Investment Declaration Form for FY 2019-20

NAME EMP NO
GENDER PAN (Mandatory)
DOB DOJ
Amount declared by
you in the Declaration
S.NO. PARTICULARS Remarks form Please Fill in

1 Rent Paid / Payable for: AMOUNT RS. (Metro / Non Metro)

April-19
May-19
June-19 Please enter your Monthly Rent
details as per the Rent Receipt /
July-19 Lease Deed.
August-19
Note:-
September-19 If the Employee is paying the
October-19 rent below Rs.3000/- per month,
he/she need not furnish the Rent
November-19 Receipts (Circular No:8/2007 Dt:
December-19 05.Dec.2007).
If Rent paid more than Rs. 1Lac
January-20 per annum, furnishing of
February-20 Landlord PAN is mandatory
March-20

TOTAL 0
S.NO. PARTICULARS MAXIMUM LIMIT (RS.) AMOUNT RS. REMARKS
Interest on Housing Loan u/s 24
(If the house is self occupied and the loan was Max Limit - Rs. 2,00,000/- Provisional Certificate issued by the Banker showing the
taken on or after April 1999). (If Self Occupied) Interest Part
Bankers Certificate to be submitted

2 Interest on Housing Loan u/s 24 Rental Income for the Period April 2019 - March 2020
(Let out/ Deemed to be let out)
Bankers Certificate to be submitted
[if the property is LET OUT - Rental Income Max Limit - Rs. 2,00,000/- Municipal Taxes PAID by the owner (employee) during the
need to be specified] (If Let Out) financial year

S.NO. PARTICULARS MAXIMUM LIMIT (RS.) AMOUNT RS. REMARKS

Medical Insurance Premium PAID by Employee:

- on the health of employee, spouse, and dependent
children.
Rs. 25,000/- (or) Rs.50,000/- [Rs.50,000/- In case employee is a Senior Citizen] (i.e.,
60 years or more).

Sec 80D (Medi Claim Policy & Preventive health Additional Amount of Rs.25,000/-
3 Medical Insurance Premium PAID by Employee on the
check up) health of parents (even not dependent on employee) .
[Rs.50,000/- In the case parents are Senior Citizen]i.e., 60
years or more
Rs. 25,000/- (or) Rs.50,000/- payment made by an employee for preventive health check-
up of parents during the financial year is eligible for
maximum deduction of Rs 5000.
Note:
The amount paid is within the overall limits ( Rs. 25000/Rs.
50000).

Here Employee gets fixed amount of deduction.

Sec 80DD (Maintenance including Medical Rs. 75,000/- (Rs.1,25,000/- for If employee has incurred any expenditure / deposited in
4 specified policy.
treatment of dependant person with disability) Severe disability) (Form 10-IA obtained from Medical Authority (Government
Hospital) has to be submitted)

Here Employee gets deduction:

Lower of the following:
Sec 80DDB (Medical treatment for specified Rs. 1,00,000/- i). Amount incurred or
5 ii). Maxmimum Rs.1,00,000/-
diseases or ailments) - Self / Dependents
(Form 10-I obtained from Medical Authority has to be
submitted)

Interest on Loan taken for Higher Education:

Amount paid by employee during the financial year on loan
taken for higher education of
No limit - Employee, spouse or children of employee or students for
6 Sec 80E (Education Loan) whom employee is a legal guardian
(only Interest Portion)
Benefit Period:
Current Period + Next 7 years

Rs.50,000/- (Rs.1,00,000/- for Here Employee gets fixed amount of deduction.

7 Sec 80U (For person with a disability) (Form 10-IA obtained from Medical Authority has to be
Severe disability) submitted)
 Amount declared by
you in the Declaration
S.NO. PARTICULARS MAX BENEFIT PERMISSIBLE (RS.) form REMARKS

AMOUNT Rs.
8 Life Insurance Premium Self , Spouse & Children only
9 Public Provident Fund (PPF) Self , Spouse & Children only
10 Pension Fund Contribution Self only
11 National Savings Certificate (NSC) Self only
12 Interest Accrued on NSC (Reinvested) Self only
13 Unit Linked Insurance Policy (ULIP) Self , Spouse & Children only
Equity Linked Savings Schemes (ELSS) - Mutual
14 Funds Self only
Maximum amount eligible for
Payment of Tuition fees for Children (Max 2 Deduction under section 80C &
Children) the university must be situated in 80CCC Categories is
India. It can be affiliated to any foreign Rs.1,50,000/-
15 university Two children only
16 Principal repayment of Housing Loan Self & Joint a/c holder
Registration charges incurred for Buying House
17 (I year Only) Self only
Bank/Post office Term Deposit for
18 5years & above Self only
19 Sukanya Samridhi Scheme Self only
20 Others(Please specify as per IT Act) Self only

TOTAL -
Max. amt eligible u/s 80CCD
21 NATIONAL PENSION SCHEME - (1b) Rs. 50000/-

S.NO. PARTICULARS AMOUNT

a) Interest Income from Savings A.c (Banks &

22 Post office only)
b)
c)
d)

S.NO. PARTICULARS AMOUNT

Income From Previous Employer (Joined after

23 01/04/2018)
a) Income after exemptions
b) Provident Fund (PF) Form 16 or Tax computation from previous employer should
c) Professional Tax (PT) be furnished

d) Tax deducted at source (TDS)

I here by
declare that
Information
as stated
above is true
and correct . I
undertake to
submit all the
Investment
Proofs and
Rent Receipts
(if any) on or
Date:
before 31st
December,
Place: Signature of the Employee
2019. I also
authorize the
company to
recover tax
(TDS) from
a)my Date
salaryof actual possession of property
based on the
PROOFS can be validated by 'Possession Certificate' issued by builder/municipal authorities etc.]
[which
Submitted by
me. I am
b)personally
Amortisation of pre-construction period interest (if any) incurred
[which
liable to needs to be considered during Current FY 2019- 20] (Amount)
Income Tax
proceedings
c) Information
for any towards the House Property (LET OUT ) - In case of more than 1 Let out House Property
misstatement
% of
s in the
Owner
declaration House Property
orShip
proofs
submitted
Muncipal
herewith if Rental Income Per Principal portion paid in the
they are Taxes Per
i) House Property 1 Annum Financial Year
inconsistent Annum
with the ii) House Property 2
requirement
of Income
Tax Act,
1961.
Guidelines to FILL

1. Metro City Mumbai / Delhi / Calcutta / Chennai

2. All the supporting
Mumbai
document
/ Delhi
should
/ Calcutta
be submitted
/ Chennaiby the end of 31st Dec-19

3. All the HRA Bills / Medical Bills / LTA Bills / Provisional Loan Certificate for House from Banker - should be ORIGINAL

4. Provisional Loan Certificate for House from Banker - should be submitted in respect All the properties declared by employee in the above table
5. As per the provisions of the Income Tax Act 1961 - HRA Exemption will not be provided, if the Employee is staying at his SELF OCCUPIED House Property

[if the Employee has claimed BOTH HRA & Interest on Self Occupied HP - For Tax Declaration ONLY one among them will be considered]

6. In case of Self Occupied / Let Out House Property the Employee has to mention the "Interest on Housing Loan" / "Principal repaid Amount"

Please mention - Full amount of "Interest" / "Principal" along with the % of Owner ship