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Name: PAN Employee Id N F Other Income Actual Total Limited 1 2 3

This document appears to be an employee tax form that collects information such as name, employee ID, gender, income sources, deductions, investments, and housing/rent details. It requests information on topics like senior citizen status, medical insurance, education loans, charity donations, permanent disability, business/profession profits, company accommodation, city population, disability status, vehicle size and rent/housing loan details.

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vinoddeswal057
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38 views2 pages

Name: PAN Employee Id N F Other Income Actual Total Limited 1 2 3

This document appears to be an employee tax form that collects information such as name, employee ID, gender, income sources, deductions, investments, and housing/rent details. It requests information on topics like senior citizen status, medical insurance, education loans, charity donations, permanent disability, business/profession profits, company accommodation, city population, disability status, vehicle size and rent/housing loan details.

Uploaded by

vinoddeswal057
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Name: EMPLOYEE ID Are you a senior citizen (age above 65 years)?

(Y or N) Male or Female Other income 1 Previous Employer Taxable Salary Interest on Self Occupied House loan (for tax exemption) Other income (interest, etc.) Deductions under Chapter VI-A Medical Insurance Premium (sec 80D) Medical for handicapped dependents (Sec 80DD) Medical for specified diseases (Sec 80DDB) Higher Education Loan Interest Repayment (Sec 80E) Donation to approved fund and charities (sec 80G) Donation to Scientific Research or Rural Development (sec 80GGA) Deduction for permanent disability (80U) Infrastructure Bonds under Section 80CCF Total Deductibles Deductions under Chapter VI-A Section 80C Dedn under Pension scheme NSC Public Provident Fund Employees Provident Fund & Voluntary PF Children's Education only Tution Fees Housing loan principal repayment, Stamp Duty, Registration Fees Superannuation Fund Equity Linked Approved Mutual Funds Approved ULIP under Section 10(23D) Deposit in National Housing Bank Deferred Annuity Scheme Insurance premium Fixed Depostits for period more than 5 Years Others Total Investments 6000 24000 Actual Actual 0 Actual 2 N F

PAN

Total 3 0 0 0 Total 0 0 0 0 0 0 0 0 Produced 0 0 0 0 0 0 0 24000 0 0 0 6000 0 0

Limited 0 0 0 Limited 0 0 0 0 0 0 0 0 0 Limited 0 0 0 0 0 0 0 24000 0 0 0 6000 0 0 30000

Name: Signature Date:

For Housing Loan House self-occupied? (Y or N) Loan taken after Apr 1, 1999? Miscellaneous Sr. citizen included in medical insurance premium? (Y or N) Sr. citizen included in medical treatment u/s 80DDB? (Y or N) Have permanent physical disability? (Y or N) Do you have Profits & Gains from Business or Profession? (Y or N) Do you live in Company provided accommodation? (Y or N) If living in Co. acco, is population of your city > 4 lacs? (Y or N) Are you a Person with Disablity? (Y or N) Vehicle cubic capacity > 1600cc? (Y or N) N N N N N N N N Y N

House Rent Allowance (HRA) HRA April May June July August September October November December January February March Total Gross Rent Paid 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 2000 24000 24000

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