INCOME TAX DECLARATION FORM

( To be used to declare investment for Income Tax that will be made during the period Apr 2015 to Mar 2016)
Company NameZemoso Technologies Pvt. Ltd

Employee NameAkash Gaurav

Father's Name Dashrath Prasad Singh
Employee ID

ZTPL0057

DOB

08/10/1994

Designation

Software Engineer

Department
PAN Number

BHEPG9250Q

Male / Female Male

DOJ

6/15/2015

E-mail Id

akash@zemosolabs.com
in INR

akashgaurav.iitr@gmail.com
Item

Particulars

Declared Amount

Deduction Under Section 10

House Rent

I am staying in a rented house and I agree to submit rent receipts when

Per Month Rent =

required.The Rent Paid per month is Rs.____________

No of Months =

8,000
9

Total rent for year =

u/s 10(13) &

Rule 2A

72,000

(copy Rent Paid Receipts must be deposited with Accounts Department

Landlord / House-owners PAN and Agreement Copy (Mandatory if the Rent paid is more than 8333/- pm)
Max Limit
Sec 80D - Medical Insurance Premium (for Self, Spouse, Dependent Children)

25,000.00

Sec 80D - Medical Insurance Premium (for Senior Citizen)

30,000.00

Sec 80E - Interest on Education Loan (for Self, Spouse & Children)

Declared Amount

No Limit

80CCDAdditional deduction of Rs 50,000 towards contributions to Pension Funds

Sec-80CCC & Sec-80C:- Contribution to Pension Fund (Pension Fund of LIC or other Insurance Compani
- Life Insurance Premium (Self, Spouse & Children)
- Deferred Annuity Plan (in the name of self, spouse & Children)
Deduction
Under Chapter - Public Provident Fund (Self, Spouse & Children)
VIA
- ULIP of UTI/LIC (Self, Spouse & Children)
- Principal Loan (Housing Loan) Repayment
- Notified Mutual Funds
-Tuition Fee paid to University/College/edu. Institute - paid in India (for any
two children)
- 5 Yrs Fixed Deposits with Scheduled Banks - Schemes Notified By Central Govt

(Maximum
Deduction
Allowed under
this head is
Rs.150,000/-)

- Deposit in NSC
Interest earned on Sukanya Samridhi Account to be fully tax free
Total

Declared Amount
Please submit Form 16 from previous employer or Form 12 B with tax
Previous
Employment computation statement
Salary (Salary SALARY paid by the Previous Employer after Sec 10 Exemption
earned from
01/04/15 till PROFESSIONAL TAX deducted by the Previous Employer
date of
PROVIDENT FUND deducted by the Previous Employer
joining)

INCOME TAX deducted by the Previous Employer

Income other than Salary Income

Max Limit

Declared Amount

Housing Loan - Principal Portion

Deduction
Interest on Housing Loan if loan taken after 01-Apr-1999
under Section
24(b)
Interest if the loan is taken before 01-Apr-1999

200,000

Note : Attach Copy of Housing Loan Certificate.

Please specify whether self-occupied or let out. If let out please specify the annual rental amount.

Start Date of Construction of House

Details for
claiming
Date of Completion of Construction of House
Housing Loan:
Date of Occupation of House
Any other
Information

Medical Bills (Up to Rs 15000) needs to be submitted

Petrol Bills (as per your eligibility)
Telephone Bills (as per your eligibility)

Declaration:
1) I hereby declare that the information given above is correct and true in all respects.
2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information being incorrect.
Date :

24 Jun 15

Place:

Hyderabad

Akash Gaurav
Signature of the Employee