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James - Payroll Declarations

The document is a payroll-related form requiring personal details, bank account information, and FBP declarations for an employee named K James. It includes sections for various allowances such as HRA, conveyance, medical, and leave travel, as well as a medical insurance registration form for dependents. The form specifies that dependents can only include a spouse and children, with a maximum of three additional dependents.

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Savitri Shrivastava
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11 views2 pages

James - Payroll Declarations

The document is a payroll-related form requiring personal details, bank account information, and FBP declarations for an employee named K James. It includes sections for various allowances such as HRA, conveyance, medical, and leave travel, as well as a medical insurance registration form for dependents. The form specifies that dependents can only include a spouse and children, with a maximum of three additional dependents.

Uploaded by

Savitri Shrivastava
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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EXCELCULT

Payroll Related
01. Please PRINT or type in each column
02. Please x in the wherever applicable

A. Personal Details

First Name K Last Name James


Date of Birth 10-08-1992 Emp. No.
Nationality : Indian Department:
AADHAAR
PAN Number: WQVPA7XXXX 102034164XXX
Number:
Gender Male Mobile 765778678
Name of Bank Citi Bank
Branch M.G Road
Bank Account Details
Account Number 95530XXXX
IFSC Code CITI000XXXX

B. FBP Declaration (All Amounts ANNUAL in INR): Total FBP


Amount:

Component Comments Employee Allocated Amount

HRA/ CLA

Vehicle Maintenance Allowance only if


mentioned in Offer. INR 1800 if
Conveyance/ Vehicle
<=1600cc or INR 2400 per month if
Maintenance
>1600cc
Conveyance: INR 1600 per month

Medical Allowance Max: INR15000 per annum

Leave Travel Allowance

HRD, Version 1.0 1


EXCELCULT

Medical Insurance Registration Form

Please include the following individuals* under the Company medical insurance scheme.

Relationship
Date of
Dependent Name with the
Birth
Employee
DEPENDENT 1

DEPENDENT 2

DEPENDENT 3

DEPENDENT 4

DEPENDENT 5

*Dependents can only be a Spouse/ Children (Self+ 3)

(Please check with us for the dependent parent medical insurance scheme).

HRD, Version 1.0 2

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