IT Declaration Form 2012 13 by FW4vj0b5

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									        Employee's Income Tax Declaration Form for the Financial Year 2012-13
        Name:                                                                                                         PAN No:
        Designation                                                                                                   Gender:
        Department                                                                                                    DOB
        DOJ:                                                                                                          Email
        Work Permit
                                                                                                                      Contact No.

           S. No.                                             DESCRIPTION                                                   Rs.
                                                                                                                                        Investment Date
                       Particulars of Income from sources other than salary from the NIT Raipur
               1      Dividends
               2      Interest
               3      Other Incomes (specify)
                                                       Total Earnings                                                               0
               B      Income from House Property
                      Annual Value of House Property (As Per Income Tax Act)
                      (I) Standard Deduction (as per Section 24(1)
                      (II) Interest on Housing Loan - as per Section 24(2) (for Tax Exemption - Self
                      Occupied Property acquired /constructed before 01-04-1999 - Rs.30,000 elgible & Self Occupied
                      Property acquired /constructed after 01-04-1999 - Rs.150,000 eligble)

                      a. Amount of Interest for the F.Y. 2012-13
                      b. Amount of Interest for Pre-Contruction Period (as per Income Tax Rule)
                      Total Income from House Property                                                                              0
               C      HRA: RENT PAID PER MONTH ( Please mention the starting and ending month)                        Rent (p.m.)

                                                        Total Rent Paid (per annum)
               D                INVESTMENTS U/S 80C, 80CCC, 80CCD capped at Rs 1 Lac
                1     Provident Fund (PF)
                2     Employees Contribution under New Pension Scheme
                3     Public Provident Fund
                4     Contribution to Certain Pension Funds
                5     Housing Loan Repayment Principal (payable in F.Y. 2011-12)
                6     Insurance Premium (including GIS contribtuion)
                7     Term Deposit with Schedule Bank
                8     National Saving Scheme / Certificate
                9     Mutual Fund
               10     Children Education Expenses / Tuition Fees
               11     Others, (Please specify if any)
                         Total Investments U/S 80C - limited to Rs 1,00,000/- only                                                  0
               E                          OTHER PERMITTED DEDUCTIONS
                      80D - Medical Insurance Premium (Maximum Rs. 15,000
                      (Rs. 20,000 for senior citizens
               2      80DDB - Expenditure on Medical Treatment for specified disease
               3      80E - Repayment of Interest against Educational Loan
                      80G - Donations (only for Prime Minister’s National Relief Fund, the Chief
                      Minister’s Relief Fund or the Lieutenant Governor’s Relief Fund)
               5      80GG - Rent Paid but not in Receipt of HRA
                      80U-Permanent Physical Disability (Normal Rs. 50000/- and Severe
               7      Others - (Please specify if any)
                                              Total Deductions                                                          0
               F                            PREVIOUS EMPLOYMENT SALARY                                      Salary Paid       TDS (in Rs.)
                      If Yes, Form 16 from previous employer or Form 12 B attached
        I, do hereby declare that investment(s) proposed will be completed on or before the proposed date and proof of investment(s) will
        be submitted by 05th February, 2013. Further, incase of any change in above declaration, I would revise it and inform the
        insitute immediately. I shall indemnify the institute for all cost and consequences if any information is found to be incorrect.

Date:                                                                Page 1 of 10                                      Name with Signature of Employee
        1. The date of Investments must be between 01-04-2012-31.03.2013.
        2. Deduction u/s 10(13A) for HRA is available only where employees have actually paid the rent. Original rent receipts may be retained at your en
        3. Declaration should have PAN Number. Those who do not have PAN are requested to apply for it immediately and mention 'NOT FURNISHED
        4. Income Tax Slabs for the Year 2012-13 (Assessment Year 2013-14)
                        Slab                                                                                  Rate
                        Rs. Nil to 2 Lacs (For Woman below 65 years limit is 2 Lacs
                     I.                                                                                          Nil
                        For Senior Citizens limit is 2.50 Lacs)
                    II. Above 2.00 Lacs to Rs. 5.00 Lacs                                                       10%
                   III. Above 5.00 Lacs to 10.00 Lacs                                                          20%
                  IV. Above 10.00 Lacs                                                                         30%

Date:                                                        Page 2 of 10                              Name with Signature of Employee
        Proof Document Required

        Appropriate Certification

        Certificate & Receipts

        Bank Certificate

        copies of rent receipts / L&L Agreement

        No proof document required
        No proof document required
        Receipts / Statement
        Bank Certificate
        Receipts / Statement, No Proof submission required for GIS
        Certificate / Acknoledgement
        Certificate / Copy of vouchers
        Certificate / Receipts

        Receipt / Statement
        Form 10-I + expense vouchers
        Bank Certificate
        Form No.10BA + Receipts

