INVESTMENT DECLARATION FOR YEAR 2011-2012 Company : InfoStretch Solutions Pvt Ltd

*E.CODE : *NAME (Mr/Ms.) *DOJ. *PAN NO. *ADDRESS (for the purposes of HRA ) Details of Dependents
I undertake to make the following investments qualifying u/s 88C of the Income Tax Act, 1961 during the financial year 2011-2012 and submit the proof thereof alongwith proof under Chapter VI-A and Rent Receipts (if applicable) before January- 2012.

DESCRIPTION AMOUNT INVESTMENTS U/S 80C capped at Rs 1 Lac Public Provident Fund (PPF) Life Insurance Premium Paid (Like LIC,ICICI Prudential, TATA AIG etc..) National Savings Certificate (NSC) Interest accrued on NSC Approved Superannuation Fund Units purchased from a recognised mutual fund Children Education Expenses / Tuition Fees Housing Loan - Principal Payment Registration / Stamp Duty charges paid for registration of house property NHB Scheme Investment in Mutual Funds / equity shares of Companies engaged in Contribution to Pension Fund Senior Citizen Saving Scheme 2004 Fixed Deposit for 5 Years or more with scheduled bank Post Office Time Deposit Account Total Investments U/S 80C - limited to Rs 1,00,000/- only 0.00 INVESTMENTS U/S 80CCF Infrastructure Bonds (Maximum limit Rs.20,000/-) OTHER PERMITTED DEDUCTIONS 80D - Medical Insurance Premium (up to Rs.15,000/-or Rs 20,000/- as applicable and Additional 1 Deductioon of Rs 15,000/- or Rs.20,000/- allowed in an Individual paying Medical Insurance Premium for His or Her Parent or Parents 2 80DD - Medical Treatment of Dependent suffering from Permanent Disability (up to Rs.50,000/-) 3 80DDB - Expenditure on Medical Treatment for specified disease (up to Rs. 40,000) 4 80E - Repayment of Interest against Educational Loan - no limits on interest paid during the year 5 80U - Permanent Physical Disability (Rs.75000/- ) 6 Total Investments under chapter VI A 0.00 Amount of Bills D. REIMBURSEMENTS 1 Medical (Exemption up to Rs. 15,000/-) 2 Leave Travel Allowance ( 2 journeys in a block of four years exempted) LTA Claimed Current Block is 2010-2013 Yes / No If I do not submit the bills the amount of Medical / LTA paid can be taxed as per the rule. E. INCOME OTHER THAN SALARY- (Attach form 12-C detailing other Income) F. INTEREST PAYMENT ON HOUSING LOAN - (Attach Form 12-C) (up to Rs.1 .5 Lacs if the loan taken after 1-4-99, 30000 if it is prior to 1-4-1999 and there is no limit on let out property) G. RENT PAID PER MONTH ( Please mention the starting and ending month) Rent per month (IF the rent amount changes during the financial year please specify the To Date:amount and the period separately) From Date: To Date: (DD/MM/YYYY format) From Date: The house is located in a Metro / Non Metro H PREVIOUS EMPLOYMENT SALARY (Salary earned from 01/04/11 till date of Joining) If Yes, Form 16 from previous employer or Form 12 B attached If no form 16 or 12B attached, confirm whether the standard deduction and Working Woman Rebate considered by the previous employer or not VERIFICATION I do hereby declare that what is stated above is true to the best of my knowledge and belief. Further, in case of any change in rent and / or occupation of the above premises I would revise the declaration & inform immediately. Note: Please do not attach any proofs to this form. This is only a Declaration .

S.NO. A. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 15 B. 1 C.

Proposed Date of Investment / submission

Rent per month

*Employees' Signature. * Indicated filled is mandatory

Date: