any institution engaged in the business of
providing long term finance.

Payment on account of Stamp Duty, Registration fees or any other payment incurred for the purpose of transfer shall also be covered
hereunder.
Proofs to be submitted : Copy of Provisional Interest certification from Bank showing clearly the amount of principle and interest separately
Back
B-9
Fixed Deposit for 5 years with a Scheduled Bank
Subscription to Fixed Deposit is eligible only if the same is for a fixed period of not less than 5 years with a Scheduled bank and
notified under the Bank Term Deposit Scheme, 2006.

I
-

Subscription to Tax Saver Fixed Deposit is eligible only if the same is purchased in the current Financial Year and in the name of the
employee.
Proofs to be submitted: Copy of the Certificate/ Receipt/ Passbook etc which duly signed & stamped

IiA

Loss on Self-Occupied House Property Income (Interest on Housing Loan) [u/s 24(2)]

Deduction u/s 24(2) is allowable in respect of interest paid, upto a maximum of Rs 2,00,000, if such loan has been taken after
1.4.1999 for constructing or acquiring a residential unit.

Benefit for Interest on Housing Loan is eligible only in case, the employee has taken possession or due to take possession of of the
House Property in the current financial year. Status of possession of property will be considered as per the Declaration by the
employee on the Proof Cover Memo.
Proofs to be submitted:1. Copy of Provisional Interest certification from Bank showing clearly the amount of principle and interest
separately.
was borrowed & 3. Date of completion of purchase/ construction of house.4) Declaration for a joint Loan
IiB 2. Date when the loanIncome
/ (Loss) on Let out / Deemed Let Out Property [u/s 24(2)]
- The calculation of Income / Loss from house property is done as under:
Rental income / Deemed Rental Income = Gross Annual Value
Less : Municipal taxes = Net Annual Value
Less : 30% of Net Annual Value as a standard deduction
Less: interest payable on any loan taken for acquisition or construction of this property
= Income / Loss from House property

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III
-

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Where the property is given on rent, the annual value will be calculated based on the actual rental and the final income (or loss) from
house property will be calculated as given above. In such a case, there is no restriction on the maximum amount of deduction
available in respect of Interest.
Proofs to be submitted:1. Copy of Provisional Interest certification from Bank showing clearly the amount of principle and interest
separately.
2. Date when the loan was borrowed & 3. Date of completion of purchase/ construction of house.4) Declaration for a joint Loan 5)
Rent agreement & Receipts for the the let out house 6) Copy of recipt of Muncipal tax paid 7) Fill the loss from letout property format

House Rent Allowance (HRA) Rebate

HRA Rebate is calculated at minimum of the following :

a. The actual amount of HRA received by the assessee in respect of the relevant period.
b. The amount by which Rent actually incurred by the assessee exceeds 10% of the Basic Salary
c. An amount equal to (i) where such accommodation is situated in Mumbai, Kolkata , Delhi or Chennai, 50% of the Basic Salary
(ii) where such accommodation is situated at any other place ,40% of the Basic Salary

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If annual rent paid by the employee exceeds Rs 1,00,000 p.a., it is mandatory for the employee to report PAN of the landlord to the
employer. In case the landlord does not have a PAN, a declaration to this effect from the landlord along with the name and address of
the landlord should be filed by the employee. In the absence of the the PAN / Declaration, the Rent declaration is liable to be rejected.
Proofs to Submitted :1. A copy of Rent Receipt from starting month April 2014 or the month during which you have joined
Mobipulse / Streamvector , (whichever is later), till the last month (Dec 2014/ Jan 2015). In case of change in rental amounts, the rent
receipt for both the months (prior to rent change and after the rent change) needs be submitted; and / or
2. Agreement copy, which is valid for the period is mandatory where Rent Per month is above Rs.8333/3. Revenue Stamp is necessary. Since it is not available, receipt will do with the landlords signature.

IV
-

Details of Salary Income from Previous Employer during the Financial Year.
Details of any Salary Income received by the employee from Previous Employer during the Financial year 2014-15 (New Joinees post
1st April 2014), shall be in consolidated in the Tax Calculation of the employee on the basis on complete details provided by the
employee.
Documents submitted with respect to Previous Employer Income shall be considered as below :
Form 16/Final Tax Computation Sheet from the Previous employer shall be considered as a valid document for
inclusion of previous employment income details for the current financial year.
-

Payslips for earlier months from the previous employer is not a valid document as the same does not provide
information in respect of exemptions / deductions.

Please note that offering previous employer income may result in a higher taxable income thereby resulting in
additonal tax liability, therefore, please consult your CA/Tax consultant for further advise

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Self Declaration for Insurance Premium Payment

I hereby declare that, the following insurance premium payment due dates fall after the cut off date for submission of investment proofs.
I have enclosed last year premium receipt in support of same.

I do hereby take the responsibility in submitting the actual premium paid receipt before 10th March 2016,
otherwise, I authorize the employer to revoke the tax exemption provided to me earlier based on the below declaration.

Insurance Type (Mediclaim, Life, etc.)

Date:
Employee ID:
Employee Name:
Employee Signature:

Policy No.

Policy Holder
Name (with
relationship)

Period (Monthly,
Quarterly, Half
yearly, Annual)

Amount

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
Net Annual Rental Income
Less: 30% for Repairs & Maintenance on Net Annual Income

0
0
0

Less:
Interest paid on borrowed Loan (From Apr 15 To Mar 16)
(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 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.

Employee Signature:
Date:
Note:

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

mputation