Haryana Power Generation Corporation Ltd.

Income tax statement of Sh./Smt. ______________________________ for the financial

year 2011-12 (Assessment Year 2012-13).
Employee Code: _______________________________
Bank Account No: ______________________________
Permanent Account No:__________________________
Sr.
No.

Pay &
Allowances

Rate

Period
From

1.
2.
3.

To

Pay
Pay Arrear
Grade Pay incl. arrear

11.

Personal
Pay/Special
Pay/BOE
Hardship
Allowance
Cash Medical
Allowance
Project
Allowance/Const.
Allowance
Rent free
Concession
Honorarium
Production Bonus
Electricity
Allowance
Shift Duty Allowance

12.

DA

13.

Reimbursement
of School Fee
Leave Travel
Allowance (One
Month Salary)
Other
component
Total (A)
(a) when Accomodation is owned by PGCS
Add 15% of Total (A) above where Rent Free
Accommodation or on Concessional Rent was
provided in the above period in a city of
population exceeding 25 lakhs as per 2001 census.
OR
@ 10% if the accommodation so provided in a
city of population more than 10 lacs but not
exceeding 25 lac as per 2001 census.
OR
7.5% population not exceeding 10 lakhs as per
2001 census.
(ii) Less : Rent Deducted in case of
accommodation on concessional rate.
(b) When accommodation is taken lease by HPGCL
Amt of lease rent paid on 15 % of salary
Less: Rent Deduction.

4.
5.
6.
7.
8.
9.
10.

14.
15.
16.
17 A

Rs.
To be filled
in by the
Employee

Rs.
For Office
use

Sr. No.

Particulars

17(B)

Add interest concession on Loans (AnnexureA

18.
19.

attached)
Any other income (To be specified)
Add: Actual House Rent Allowance received

To be filled
In by the
Employee

For Office
Use.

from the Corporation during the above period.

Less: Deduction being least of the following
(i)
Actual HRA received during the period
(ii)
40% of the Salary (Pay+GP+DA) during the
above period
(iii)
HRA paid in excess of 10% of salary during
20.
21.

the period (Salary here means Pay+GP+DA).

Total (Income chargeable under the head Salaries)
Any other income:
(i) Income from Bank Interest/ Accrued int on NSCs
(ii) income from House Property
(iii) Less from House Property

22.

( Accrued Interest on HBA)

Gross Total Income (20+21)

23.

Net Taxable Income

24

Deductions under Section 80(c)

25.

Amount deposited in GPF/CPF (Account

26.
27.
28.
29.
30.

No. _________________________)
Amount deposited in Mutual Fund*
Life Insurance Premium
GIS
Investment made in the NSCs
Tuition Fee of Children (Restricted to two

31.

Children only)
Amount deposited in PPF (Account
No. ___________________________) up to

32.

100000/- as per PPF scheme

Repayment of Housing Loan towards cost of

33.

construction/purchase of residential property.

CTD Deposit in 10 years account or 15 years

34.

account in post office

Term Deposit for the period of 5 years or more

35.

with schedule bank.

Any other deduction(s) if any allowable u/s

36.

80(c) of income tax.

Deductions under Section-80 CCC
LIC Jeewan Suraksha/Pension Plan

Sr. No.

Particulars

37.

Total Deductions (Subject to a maximum of

38

Rs. 1,00,000/- u/s 80C & 80CCC) total of 25 to 36

Deduction u/s 80 CCF Long Term-Infrastructure

39.

Bonds ( Subject to maximum Rs 20000/-)

Deduction u/s 80-D Medi-claim policy/Central
Govt. Health Scheme)

To be filled
In by the
Employee

For Office
Use.

