THE UNIVERSITY OF BURDWAN

FINANCE DEPARTMENT

Declaration for Availing Exemption and Deduction from Salary for F.Y. 2019-20 (A.Y 2020-21)
for the Purpose of TDS

(1) Full Name:

Mr. /Mrs./Ms. .....................................................................................

P.F. No. ...............................................................................

Department ..................................................................................
Designation ...................................................................

Contact No. ............................................................................ Male / Female...........................................

Email Id ..................................................................................................................

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

(MANDATORY) Please provide Xerox of PAN Card.

Deduction available from salary income under chapter VI A in respect of payment:

Sr. No. Description of Savings/ Expenses Incurred Documents Required Amount in Rs.

1 House Rent Allowance - Sec. 10(13A) and Original Rent Receipts every month (with Revenue Stamp above
rule 2A Rs.4999/-) or Rent Agreement. Receipt should contain PAN of
Landlord if Rent for the year exceeds one Lakh.

2 Contribution to National Pension System Copy of Payment Receipt / Passbook

notified by Central Government-80CCD(1)

3 National Pension System-80CCD(1B) Copy of Payment Receipt / Passbook

4 Mediclaim – 80D (Self, Family & Parents) Mediclaim Policy Copy or Premium Certificate

5 Mediclaim – 80D (Self, Family & Parents Mediclaim Policy Copy or Premium Certificate
Sen. Citizen)
6 Medical Expenditure for Himself, Family, Original Medical Bills
Parents (Sen. Citizen or not) (not having
Mediclaim Policy) -80D
7 Interest on Housing Loan (Loan taken prior Certificate from Bank / Financial Institution
to 01/04/99) -Sec.24(b)
8 Interest on Housing Loan (Loan taken after Certificate from Bank / Financial Institution
01/04/99)-Sec.24(b)
9 Expenditure on Maintainence or Medical Certificate from Prescribed Authority in Rule 11A Form No. 10-IA Sec.
treatment being Dependant with – Disability 80DD
Rs. 75,000 – Several Disability Rs.1,25,000-
80DD
10 Expense on Dependent for Specified Disease Prescription from Prescribed Authority in Rule 11DD Sec. 80 DDB
[Very Sen. Citizen ie., (80 years) Rs 80,000
for others Rs 40,000]-80DDB
11 Person with disability Rs. 75,000 – Severe Certificate from Prescribed Authority as per Rule 11A Form No. 10-IA
disability Rs.1,25,000-80U
12 Donations -Section 80G Receipt from appropriate authority

1
 THE UNIVERSITY OF BURDWAN
FINANCE DEPARTMENT

Declaration for Availing Exemption and Deduction from Salary for F.Y. 2019-20 (A.Y 2020-21)
for the Purpose of TDS

Sr. No. Description of Savings/ Expenses Incurred Documents Required Amount in Rs.

Deduction u/s 80C

1 Public Provident Fund Copy of Payment Receipt / Passbook
2 Life Insurance Premium (beyond salary Copy of Premium Payment Receipt
savings)
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 (upto Two Children) Copy of Payment Receipt from School

8 National Saving Scheme Copy of NSS Certificate/s

9 Tax Savings Fixed Deposit (More than 5 Copy of FD Receipt

Years)
10 Sukanya Samriddhi Account Copy of Deposit Receipt
Any other income/s
1 Savings Bank Interest Copy of Passbook
2 Interest Copy of documents from bank

3 Exam. Remuneration / O.T. / H.A. Etc from Copy of documents from B.U. Or from other institution/s
B.U. Or from any other educational
institution/s.

Please Note:-
1.Deduction under section 80C+80CCC+80CCD(1) limited to Rs 150,000/- ( Section 80CCE)

2. Deduction of Rs. 50,000/- under section 80CCD(1B) is over & above Rs.150000/-.

3. Provided No Deduction under section 80CCD(1B) shall be allowed in respect of the amount on which a deduction has been claimed and allowed u/s 80CCD(1)

4. Deduction u/s 80D shall be allowed only if the payment is made by any mode other than cash. Exception is only for amount paid for Preventive health check
up.
5. Maximum Deduction u/s 80D shall be allowed only upto RS 50,000/- in case point 5 & 7 AND RS 25,000/- in any other case.
6. For Inerest on housing loan:- provided such acquisition or construction is completed within [three] years from the end of the financial year in which capital
was borrowed.

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 informationgiven in the form, I undertake to inform the same to the university. 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 16th December 2019 and if I fail to do so, the University
can make full deduction of income tax dues from January 2020 & February 2020 salary.

Date :

Signature of the Employee