Name of Company_____________________

INVESTMENT DECLARATION FORM FOR CLAIMING TAX BENEFITS For the Financial Year 2016-17
PERSONAL INFORMATION (ALL FIELDS ARE MANDATORY)
EMPLOYEE CODE
NAME
FATHER/HUSBAND NAME
DATE OF BIRTH
GENDER
LOCATION
PAN
CONTACT NO.
DATE OF JOINING

SECTION-I

(Only original Rent receipts will be considered)

RENT PAID FOR THE PURPOSE OF CLAIMING BENEFIT OF HRA U/S 10(13A) OF THE I.TAX ACT, 1961
From date

To date

Full Address

City

Rent Paid Per month

Below information is mandatory if rent exceeds Rs. 100000/- annual (8333/- P.M)
PAN OF LANDLORD

NAME & ADDRESS OF LANDLORD

SECTION-II

(Photocopies to be attached)

(DECLARATION OF SAVING ALLOWED U/S 80 OF THE IT ACT, 1961) In respect of Saving allowed under Chapter VI
S.No
1

Description

Amount

U/s 80D- Medical Insurance Premium- Individual, Spouse & Children ( Max Limit - 25,000
Additional Rs. 5,000 if any person insured is a senior citizen)
U/s 80D- Medical Insurance Premium- Parents (Max Limit - 25,000, Additional Rs. 5,000 if
any person insured is a senior citizen)
U/s 80D- Preventive Health Check-up- Max 5,000 (Within aforesaid limit of 25000)

U/s 80DD- Maintenance including Medical treatment for dependent Handicapped

(If Disability is more than 40% but less than 80%) - Max Limit
-U/s
75,000
80DD- Medical treatment for dependent Handicap

U/s 80DDB- Medical treatment for Specified disease

(If patient is not a senior citizen) - Max Limit - Rs. 40,000 and actual Expenditure whichever
is lower
U/s 80DDB- Medical treatment for Specified disease
(If patient is a senior citizen) - Max Limit - Rs. 60,000 and actual Expenditure whichever is
lower
Please mention, if any other :

(If Disability is more than or equal to 80%) - Max Limit - 1,25,000

SECTION-III

(saving u/s 80C, 80CCC OF THE IT ACT, 1961) (Photocopies to be attached)

Total Amount of Deduction allowed up to Rs. 1,50,000/- (Including Provident Fund deducted through salary)

S.No

Description

Public Provident Fund (PPF) - Self, Spouse & Children Only

LIFE INSURANCE (LIC) - Self, Spouse & Children Only

National Savings Certificate Purchased (VIII Issue) and accrued Interest there on

Housing Loan repayment of Principal (Including Stamp Duty, Registration Fees &
Other Expenses incurred for the purpose of Transfer of Property to the Assessee.)

Unit Linked Insurance Plan (ULIP)

Mutual Funds notified u/s 10(23D)

Investment Declaration

Amount

Page 1

Investment u/s.80CCC (Pension Policy) will also qualify under this Sec - Rs.1 Lac

Children Tuition Fee - Only Tuition fee for Two Children only

Term Deposits (Made during April'16-March'17) for a fixed period of not less than 5
years with a Scheduled Bank

10

5 year Post Office time deposits

11

Senior Citizens Savings Scheme

12

Notified Bonds issued by national bank of agriculture and rural developments

13

Any other eligible investments

SECTION-IV (Saving U/S-80CCD-NPS)

National Pension Scheme(U/S 80CCD)- Maximum Amount upto Rs. 50,000/-(over
and above 1,50,000 u/s 80C)

SECTION-V

(DEDUCTION U/S 24 OF THE IT ACT, 1961 INTEREST ON HOUSING LOAN)

With respect of the amount of any interest payable on borrowed capital for acquiring, constructing , renewal, repairing or re-constructing property.

1. Address of the Property against which Loan taken : __________________

_____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
2. Status of Property (Self-Occupied/Rented and vacant :_____________(if Rented/Vacant, details must be submitted seprately for income earned)
3. Amount of Loan taken, Date of loan availed and Name and the address of the lender (loan Provider): - __
-____________________________________________________________________________________________________
________________________________________________________________________________________________________________
4. Purpose of the Loan (construction / Acquiring property) ______________________________________________________
5. Construction of Property will be completed on or before (expected date)__________In time
6. Date on which Construction has Completed:__________________________________________________________________
7. Date of Possession of Property

_________________________

8. Proof of Possession of Property (Builder Certificate/Registry copy):

_________________________

Amount
9. Total amount of interest paid (post construction/possession) during the financial year (April
2016 to March 2017)
10. Specify amount of interest paid for pre-construction/possession period. If deduction has not
been taken.
11. Ownership ( Joint or Sole)
12. If Joint Ownership Name and Relationship with Owner(s)
Share of Joint Owner(s) in Property
Whether any sum Contributed by Joint Owner in Acquiring Property

(if Joint Owner, Declaration must be

submitted )

Name(s) of Joint Owner(s) (Apart from the Employee) Who are Repaying
Aforesaid Housing Loan
Whether Joint Owner(s) is/are claiming Deduction Under Income Tax Act , 1961
On Account of Housing Loan Taken for Aforesaid Property

SECTION-VI
Other Income details to be accounted for tax calculation :
1
2

SECTION-VII
I, ___________________________, do hereby declare that the aforesaid information is true and correct to the best of my information
and belief and I shall indemnify the company against all costs and consequences if any information is later on found to be incorrect.
Signature of Employee :______________________
Date

:______________________

Place

:______________________

Investment Declaration

Page 2