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Income Tax Declaration Form1

This document is an income tax declaration form for the 2010-2011 financial year. It requests information such as the employee's name, account number, gender, and details of any rent paid if living in a rented accommodation. It also requests details of deductions that can be claimed under Chapter VI A of the income tax act, including deductions for investments, medical expenses, tuition fees, donations, and disability. The form additionally requests details of other income, earnings and deductions from any previous employer, and requires the employee's signature and date.

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Surendra Raju
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63 views

Income Tax Declaration Form1

This document is an income tax declaration form for the 2010-2011 financial year. It requests information such as the employee's name, account number, gender, and details of any rent paid if living in a rented accommodation. It also requests details of deductions that can be claimed under Chapter VI A of the income tax act, including deductions for investments, medical expenses, tuition fees, donations, and disability. The form additionally requests details of other income, earnings and deductions from any previous employer, and requires the employee's signature and date.

Uploaded by

Surendra Raju
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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INCOME TAX DECLARATION FOR THE FINANCIAL YEAR 2010- 11

Employee Name Permanent A/c No. (PAN)


Employee No. Gender

If staying in rented accomodation, please give details of rent paid


Month Amount (Rs) Month Amount (Rs)
April-10 October-10
May-10 November-10
June-10 December-10
July-10 January-11
August-10 February-11
September-10 March-11

DEDUCTIONS UNDER CHAPTER VI A


Particulars Amount (Rs)
1. Section 80C
Pension Plan U/s 80CCC
Life Insurance premium of self or dependants
Employee Provident Fund
Public Provident Fund
National Savings Certificate (NSC)
Accrued interest on NSC Investment
Unit linked insurance plan of LIC / UTI
Annuity plan of LIC
Housing Loan repayments (Principal only)
Tuition Fees towards full-time education of any 2 children of assessee
Investment in units of notified mutual funds
2. Other Deductions U/c VI-A
Mediclaim Insurance U/s 80D
Medical treatment of dependent with disability U/s 80DD
Medical treatment of assessee for specified ailments or diseases U/s 80DDB
Repayment of interest on Educational Loan U/s 80E
Donations for charitable purposes U/s 80G
Deductions for disability U/s 80U

Note: The aggregate amount of deduction under Section 80C is restricted to Rs.1,00,000/-. The quantum of
deductions available under other Sections are as under:

80D Rs.20,000/-, condition being that the payment of premia has to be made by cheque
80DD Rs.50,000/- for 'ordinary' disability and Rs.75,000/- for 'severe' disability
80DDB Rs.40,000/-
80E The entire amount of interest is deductible without any limit
80G The quantum of deduction depends on the type of donee.
80U Rs.50,000/- for 'ordinary' disability and Rs.75,000/- for 'severe' disability

OTHER INCOME / LOSS


Particulars Amount (Rs)
1. Interest on Housing Loan, if any, in case the property is self-occupied
2. If the property is let out, net rental income ( Attach computation of rental
income separately)
3. Any other Income

EARNINGS & DEDUCTIONS FROM PREVIOUS EMPLOYER


(Applicable only for those employees who join during the financial year, i.e after April 1, 2010)

Particulars Total amount


(Rs)
Earnings
Basic Salary
House Rent Allowance (HRA)
Conveyance
Medical Reimbursement
Other Allowances
Taxable value of perquisites
Deductions
Employee Provident Fund (EPF)
Professional Tax (PT)
Income Tax (TDS)

Notes:
1. Copy of Form 16 or Form 12B must be enclosed, if salary has been received from any
other employer during the year
2. Necessary documents in support of the above investments / declarations must be furnished
not later than February 15, 2011. In the event of non-submission of proof of investment within the
stipulated time, income tax will be deducted as applicable.

Name:
Date: (Signature)

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