        Form 12 B from previous employer

Date:                                             Page 3 of 10       Name with Signature of Employee
ent. Original rent receipts may be retained at your end while xerox copies can be provided to Main Office
 y for it immediately and mention 'NOT FURNISHED'

                Date:                                                          Page 4 of 10                 Name with Signature of Employee
Date:   Page 5 of 10   Name with Signature of Employee
Date:   Page 6 of 10   Name with Signature of Employee
Date:   Page 7 of 10   Name with Signature of Employee
                                                                                                     FORM NO. 12B
                                                                                                      [See rule 26A]
Form for furnishing details of income under section 192(2) for the year ending 31st March,_______
Name and address of the employee
Permanent Account No.
Residential status
                                                                                 Particulars of salary as defined in section 17, paid or due to be paid to the                                 Total amount
                                                                                                           employee during the year                                   Amount deducted in
                                                                                                                                                                                                   of tax
                                                                                                       Total amount of house rent                                         respect of life
                              TAN of the         Permanent                                                                                                                                       deducted
               Name and                                                                                  allowance, conveyance       Value of perquisites   Total of   insurance premium,
                             employer(s) as       Account         Period of                                                                                                                     during the
   S.No        address of                                                         Total amount of         allowance and other           and amount of      columns 6,     provident fund                       Remarks
                             allotted by the   Number of the     employment                                                                                                                    year (enclose
              employer(s)                                                         salary excluding      allowances to the extent    accretion to employee's 7, and 8  contribution, etc., to
                                   ITO          employer(s)                                                                                                                                      certificate
                                                                                 amounts required     chargeable to tax[See section provident fund account               which sec. 80C †
                                                                                                                                                                                               issued under
                                                                                   to be shown in    10(13A) read with rule 2A and (give details in the               applies (Give details)
                                                                                                                                                                                               section 203)
                                                                                 columns 7 and 8             section 10(14)]             details in the
     1             2                3                4                 5                  6                         7                           8               9               10                  11           12

† With effect from 1-4-1991, section 80C has been replaced by section 88.                                                                                             Signature of the employee

I,______________________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the_____________________day of______________________
Place                                                                                                                                                                 Signature of the employee
                                                                                           [See column 8 of Form No. 12B]
                                                         Particulars of value of perquisites and amount of accretion to employee's provident fund account
Name and address of the employee
Permanent Account No.
Period : Year ending 31st March,_______________
                                     Value of rent-free accommodation or value of any concession in rent for the accommodation provided by the employer (give basis of computation)[See rules 3(a) and 3(b)]
                                                                                                       Where accommodation is furnished
                                                                                                                                                                                                                   Value of
                                                                                                                                                                                                                 (column 3
 Name of
             TAN/PAN of                       Value as if                                                                                                                                                           minus
   the                           Where                        Cost of furniture (including television sets, radio sets, refrigerators,   Perquisite value of furniture (10%                        Rent, if any,
             the employer                   accommodatio                                                                                                                      Total of columns 4                  column 8
 employee                   accommodation                               other household appliances and air-conditioning                     of column 5) OR actual hire                            paid by the
                                                 n is                                                                                                                                and 6                       or column
                             is unfurnished                    plant or equipment) OR hire charges, if hired from a third party                   charges payable                                   employee
                                             unfurnished                                                                                                                                                           7 minus
                                                                                                                                                                                                                  column 8
                                                                                                                                                                                                                  as may be
     1             2               3                4                                            5                                                       6                            7                 8             9

                                                                                                                                                                                           credited to the
                                                                              Remuneration paid                                     Estimated value of any other                               assessee's
                                                                                                                                                                            Employer's                      Total of
                                                                               by employer for Value of free or concessional benefit or amenity provided by the                               account in
                                                                                                                                                                         contribution to                   columns 9
           Whether any conveyance has been provided by the employer free or domestic and/or       passages on home leave and          employer, free of cost or at                            recognised
Name of                                                                                                                                                               recognised provident                   to 15
           at a concessional rate or where the employee is allowed the use of personal services other travelling to the extent    concessional rate not included in                        provident fund
  the                                                                                                                                                                fund in excess of 10%                 carried to
           one or more motor cars owned or hired by the employer, estimated     provided to the chargeable to tax (give details)     the preceding columns (give                             in excess of
employee                                                                                                                                                                of the employee's                  column 8
                    value of perquisite (give details) [See rule 3(c)]          employee (give [See rule 2B read with section         details), e.g., supply of gas,                        the rate fixed
                                                                                                                                                                      salary [See Schedule                  of Form
                                                                               details) [See rule          10(5)(ii)]             electricity or water for household                       by the Central
                                                                                                                                                                           IV - Part A]                     No. 12B
                                                                                     3(g)]                                       consumption, free educational faci                          Government
                                                                                                                                                                                           [See Schedule
                                                                                                                                                                                             IV - Part A]

    1                                     10                                          11                       12                               13                            14                 15           16

Name of Employee                                                                                                                                                    Signature of the employee

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