Sample Income Tax Declaration
Form for Financial Year 2012-13, 2013-14, 2014-15 in word/. doc / excel Format
for salary persons in India
45/1 Ambani Road
PRELIMINARY
DECLARATION FOR CLAIMING INCOME TAX REBATE
FOR THE FINANCIAL
YEAR 2012 – 2013
[ASSESSMENT YEAR 2013-2014]
To
Accounts Department Name :
Rocket Sales Ltd PAN No.:
Mumbai – 458 545
I give below
the necessary declaration
for the payments / investments to be made
by me during
the period 1st April, 2012 to 31st
March, 2013 to enable
me to avail
of the tax
rebate as per
the provisions of
the Income Tax
Act, 1961 (as amended
up to date).
(A) FOR CALCULATION OF NON-TAXABLE RENT ALLOWANCE
MONTHLY RENT PAID TO LANDLORD : Rs.
_________
(The rebate will be allowed only on furnishing
Copy of original rent receipt) :
_________________________________________________________________________
(B) DEDUCTION ALLOWABLE UNDER SECTION 80 C
N.B. Total claim for deduction u/s. 80C is
restricted upto Rs.1,00,000 for contribution to Life Insurance Premium (LIC
& others), ULIP, contribution to EPF, VPF, PPF, investment in NSC, Mutual
Funds, schemes of different annuities, payment of tuition fees of children,
housing loan principal repayment, investments in debentures / equity shares in
a public company engaged in infrastructure including power sector as also in
subscription to equity shares and debentures of a public company forming part
of eligible issue of capital for the purpose of providing telecommunication
services (whether basic or cellular), etc.
(1) PREMIUM ON LIFE INSURANCE POLICIES
POLICY CAPITAL DATE ANNUAL
NO. SUM ASSURED OF MATURITY PREMIUM
(2) UNIT LINKED INSURANCE POLICY (ULIP) Rs. __________________________________________________________________________
(3) P. O. CUMULATIVE TIME DEPOSITS 10/15 YEARS Rs.
__________________________________________________________________________
(4) PUBLIC PROVIDENT FUND Rs.
__________________________________________________________________________
(5) NATIONAL SAVINGS
CERTIFICATE VIII ISSUE
PURCHASED BETWEEN
(01.04.2011 TO 31.03.2012) Total amount invested as per following
details:-
DATE OF
PURCHASE CERTIFICATE NO. AMOUNT
(Rs.)
__________________________________________________________________________
(6) INTEREST ON
NATIONAL SAVINGS CERTIFICATE
VIII ISSUES (for
existing holding up to
31.03.12 for 1st 5 years only)
DATE OF PURCHASE CERTIFICATE
NO. PRINCIPAL INTEREST
AMOUNT
(Rs.) AMOUNT (Rs.)
Total Interest Accrued
_________________________________________________________________________
(7) HOUSING LOAN
REPAYMENT (PRINCIPAL ONLY) Rs.
(8) TUTION FEES
PAYMENT (FOR UPTO 2 CHILDREN ONLY) Rs.
(9)
INVESTMENTS MADE UNDER JEEVAN DHARA / JEEVAN AKSHAY PLAN/NSS WHICH WERE MADE PREVIOUSLY UNDER SECTION 80CCA
JEEVAN DHARA Rs.
JEEVAN AKSHAY Rs.
_________________________________________________________________________
(10)
INVESTMENTS UNDER EQUITY-LINKED SAVINGS SCHEME PREVIOUSLY MADE
UNDER SECTION 80CCB (ELSS)
Total amount proposed / Invested Rs.
_________________________________________________________________________
(11)
INVESTMENTS IN EQUITIES / MUTUAL FUNDS OF COMPANIES FOR DEVELOPING,
MAINTAINING
AND OPERATING AN
INFRASTRUCTURAL FACILITY OR
FOR GENERATING POWER
AND TAX SAVINGS
BONDS OF ICICI
/ IDBI ETC.
Rs.
________________________________________________________________________
(12) DEDUCTION UNDER SECTION
80CCC IN RESPECT
OF CONTRIBUTION TO
A PENSION
FUND WITH LIC / UTI / ANY OTHER INS. CO. Section
80CCC Rs.
(Subject to a maximum deduction ceiling of Rs. 1,
00,000/- allowable under section 80C)
_________________________________________________________________________
(C) DEDUCTION
UNDER SECTION 80D IN RESPECT OF MEDICAL INSURANCE PREMIUM
(Subject to
a maximum deduction
of Rs.10,000/- /
Rs.15,000/- p.a.) Rs. _________________________________________________________________________
(D) DEDUCTION
UNDER SECTION 80DD IN RESPECT OF MEDICAL TREATMENT OF
HANDICAPPED
DEPENDANTS
(Subject to
a maximum of
Rs.50,000/- p.a.) Rs. _________________________________________________________________________
(E) DEDUCTION UNDER SECTION 80DDB IN RESPECT
OF MEDICAL TREATMENT OF
WOHLLY
DEPENDANT PARENTS/BROTHERS/SISTERS/SPOUSE/CHILDREN
(Subject
to a maximum of Rs.40,000/- p.a.) Rs.
_________________________________________________________________________
(F) DEDUCTION
UNDER SECTION 80E
IN RESPECT OF
REPAYMENT OF LOAN
FOR HIGHER EDUCATION
(Entire
payment of interest is deductible) Rs.
_________________________________________________________________________
(G) DEDUCTION
UNDER SECTION 80G
IN RESPECT OF
DONATIONS TO CERTAIN
FUNDS, CHARITABLE INSTITUTIONS
ETC.
(Only in
case of 100%
relief like Prime
Minister’s Relief Fund,
etc) Rs. ____________________________________________________________________
(H) DEDUCTION
UNDER SECTION 80U
IN CASE OF
PERMANENT PHYSICAL DISABILITY
(INCL. BLINDNESS)
(Up to a maximum of Rs.50,000/- p.a.
(Rs.75,000/- p.a. for severe disability) Rs.
_________________________________________________________________________
(I) DEDUCTION UNDER SECTION
24(B) IN RESPECT
OF HOUSING LOAN
REPAYMENT (INTEREST ONLY) (Up
to a maximum
of Rs.1,50,000/- p.a.) Rs.
ANY OTHER INCOME AND / OR PREVIOUS SALARY DETAILS Rs.
(Please attach
Statement of Income and / or Form 16 / Salary Certificate of previous Employer
if any)
_________________________________________________________________________
THIS DECLARATION IS
TRUE TO THE
BEST OF MY
KNOWLEDGE. PROOF OF
ACTUAL INVESTMENTS, AS APPLICABLE
SHALL BE PROVIDED
WITH THE SPECIFIED
TIME. I ALSO
DECLARE THAT I
WILL INVEST THE
AMOUNT SPECIFIED ABOVE
WITH IN THE
SPECIFIED TIME.
SIGNATURE……………………………. Date-.…………………
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