ql(#q frqr{q-il{ srfr6<!

ilAtRpoRTs AUTHoRtw oF tNDtA

ffifrq C{rt q-gr / USAKHAPATNAM TNTERNAnoNAL AtRpoRT

ffic q{ 2O2O-21 + fdg qFIi"< qrffi{ sr fr{o/piritculars for ass€sstn8 tncome Tar for the flnanctatyear 202G21

Emp.llo' q-flPA[ *

{rq/Name t o€sl8n

1 ffiq E{ 2020-21 +ftq \rd.qR.q qz/HRA EXEMPTION FOR FY 202G21

qrfl rr flq \'?i qr{rq $r TrI lir(Tf,cr{) owner.s Name &
(a)
House Address in full(Present)

F<rqr/qr{tr TrdriAc(ft{rq Fr T$-< 3it E{r{ clfrn $r

q-{ sr€ ff riff qft fr{rqr l
oooooi- rfr qrdr + Brd-6 l't di
{ii{ nt )RenvMonth paid /payabte (Attach rent recejptand
l-rndlord PA card copy if rent exceeds Rs.lOOOOO/-Der yearl.
(b q]qElLB.gT., qrdr{I +at+* r/Whether residinq in AAt
2 arn< ffitrr r< <rq <+r1q{ qfrF) / txraiEsr o }tousa lurlorNc aovANcE (s!!f occlrr.EDl

Tq qQr toan
qrq {IRt tnterest Amount

{t.E.rr,Glf,r,fu1 t qq.ff.q/HBA from AAt {Department)

{q dRrl / +i i rrq.ff.q/8BA from oth€r tnstirution/8anks

Tq iqr / LoAN NUMBER

fn / ffiq dF{r {T ilq \Fi qirT/Na me & Address of EANr/FINANC|A|
INSTITUTION

;l'trGiftq tFtr fi q_{ {Eqr/pAN

N U MBE R o F BAN K/FtNANC|AL tNSTtruIoN

3 ar{r(iicft + qrc (fr<Iq + E{ t frOtNCOME FROM HOUSE pROpERw {FOR RENTEo HOUSE)
dvft rt rerAddress of lroperty:- tq <rQr/ban emount tt fl frq'{tnlrlx onArs

ir rr l-c *pAx ro or sAxx -

(i) r+-q qrfif6 {-q(yrq fr{r{ryGross annuat vatue (Rent receivabte)
(ii) 6F. ES + ftq R ft{rt * +d +r 5q-6pagfi-q 6 yRftR dqr +tvress :

[4unicipaltaxes paid for the year (Attach copy of receipt)

(iii) (i)-(ii) gnl EfiF1" Net annuat vatue (i)-(ii)
Tiq/
(iv) ?rRr 24 * qri-{:6+&/ Less : oeduction under section 24

{n-{ i..tff (Iiq Erfftr {q.ir 3O%y Srandard deduction (30% of ner annuat value)
gurr qr.lt {dr r<qrq (€q qq{rq@

lv)(iir - (iv)ilr{rs dyfr i qr{ffrfrirncome/Loss from house property (iii), (iv)

rftq /ADplicable for 1 & 2 - certiried that the house rete,red above has been acquired/constrrction
completed ,rit6 ir, 3 years
trom the date of the Financial year in which the capital was boarowed and date of Completlon is
_
4 {q ffi + qrc / tNcoME FRoM oTHER souRcEs
a;i'+ cr* r< arcl tnterest on Bank Ay'c

b) tcrn / Pension
c) *{ +q qp,7 gnt other tncome

Page 1 ot 2
 5 {{q( 80 t arq d-dtfi/sEcnoN 80 oTHER DEDUcTtoNS

+a FadE (\r{.ff.tlr) t n{r< +qfl t +.rfl{ / contribution to pension

{a) scheme of Central Govemment (NPS)

