8/3/2019 Investment Income Declaration Form

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Sr No.1

2

3

4

5

6

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1

2

1 Interest on housing loan repaid during the year

1

(i) Income from house property

(in case of loss, enclose computation thereof)

(a) Rent from Property

(In case any change is expected during

the year please provide info. for the same)

(b) House Tax

(ii) Income from other sources

(a) Dividends

(b) Interest

(c) Other incomes

2 Aggregate of sub-items (i) to (ii) of item 1

3 Tax deducted at source (enclose certificate issued under section 203)

SECTION 80G - Donation to certain funds

SECTION-II

INVESTMENT PROFILE

SECTION 80C

Amount (In Rs.)

Location of Property taken on Lease / Rent

CONTACT NO. (MANDATORY)

E-MAIL ID

Rent [Per Month]

LIC Premium

PPF

NSCs

Interest on NSCs

SECTION 80E - Interest on Education Loan

SECTION 80U - Deduction in respect of Disability

SECTION 80CCC

ULIP

ELSS

Notified Mutual Fund

Infrastructure Bonds

SECTION-IV

DECLARATION FOR THE PURPOSE OF DEDUCTION U/S 24 OF INCOME TAX ACT, 1961

(HOUSE RENT PAYMENT (Relief provided against sumission Lease agreement, Proof of ownership such as copy of

share certificate issued by Co-op Hsg. Society or Copy of Property Tax Bill of Copy of Monthly Society Charges Bill).

If Rent Lease Agreement is not available, please attach Rent Self Declaration & Declaration from Landlord. Please

Mention No. of Months rent payable during April 200 to March 200 . Montly Rent________ No. of Months ______

Child Education Fees - Tuition Fees for full time education to Indian School, University

Term Deposit for a fixed period of not less than 5 years with a Scheduled Bank

5 Years Term Deposit under Post Office Term Deposit Rules

Amount (in Rs.)

Notified Annuity Plan of LIC or any other Insurer (New Jeevan Dhara, New Jeevan Dhara-

I, New Jeevan Akshay, New Jeevan Akshay-I and New Jeevan Akshay-II)

SECTION 80DD

SECTION-III

DECLARATION OF RENT FOR THE PURPOSE OF EXEMPTION U/S 10(13A)

Maintenance Including Medical Treatment Of Handicapped Dependent

Principal on Housing Loan (including stamp duty, registration fees & other Expensesincurred for the purpose of transfer of property

Pension Scheme InvestmentSECTION 80D

Medical/Health Insurance Premium

Deposit in account under the Senior Citizens Savings Scheme Rule 2004

CPF/ GPF/ LIC (Salary Saving Scheme)

SECTION-V

PAN NO. (MANDATORY)

DATE OF JOINING (REQUIRED ONLY IF JOINED ON OR AFTER 1ST APRIL 200 )

INVESTMENT & INCOME DECLARATION FORM

EMPLOYEE CODE (MANDATORY)LOCATION

SECTION-I

FOR THE FINANCIAL YEAR 200 - 200

(To be filled in only if the employee wishes to furnish any other income (including loss under house property) other than salary

income.

Form for sending particulars of Income under section 192 (2B) read withrule 26B for the year ending 31st March, 2008

Particulars of Income under any head of Income other than Salaries (not being loss under any such head other than

the Loss under the head "Income from house property) received in the financial year.

ADDRESS

PERSONAL INFORMATION

NAME OF THE EMPLOYEE

Description

DECLARATION

With Best Regards,

CA Rakesh Sadashiv Devadiga

8/3/2019 Investment Income Declaration Form

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(Signature of Employee)

Place

Date

I,do hereby declare that the aforesaid information is true and correct to the best of my information and belief and I shall

indemnify the company against all costs and consequences if any information is later on found to be incorrect.

With Best Regards,

CA Rakesh Sadashiv Devadiga