INCOME TAX DECLARATION FOR THE FINANCIAL YEAR April 2016- March 2017

I hereby declare that I will be making the following investments for the year ending 31st March, 2017 You are requested to ta
same into consideration while computing my taxable salary and tax to be deducted at source there from. The necessary pr
investment will be produced by December 31, 2016 and for the remaining months by February 10, 2017

Particulars
Medical allowance
Leave travel allowance (as per policy)
Rent

(Rent is more than Rs. 8,333 per month, Landlord PAN details required)
Address of place in respective of which the rent will be given:
Provide your address

Sec: 80-DD
Handicapped Dependent Exp.
Sec 80-U
Permanent Physical Disability
Sec 80-E
Interest paid on loan for Higher Studies
Sec 80-CCC
Pension Fund
Sec 80-C
(a) Public Provident Fund
(b) Life Insurance Premium (Premium for self, spouse or child)
(c) Unit Linked Insurance Plan of UTI or LIC Mutual Fund
(d) Subscription to NSC - VIII issue
(e) Children education fee (Tuition Fee only)
(f) Infrastructure Bonds

Amount Rs. (P/M)

(g) Repayment of Principal amount on Housing Loan to any Financial Institute

for purchases of house property (House should be completed by 31st March,
2017)
(h) Approved Mutual Funds for I/Tax exemption u/s.80C
(i) Fixed deposit of I/Tax exemption u/s.80C
(j) Others (Pl. specify)
NSC Interest
Interest paid/payable on Housing Loan (House should be completed before 31st
March, 2017)

I certify that I am the owner of the house property mentioned above. The concerned house property in respect of the in
payment/repayment of principal, as stated above, is complete or will be completed within 31st March, 2017

I further certify that I shall indemnify the company for any tax, interest or penalty which may arise due to wrong declaration or n
fulfillment of the declaration made by me.

Signature of the Employee

Emp_Name
Emp_id
PAN No.

**Form 12C (As enclosed) is compulsory to be filled and submitted along with the declaration for availing benefit of the Housin
Loan
Note:
1. Salary Allowances in the nature of HRA, Dress, Lunch, Hot Skill, Medical Subordinate ,LTA etc., are exempt if they actually
by the employee and proof of spending is produced by the employee every month, otherwise they will be treated fully taxable.

rch 2017

7 You are requested to take the

e from. The necessary proof of
017

Amount Rs. (P/A)

15000
50000

120000

50000

operty in respect of the interest

h, 2017

e to wrong declaration or non-

ailing benefit of the Housing

are exempt if they actually spent

ll be treated fully taxable.

FORM NO.12C
(See Rule 26B)
Form for sending particulars of income under section 192(2B) for the year ending
31st March, 2017

Name and Address of the Employee

Permanent Account Number

Residential Status

5
6

Resident in India

Particulars of income under any head of income other than

"Salaries" (not being a loss under nay such head other than the
loss under the head "Income from House Property") received in
the Financial Year 2016-2017
i. Income fro house property (interest paid on housing loan for
the period 01-04-2016 to 31-03-2017)
(In case of loss, enclose computation thereof)
ii. Profits and Gains from Business or Profession income
iii. Income from other sources
(a) Dividends
(b) Interest
Other Incomes (Please specify)
Aggregate of sub-items (i) to (iii) of item 4
Tax deducted at sources (enclose certificate(s) issued under
section 203)

0
0
0
0

Place
Date
Signature
of the
employee
Verification
I, do hereby declare that what is stated above is true to the best of my knowledge and belief.

Place

Date

Signature
of the
employee

Computation of Income/Loss from House property

Asst. Year
Previous Year
Address of Property

Self Occupied/Let Out

(If self occupied Annual Let Out value will be NIL)

Self
Occupied

i. Annual Let Out Value (As received by you from Tenant for the Pd.01-04-2016 to
31-03-2017)
ii. Less: Municipal Tax Paid (if any)
(iii) Net Annual Value from House Property
Less:
(iv) Repairs Allowed - 30% of Net Annual Value
(a) Interest paid/payable on Housing Loan (From April 2016 to March 2017)
(maximum Allowed Rs.2,00,000/- in case of self occupied property and constructed
with borrowed capital after 31st March, 1999, otherwise maximum allowed
Rs.30000)
(b) 1/5th of interest paid before possession
(v) Total interest paid till 31st March, 2017 (a+b)
(vi) Income/Loss from House Property (iii-iv-v)

Note: This is a suggested computation sheet for income under the head House Property which may vary
from case to case based on the actual circumstance