{80 <rdl (Q-qirT) qI4cT6 yrrlgr-rl:r {i.rT lst/Ctaims u/s 8OU

(b) (Phvsicallv handicapped)- Enclose necessarv ce.tifi cate
2020-21 t Rq $rdri ft{r r{r <m 1ga t ftg rr.ft.xr.,
Xl+ aot o-g REfi h ftq (Et/q-*/!S) +dHqr t s'cror c{ ftrr z"r trq rd Ultntcr.n r,.u for 2o2G21r(AAl
{ir[ +:t t/lnterest on Loan taken for HiSher Education u/s 8oE Edn.toan not elldblc for€rcmprlon)
(Self/ Spouse/Children) (Enclose certificate from
(c)
Bank/lnstitution)
fuqr rm aq ff frfuit-oan qrc Brtri {r ii ff frfuioate on
which lnter€st Paym€nt rtart!:

5 TTnAq< vt- q (80fr T'rrff) savrNGs{r{AprER vr-a (8oc oEDUcroNs)

(a) qe. qG.ftlff.C.l.qrt., +EtI-frFiI i ift-{ [r,+r-{ h {qr{r {a .F+ff/Lrc/pLr rnru6nc. p,ehiuh ,.min.n.. loh.r th.n s.l.,r d.d!.doi)

2020-2021 c{ t ftg tc *str frFn/rotat Pr€rntum fo{ the year

cIFrff Ti./Policy No h/qr{I{rFf5-fr cr-ftFQtly/Monthly^€arly - Prem ium 202G21

mffitr cfrq ff& + +r{<F1tt< r/rfr i aar<lcontribution to Public

(b) Provident fund lother th.n S.lary dedu.don)
(c) rrfra a'lt rrrw-retNational savinSs certifi cate

(d) (2)s'ii + ftq qqr{ {I-n6F/Iuition Fees for children (2)

(e) 1R-e-a-5a-a *m *q;lrtunit Linked lnsurance Plan

(fl r{Tfi '5.S[I/Mutual Funds

(h) rr+n ur<r 3r<ifn cfr qfr * frAvlnvenment in Govt approved seturitiet
\rs.*.q., Tir [d sr Trff(Rlfi'tq 3lr{ qr{{ t)/HBA
(i) principle repayments (Depanm€ntal & Outside)
+€ 3rq Fi{ (80ff t iiitlf( drq)/Any other lnvestments{Elirible u nder

0) 80c)
fdT/roTAr

Rrmtrrrrtrre r<r gE1qfr mI +r RT''q *.t.Vff.\rs c., !F + frc Tfl trql t.)EDucarloN/HosrEt
7
ALLOWANCE ExEMPIION (if Perks option CEA/CHA selected for exemption)

{i5I irqlNam€ of the dild qq,l.tt+qiFI q/Name of school/colleSe ArIFTFI elztr {:PlT;l/Hortel fees Paid

ii

frttrTT / Declaration
r.{(Fffi6rnrq).,s}slnc'cdrdmcff{frn5uswr-6tlrlTtT(ttlndkQqm+a-5qR
rfftrlr. (Name of Employee) do declare that what is stated above i5 true to the best of my

z. lt ffitqrB-< i sqt6 E. t<rfrr.{ qIft rr cr{r Tfi ft{r t t/My spouse/Dependenr has not clalmed above mentloned rebate/clalms/savirys €tc
d arl*rmarot {,rt{r{ + tfrq
g-if((f+ t/Funher, I am aware that if at any stage, the information/documents/claims
furnished above is found to be false, I

(qFT/Place
Ittq/Date n+rart fi (Ffilf{/slfnatur€ of the EmPloYe€

qitgTt/l moortant r

ZOzozJEfrq *'ffi sil ,rfiT "q ti * ftq R-6r{riffi 6c + 15/07/2020 + cr sEt c.{t f{ 6{ tin {51TFr
fu<T orqr/ to be returned to Finance section duly tilled iniElbglglg!5l@zg4 positively in order to finalise tax
liabilitv

Page 2 ol2