INCOME TAX DECLARATION FORM - F.Y.

2018-19
(To be used to declare investment that will be made during the period from 01/04/2018 to 31/03/2019 for Income Tax purpose)

Company Name Emp ID

PAN of Employee
Employee Name
(compulsory)

As per section 206AA, in case PAN is not submitted, TDS will be deducted at flat rate of 20%
ITEMS PARTICULARS MAXIMUM LIMIT DECLARED AMOUNT

DEDUCTION U/S 10

HOUSE RENT I am staying in a rented house and I agree to submit Leave & Licence METRO /
A'ment when required.The Rent Paid is (Rs. _____________ X NON METRO
_______ months) & the house is located in a METRO / NON METRO
(Tick whichever is applicable)
Max Limit Declared Amount
Sec 80D - Medical Insurance Premium (If the policy covers a senior citizen
then exemption is Rs.30,000/-) -
Sec 80DD - Handicapped Dependent -
Sec 80E - Repayment of Loan for higher education (only Interest) -
DEDUCTION UNDER
CHAPTER - VI A Sec 80GG - Rent Paid 99,000.00
Sec 80U - Handicapped -
Sec 80CCG - Rajeev Gandhi Equity Saving Scheme
(Investment max upto Rs.50,000, would get a deduction of 50% on the
amount invested) 25,000.00
Sec 80TTA - Interest on saving a/c 10,000.00
Any other Deduction (Please specify)
Max Limit Declared Amount
A. EPF & VPF Contribution 1,50,000.00
B. Public Provident Fund (PPF) 1,50,000.00
C. Senior Citizen’s Saving Scheme (SCSS) 1,50,000.00
D. N.S.C (Investment + accrued Interest before Maturity Year) 1,50,000.00
E. Tax Saving Fixed Deposit (5 Years and above) 1,50,000.00
F. Tax Savings Bonds 1,50,000.00
G. E.L.S.S (Tax Saving Mutual Fund) 1,50,000.00
H. Life Insurance Premiums 1,50,000.00
DEDUCTION U/S 80C I. New Pension Scheme (NPS) (u/s 80CCC) 1,50,000.00
J. Pension Plan from Insurance Companies/Mutual Funds (u/s 80CCC) 1,50,000.00
K. 80 CCD Central Govt. Employees Pension Plan (u/s 80CCD) 1,50,000.00
L. Housing. Loan (Principal Repayment) 1,50,000.00
M. Sukanya Samriddhi Account 1,50,000.00
O. Tuition fees for 2 children 1,50,000.00
Others (please specify) 1,50,000.00
Others (please specify) 1,50,000.00
DEDUCTION U/S 80CCC Annuity/Pension Plan 1,50,000.00
DEDUCTION U/S 80D Medical Insurance premiums (for Self ) 50,000.00
DEDUCTION U/S 80D Medical Insurance premiums (for Parents) 50,000.00
DEDUCTION U/S 80DDB Expenditure on Selected Medical Treatment for self/ dependent 50,000.00
DEDUCTION U/S 80CCD Notified Pension Scheme 1,50,000.00
Aggregate Deduction U/S 80C, 80CCC & 80CCD cannot exceed Rs. 150000/-
Additional Deduction U/S 80CCD (1b) of Rs. 50000/-
Max Limit Declared Amount
Interest on Housing Loan on fully constructed accomodation
only 200,000.00
DEDUCTION U/S 24
Interest if the loan is taken before 01/04/99 on fully constructed
accomodation only 30,000.00

DECLARATIONS:

I hereby declare that the information given above is correct and true in all respects. I am also aware that the company will be considering
the above details in utmost good faith based on the details provided by me and that I am personally liable for any consequences arising
1. out of errors, if any, in the above information.

I am also aware that any person making a false statement / declaration in the above form shall be liable to be fined and prosecution u/s
277 of the Income Tax Act, 1961
2.
3. The proof of payment / Supportings for claim, will be provided latest by _________________

Note -
Date :
Place: SIGNATURE OF THE EMPLOYEE
 Form 12c
PARTICULARS OF INCOME U/S 192 (2B) FORM 12-C

FORM NO. 12C

[See rule 26B]

Form for sending particulars of income under section 192 (2B) for the year
ending 31st March, 2018

1 Name and address of the employee

2 Permanent Account Number
3 Residential Status
4 Particulars of income under any head of income other than
"salaries" (not being a loss under any such head other than the
loss under the head "Income from house property") received in
the financial year.
Rs.
(I) Income from house property _____________
(in case of loss, enclose computation thereof)
(ii) Profits and gains of business or profession _____________
(iii) Capital gains _____________
(iv) Income from other sources Rs.
(a) Dividends _____________
(b) Interest _____________
(c) Other incomes (specify) _____________
Total _____________
5 Aggregate of sub-items (I) to [(iv)] of item 4
6 Tax deducted at source [enclose certificate(s) issued under
section 203]
Place _____________
Date _____________ _______________________
Signature of the employee
______________________________
1 Inserted by the IT (Eighth Amdt.) Rules, 1987.
2 Substituted by the IT (Fourteenth Amdt.) Rules, 1998, w.e.f. 14-9-1998. Prior to its
substitution, item 4, as inserted by the IT(Eighth Amdt.) Rules, 1987, read as under:
3 Substituted for "(v)" by the IT (Fourteenth Amdt.) Rules, 1998. w.e.f. 14-9-1998

Form 12C 1.428

INCOME-TAX RULES, 1962
Verification
I,_________________________,do hereby declare that what is stated above is true to the best
of my knowledger and belief.
Verified today, the ____________________day of ___________________20….
Place _____________
Date _____________ _______________________
Signature of the employee

_____________________
ACTION POINTS

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 Form 12c
1 This form is to be used by an assesse-employee when he desires that his income from
sources other than "salaries" may also be taken into account by the employer for purposes of
deduction of tax of source. This form may be submitted by the assessee employee to his
employer.

2 Once the Form is submitted by the assessee employees, the employer has to take into
account the other income disclosed by the assesse and the tax deducted at source thereon
while computing the tax deductible at source from the assessee's salary.

3 From the assessment year 1999-2000, the assessee is permitted to furnish particulars in
respect of any loss under the head 'Income from house property' to his employer. The Form
has consequently been enlarged, so as to enable the assessee-employee to furnish particulars
of such loss. Employees having loss under the head 'Income from house property' will find
it to their advantage to furnish such loss (if any) to the employer, since the tax deductible at
source will get corresponsdingly reduced. This apart, such employees will also be saved from
the botheration of filing a return of income just for the purpose of obtaining tax refund.

4 The assessee-employee cannot however furnish particulars of loss (if any) under any head of
income other than 'Income from house property'.

_____________________

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