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Tax Savings Declaration For The Year April 2010 To March 2011
Employee Code :
Employee Name :
Department :
PAN No.
The following Investments will be made by me during the Period April 2010 to March 2011
Restricted to
your Annual
LTA Eligibility
7 Sec 80C
7.1 Life Insurance Premium (other than salary deduction)
7.2 Deferred Annuity
7.3 Contributions to statutory provident fund / recognized provident fund
7.4 Public Provident Fund
7.5 Deposit in NSC
7.6 Interest on NSC reinvested (upto 5th completed year only)
7.7 ULIP of UTI/LIC
7.8 Principal Loan (Housing Loan) Repayment
7.9 Mutual Funds
7.10 NHB Scheme (housing loan account scheme / pension fund)
7.11 Tuition fees for full time education for children
7.12 Investment in Infrastructure Bonds (as specified in section 80C)
7.13 FD with scheduled bank for 5 years or more
7.14 Deposit in post office under five year time deposit scheme
7.15 Others (please specify)
Note: Maximum deductible under sections 80C & 80CCC cannot exceed Rs.1 lacs + 20,000 additional for
infrastructure bonds
Note: Please note that income (previous employment) can only be taken
based on declaration(Form 12B). No benefit for deductions like
PF,Profession Tax, Income Tax deducted at source can be given unless
Form 16/Tax Certificate from previous employer is attached.
Signature of the Employee
Note: PAN is mandatory for all employees without which Form -16 can't be issued. If you don't have the
PAN please initiate the PAN application process.