Reckitt Benckiser (India) Ltd

Investment Proofs Submission Form for the Year 2011-2012

IPSF ID : 0044100578 Gender * F

Employee 069736 ID *

Date of 01/07/2 Joining 010 No. of Children going Name * Anuradha Bhawal 0 to School * No. of Children going PAN * ALZPB2990C 0 to Hostel * Section A - Rent Paid for claiming HRA exemption (Only Original Rent Receipts will be considered) PAN of From To Date Address Rent Paid Per Month Landlo Date rd A-201, Kunti Park, Military Rd., Marol, 01/04/201 31/08/2011 Andheri 4750.00 1 (E),,MUMBAI,MAHAR ASHTRA No.40, 1st Main, 1st Cross, Konena Agrahara, 01/09/201 31/03/2012 HAL 7500.00 1 Post,BANGALORE,KAR NATAKA As Per Last Section B - Chapter VI A - Deductions from Total Value of Proof Attached. Declarati Income on 0 Medical Insurance Premium (U/s 80D) 0.00 Medical Insurance Premium (U/s 80D) - Parents not 0 0.00 being Senior Citizens Medical Insurance Premium (U/s 80D) - Parents 0 0.00 being Senior Citizens Medical Treatment/Handicapped Dependent (U/s 0 0.00 80DD) < 80% Medical Treatment/Handicapped Dependent (U/s 0 0.00 80DD) > 80% 0 Interest on Educational Loan (U/s 80E) 0.00 0 Permanent Physical Disability (80U) < 80% 0.00 Permanent Physical Disability Severe Disabilitty 0 0.00 (80U) > 80%

Long Term Infrastructure Bond (U/s 80CCF >= 10 Years) Section C - Chapter VIA - Section 80C 0 Contribution to Pension Fund ( 80CCC ) 50000 Public Provident Fund (PPF) 0 National Savings Certificate (NSC) 0 Infrastructure Bonds 0 Children Education Tuition fees 0 Equity Linked Savings Scheme (ELSS) 0 Mutual Funds 0 Unit Linked Insurance Plan 0 5 Year Deposit under Senior Citizen Saving Scheme 0 Cumulative Term Deposits 0 5 Year Time Deposit in Post Office 0 Fixed Deposit Scheme (Block Period of 5 yrs) NSC Interest (Will also be considered as Other 0 Income) Section G - Other Income 0 Bank Interest 0 Pension 0 Others Control Total (Please total the figures entered in A + B + C + G ) (Mandatory) 0

0.00 0.00 50000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 62250.00

Declaration: 1. I hereby declare that I have read and understood the guidelines provided in 'Proofs Option Document' and that, all information provided above is true and correct in all respects. 2. LTA exemption claimed by me(if applicable) is as per IT rule which specifies that exemption can be claimed twice in a block of 4 years. (irrespective of the number of employers in the block period) 3. I also undertake to indemnify the company for any loss / liability that may arise, in the event of any incorrect information provided by me. Date: Place: Signature of Employee * ________________________________ * Indicates mandatory fields as per our database. Please verify the same and if blank, please fill and submit the form.