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INCOME TAX DECLARATION FORM - F.Y.

2020-21
(To be used to declare investment that will be made during the period from 01/04/2020 to 31/03/2021 for Income Tax purpose)

Company Name Emp ID


PAN of Employee
Employee Name
(compulsory)

Date of Birth

As per section 206AA, in case PAN is not submitted, TDS will be deducted at flat rate of 20%

ITEMS PARTICULARS MAXIMUM LIMIT DECLARED AMOUNT


DEDUCTION U/S 10
City Name

METRO /
HOUSE RENT
I am staying in a rented house and I agree to submit Leave & NON METRO _________________
Licence A'ment when required.The Rent Paid is (Rs. _____________ X _______
months) & the house is located in a METRO / NON METRO (Tick whichever is applicable)

Max Limit Declared Amount


Standard Deduction Standard Deduction is allowed to all 50,000.00
Sec 80D - Medical Insurance Premium (If the policy covers a senior
50,000.00
citizen then exemption is Rs.50,000/-)
Sec 80DD - Handicapped Dependent 75,000.00

Sec 80E - Repayment of Loan for higher education (only Interest) -


DEDUCTION UNDER
Sec 80GG - Rent Paid -
CHAPTER - VI A
Sec 80U - Handicapped 75,000.00
Sec 80CCG - Rajeev Gandhi Equity Saving Scheme
(Investment max upto Rs.50,000, would get a deduction of 50% on
the amount invested) -
Sec 80TTA - Interest on saving a/c 10,000.00
Any other Deduction (Please specify)
Max Limit Declared Amount
Contribution to Pension Fund (Jeevan Suraksha) 1,50,000.00
Life Insurance Premium on life of self/spouse/child only 1,50,000.00
Deferred Annuity 1,50,000.00
Public Provident Fund in own name/spouse/child only 1,50,000.00
ULIP of UTI/LIC in own name or spouse and child only 1,50,000.00
Repayment of Housing Loan (Only principal) 1,50,000.00
Contribution to Pension Fund or UTI or Notified Mutual Fund 1,50,000.00
DEDUCTION U/S 80C
Investment in ELSS made in units of Notified Mutual Fund 1,50,000.00
Children Tuition Fee: Restricted to a max of 2 Children 1,50,000.00
Deposit in home loan account scheme of NHB/HDFC 1,50,000.00
5 yrs. Term deposit in a Sch.Bank 1,50,000.00
Others (please specify) 1,50,000.00
Others (please specify) 1,50,000.00
DEDUCTION U/S 80CCC Annuity/Pension Plan 1,50,000.00
DEDUCTION U/S 80CCD Notified Pension Scheme 1,50,000.00

Max Limit Declared Amount

DEDUCTION U/S 24 Interest on Housing Loan on fully constructed accomodation only

DECLARATIONS:
1. I hereby declare that the information given above is correct and true in all respects. I am also aware that the company will be considering
the above details in utmost good faith based on the details provided by me and that I am personally liable for any consequences arising
out of errors, if any, in the above information.

2. I am also aware that any person making a false statement / declaration in the above form shall be liable to be fined and prosecution u/s
277 of the Income Tax Act, 1961
3. The proof of payment / Supportings for claim, will be provided latest by _________________

Note -

Date :
Place: SIGNATURE OF THE EMPLOYEE
Income Tax Slab For Financial Year 2018-19 (BOTH FOR MAN & WOMAN)
Income Slab
Income up to Rs. 2,50,000.00 5%
Income up to Rs. 2,50,001.00 to Rs.5,00,000 20%
Income up to Rs. 5,00,001 to Rs.10,00,000.00 30%

Cess 4% on Total of Income Tax + Surcharge

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