JOHNSON & JOHNSON LIMITED

PROVISIONAL INCOME TAX FORM FOR THE FINANCIAL YEAR 2012 - 2013 Employee Name : Date of Joining : Sr. No. A 1 2 PAN : Description (Please include payments made/to be made in year 2012-13 only) DEDUCTIONS UNDER CHAPTER VI - A 80D - Medical Insurance Premium for Assessee (incl spouse & dependent children) a) 80D - Medical Health Check up self spouse and family including parents b) 80D - Medical Insurance Premium for Parents c) 80D - Medical Insurance Premium for Parents (Senior Citizen) 80DD - Medical Treatment of Dependent suffering from Permanent Disability 80DDB - Expenditure on Medical Treatment for specified disease WWID : Location Maximum Investment Limit Value

3 4

5 80E - Repayment of Higher Educational Loan-Only interest repayment taken for higher education of Self/Spouse/Children 6 80U - Permanent Physical Disability TOTAL of "A" B INVESTMENT UNDER SECTION 80C & 80CCC 7 80CCC - Contribution to certain pension funds 8 80CCD- Contribution to Pension Scheme of Central Government 9 Life Insurance Premium paid by an employee, on his life, his/her spouse / life of any child (including 10 Deferred Annuity 11 Public Provident Fund (PPF)- Photocopy of the Passbook & Copy of the deposit slip 12 Unit Linked Insurance Plan (ULIP) of UTI/ LIC Mutual Fund 13 Mutual Funds 14 National Saving Certificate Deposit (NSC) (Only Fresh Invsts made in current year -For Self / Spouse / Children) 15 Accrued Interest on NSC (Copy of Old Certificates to be Enclosed) 16 Housing Loan Principal Repayment (Repayment for fully constructed property.) 17 Tuition Fees (excluding development fees, donation and such other exps) 18 Stamp-Duty, Registration Fee And Other Expenses Incurred For Transfer Of Property 19 Investment in term Deposit in a scheduled bank for not less than 5 yrs 20 Amount deposited in Five year Time Deposit Scheme in Post office TOTAL of "B" C Interest on Housing Loan Date of 21 a) Self Occupied Loan : b) Let Out - No Restriction- Calculation need to be provided TOTAL of "C" D Income Other than Salary TOTAL of "D" Previous Employment Salary (Salary earned from 01/04/2012 till date of Joining JnJ) E 22 Previous Employer Income (As per Form 16 / Income & deduction certificate)

Rs.15,000 or Actual whichever is lower Rs. 5,000 or Actual whichever is lower Rs.15,000 or Actual whichever is lower Rs. 20,000 or Actual whichever is lower Rs. 50,000 (in case of severe disability - Rs. 100,000) Rs. 40,000 (in case of Senior Citizen, the limit is Rs. 60,000) or amount actually paid which ever is lower No Limit. Rs. 50,000 (in case of severe disability - Rs. 1,00,000)

5000 15000

20000

40000

20000

Limited up to Rs. 100,000 including all investment.

40000

100000 Restricted up to Rs. 1,50,000 if the loan is availed after 1-4-1999, else, Rs. 30,000 No Limit 200000

200000

Important to submitt Orginal copy of certificate duly signed by Authorised Signatory 23 Previous Employer PF (As per Form 16 / Income & deduction certificate) 24 Previous Employer PT (As per Form 16 / Income & deduction certificate) 25 Previous Employer Income Tax Deducted (As per Form 16 / Income & deduction certificate) Rent Paid per month (Please mention the starting and ending month) 26 If the rent amount changes during the financial year please specify the amount and the period separately in DD/MM/YYYY format- From Date to be from DOJ or 1st April 2012 Kindly Mark "Y" for Metro & "N" for Non-Metro From Date : 1/4/2012 To Date : 31/03/2012 From Date : To Date : From Date : To Date : From Date : To Date : Children Details for Education Allowance Exemption u/s 10 27 (a) Children Education Allowance (b) Any allowance granted to an employee to meet the hostel expenditure on his child Exemption limit is Rs.100 per month perchild upto a maximum of 2 children Exemption limit is Rs.300 per month perchild upto a maximum of 2 children

Rent per month 14900

No. of Children

Declaration I do hereby declare that the information given above is correct & true in all respects.

The following members of my family is wholly dependent on me and whatever investment contribution done on behalf of them is totally invested by me. RELATIONSHIP NAME OF THE DEPENDENT AGE

Date: 16/04/2012 Place: Employee Signature