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 31stMarch, 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-.…………………