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FORM OF DECLARATION FOR THE A.Y. 2015-16 / F.Y. 2014-15

PLEASE NOTE:

            »         PAN  & Address are mandatory. Please do not fail to furnish the same.

            »         Please indicate details of your investments in appropriate columns only.

(1)     Full Name:

Mr. /Mrs./Ms. ____________________________

Department ______________Designation ______

Branch _________________________________

Contact No. ______________ Male / Female  ___

Email Id __ ______________________________

Date of Birth ________Date of Joining _________

(2)     Income Tax Permanent A/c. (PAN) No. : __________

(MANDATORY) Please provide Xerox / Scan copy of PAN Card.

Deduction available from salary income under chapter VI A:

Sr.

No.

Description of

Investment/s

Documents Required

Maximum

Limit

Rs.

Amount in Rs.

(to be filled in by the employee)

1

House Rent paid to the Landlord

Original Rent Receipts every month (with Revenue Stamp above Rs. 4999/-) or Rent Agreement. Receipt should contain PAN of Landlord if Rent for the year exceeds one Lakh.

(Monthly Rent Amount)

2

Mediclaim – 80D

Mediclaim Policy Copy or Premium Certificate

15,000/-

3

Mediclaim – 80 D (Parents)

Mediclaim Policy Copy or Premium Certificate

20,000/-

4

Interest on Housing Loan Loan taken prior to 01/04/99

Certificate from Bank / Financial Institution

30,000/-

5

Interest on Housing Loan  Loan taken after 01/04/99

Certificate from Bank / Financial Institution

2,00,000/-

6

Expenditure on Dependant with – Disability Rs. 50,000 – Several Disability Rs. 1,00,000-80-U

Certificate from Prescribed Authority in Form No. 10-IA Sec. 80 DD

1,00,000/-

7

Expenditure on Specified Disease

Certificate from Prescribed Authority in Form No. 10-I Sec. 80 DDB

40,000/-

Deduction u/s 80C (Maximum of Rs. 1,50,000/-)

Sr.

No.

Description of

Investment

Documents Required

Maximum

Limit

Rs.

Amount in Rs.

(to be filled in by the employee)

1

Public Provident Fund

Copy of Payment Receipt / Passbook

1,50,000/-

(Do not write EPF)

2

Life Insurance Premium including Pension Plan & ULIP

Copy of Premium Payment Receipt (proposal receipt will not be considered)

3

Repayment of Housing Loan Principal

Certificate from Bank / Financial Institution

4

Mutual Fund (Equity)
(Sec. 10(23D))

Statement of Holding

5

NSC Purchased during the year

Copy of NSC Certificate/s

6

Interest on NSC Purchased

Statement regarding date of purchase & amount

7

Tuition Fees

(Up to Two Children)

Copy of Payment Receipt from School

8

National Saving Scheme

Copy of NSS Certificate/s

9

Bank Fixed Deposit (More than 5 Years)

Copy of FD Receipt

10

Sukanya Samriddhi Account

Copy of Deposit Receipt

 1,50,000/

11

Donation to Registered Trust – 80 G

Original Donation Receipts & PAN of Donnie

12

Other Investments

Medical Bill Reimbursement

Original Medical Bills (including Parents, Wife/Husband, Children)

1250/- every month

DECLARATION

I, declare that the above statement is true to the best of my knowledge and belief. In the event of any change that may occur during the year pertaining to the information given in the form, I undertake to inform the same to the company. Income Tax liability arising due to failure, if any, for not making / not intimating payment / investment made or proposed to be made by me and / or any wrong declaration would be my responsibility.

I further undertake to provide all documentary proofs of payment made by me before 31st March 2015 and if I fail to do so, the company can make full deduction of income tax dues from March 2015 salary.

Date : ___________________________                                                                     _________________________________

Signature of the Employee

 

DECLARATION FOR HOUSE RENT ALLOWANCE RELIEF – FINANCIAL YEAR 2014-15

Details of rent actually paid:

a.       Address of residential property in respect of which rent paid.

__________________________________________________

b.       Name of Landlord to whom rent is paid: ____________________________

c.       Rent payable / paid during the Financial Year:  Rs.____________________

(Please attach copy of Lease / Rent Agreement. In case no agreement is executed submit copy of ORIGINAL rent receipts. In case rent receipt is not submitted, the relief will not be given.)

DECLARATION:

i.        I hereby declare that I shall inform immediately to the company any change in monthly rent stated above or discontinuation of house rent payments.

ii.       I also declare that no residential accommodations owned by me or by my spouse or by my child or by HUF of which I am a member at the place where I reside or perform the duties of employment.

iii.     I hereby declare that what is stated above is true and correct. Any Income Tax dues arising out of wrong declaration will be my sole responsibility.

 

Date : ___________________________                                             _________________________________

                                                                                                                                          Signature of Employee

(Republished with Amendments)

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11 Comments

  1. DIBYENDU PAL says:

    I am a Jr.accountant, Iwant to know after doing all the formalities where to send?

    Regard,

    Dibyendu pal
    Rajendra palce
    New delhi -8

  2. Sujit Talukder says:

    For allowing relief for HRA, it is mandatory to quote the PAN of the landlord if rent payment exceeds Rs 1,00,000/- during the year. If the landlord does not have a PAN, a declaration to that effect is required.

    It is thus suggested to incorporate a field for “PAN of the Landlord or declaration if no PAN)

    Regards
    SUJIT TALUKDER

  3. Hemant D says:

    can donations u/s 80G be claimed through salary other than the ones specified in S. 80G. Does it mean that one need not claim refund by filing return but can get it at source. Am I right in my interpretation?

  4. vswami says:

    < 2.Manoj K. Modi says:
    January 23, 2012 at 10:47 AM "

    Going by its date, certainly his suggestion has no reference to the "Format" . Kindly clarify !

  5. vswami says:

    Sorry ! Completely lost/nonplussed. No clue, it appears to me,is given as to whether this is a format prescribed by the lawmakers. the Revenue, so as to be followed. Open to correction, if i have overlooked something.
    Kindly clarify.

  6. Bharat says:

    it is helpful to resolve many questions. but one thing is there the presentation of formats should be clear.i.e. format of declaration for claiming deduction from salary. we can’t download any format.

  7. Manoj K. Modi says:

    Some Suggestions:

    1.  A statement can be added regarding Perquisites / facilities provided by Company, like Car, Driver, Rental / Rent Free Accommodation etc.

    2.  Any Income pertaining to Head other “Salary Income” which employee wish to declare for the purposes of considering TDS.

    3.  Previous Employer’s Salary Income, if any [ just to make it standard declaration].

    4.  Investments qualifying u/s 80CCF

    Regards
    Manoj K. Modi 
    B.Com, LL.B
    manojkmodi@gmail.com

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