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Income Tax declaration for the Financial Year 2012-2013

Sl.No Description DeclarationAmount

1 Income from House Property - Use Negative sign for Loss

2 Interest payable on housing loan - Self Occupied

a Loan taken prior to 1 April, 1999 - Upto Rs.30,000/-

b Loan taken on or after 1 April, 1999 and acquisition / construction completed within 3 years from the end of Financialyear in which capital was borrowed- Upto Rs.150,000/-

3 Income from Other Sources, if any (Please specify)

4 Deduction under Chapter VI A

a (u/s.80 D) Medical Insurance Premium paid for self/spouse and dependent children (Upto Rs.15,000)

b (u/s.80 D) Additional Medical Insurance Premium paid for parents(Upto Rs.15,000. In case either of the parents is aSenior Citizen upto Rs.20,000)

c (u/s 80DD) Expenditure on medical treatment / Payment under specified schemes of LIC/UTI of benefit of Handicappeddependent. Upto Rs.50,000/- (Rs.1,00,000/- in case of severe disability)

d (u/s.80E) Deduction in respect interest on Education Loans for pursuing higher studies

e (u/s.80U) Exemption for physically handicapped (self) Rs.50,000.(Rs.1,00,000 in case of severe Disability)

f (u/s.80DDB) Medical Expenses incurred for specific Disease

5 (I) Deduction under Section 80C - Upto Rs.100,000/- (Including PF/VPF contribution)

a Insurance Premium Payable for self/spouse/children

b NSC Investments in National Savings Certificates

c PPF Deposit in Public Provident Fund

d MF Investment in notified Mutual Funds

e ELSS Investment in notified Equity Linked Saving Schemes

f ULIP Contribution to Unit Linked Insurance Plan

ees Children Education uition ees Ex enses Max of 2 Children

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ees Children Education uition ees Ex enses Max of 2 Children

Sl.No Description Rent Amount

1 Rent of April

2 Rent of May

3 Rent of June

4 Rent of July

5 Rent of August

6 Rent of September

7 Rent of October

8 Rent of November

9 Rent of December

10 Rent of January

11 Rent of February

12 Rent of March

** I hereby declare that the information given above is correct and true in all aspects.

** I understand that the eligibility to deductions under Chapter VI - A and investment/expenditure u/s.80C is based on estimatedprojections which I will confirm with documentary evidence before 31 st December 2012

** I hereby undertake, agree and confirm that I shall be fully responsible for any income tax liability that may arise if this declaration isfound incorrect in any manner.

**I understand that no refund of excess tax, if any, deducted from my salary will be made to me by the company under anycircumstances and that any such refund will have to be claimed by me in my Tax Return, to be filled by me with the Income-taxauthorities.

Sl.No Accrued Interest Workings Int. Rate NSC Value Interest Amt

1 N S C - Purchased during 01-04-07 to 31-03-08 11.17

2 N S C - Purchased during 01-04-08 to 31-03-09 10.33

3 N S C - Purchased during 01-04-09 to 31-03-10 9.55

4 N S C - Purchased during 01-04-10 to 31-03-11 8.83

i

Acc. Int NSC - Accrued Interest

j Fixed/Term Deposit with Nationalised Bank/Post Office under tax saving scheme. (Minimum 5 years)

k 80CCC - Insurance Premium Payable for Pension Scheme

6 No of Children

7 Previous Employment Salary Details

a Salary - Salary after section 10

b TDS Income Tax Deducted

c PF Provident Fundd PT Professional Tax

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5 N S C - Purchased during 01-04-11 to 31-03-12 8.16