(i)

For Senior Citizen Maximum Rs. 20,000/-

For Others Maximum Rs. 15,000/Deduction u/s 80-DD Mtc. of handicapped dependent.
Total Deduction (37+38+39)
Total Income (23-41)
Tax on total Income
(ii)

40.
41.
42.
43

For Women assessee:

Up to 1,90,000/-

Nil

From 1,90,001/- to 5,00,000/-

@ 10%

From 5,00,001/- to 8,00,000/-

@ 20%

Above Rs. 8,00,001/-

@ 30%

For Senior Citizen Assessess :

Up to Rs. 2,50,000/-

Nil

From 2,50,001/- to 5,00,000/-

@10%

From 5,00,001/- to 8,00,000/-

@ 20%

Above Rs. 8,00,001/-

@ 30%

For other Assessees :

Up to Rs. 1,80,000/-

44.
45.
46.
47.
48.
49.

Nil

From 1,80,001/- to 5,00,000/-

@10%

From 5,00,001/- to 8,00,000/-

@ 20%

Above Rs. 8,00,001/-

@ 30%

Net Tax Payable

Add : Education Cess @ 2% (to be calculated on 44)
Add : Higher Education @ 1% (to be calculated on 44)
Total Tax payable (43+44+45+46)
Less : Tax deducted at source
Balance to be Recovered/Refunded

Special Notes with regard to certain investments/contributions/payments:

PPF : Must specify the PPF Account No. Also attach the proof of deposit in the PPF
MUTUAL FUND: Please provide the following details.
Sr. No.

Name

Relationship

Amount invested

CTD Deposit: Please provide the following details.

Sr. No.
Name
Relationship

Amount invested

Life Insurance premium Details: Aggregate of the total premium worked out in the
following columns should be indicated in the column No. 26 above.
Sr. No.
Policy No.
Amount of
Amount of
Insurance
Insurance
Premium

(b) Certified that I had purchased the following National Saving Certificates VIII issue
in my name or in the name of my spouse or my minor children out of my savings. These
have not been en-cashed so far and the interest accrued thereof is to be treated as reinvested. I am entitled for deductions under Sec-88 of the Income Tax Act as under:Sr. No.
of NSC

Date of
Purchase

Face Value
of Certificate

The Year Ist/

2nd/3rd/4th/
or 5th completed
Year

Amount of
Interest
Deemed to be
Invested.

Note:- Interest on issue of NSCs to be calculated on

The basis of table A attached:

Total Rs.______________

Children Fee : The concession of children fee is available for payment made to a
recognized institute towards the tuition fee not being fund or development fund etc. the
concession is available only for two elder children in case of more than two children.
Note:
(i) Certified that I have not been provided with any Motor-Car, Motor cycle, Scooter
or other moped for use otherwise than wholly or exclusively to the performance
of my official duties.
(ii)

Certified that the Local Outdoor Duty Allowance/Special allowance paid to me

for the period _________ to __________ has been fully spent on the
performance of my official duties within a radius of 8 Kms from the place of
my duty and has not resulted to be source of profit.

(iii)

I
am
residing
in
Boards
accommodation/quarter/Kothi
__________________ field hostel Since ____________________.

(iv)

Certified that the deposits under NSS were made out of income chargeable to
tax and deposits, if any or previous years en-cashed during the year 20092010 have been made included in the income along with interest thereon.

(v)
(vi)

No.

Certified that deposits under NSC/CTD/ULIP/LIC/mutual Funds/ULI/PPF/PLI

etc. were made out of income chargeable to tax.

(Signature of Assessee)
Name:_____________________
Designation:________________
Address : __________________

To,
The Chief Accounts Officer,
Pay & Accounts Section,
HPGCL, Panchkula.
CERTIFICATE FOR THE DRAWL OF LOCAL OUTDOOR DUTY ALLOWANCE FOR
THE PERIOD OF 1-4-2011 TO 31-03-2012
Certified that:1. I have not been provided with corporations vehicle.

2. I will not use any vehicle of the corporation for the performance of journeys within
a radius of 8 kms.
3. In the event of my availing any leave other than casual leave I shall inform the
drawing & Disbursing Officer.
4. I a maintaining a Motor-Car/Motor cycle/Moped No. _________________ Which
is duly registered in my name and the same is being used for corporations work.
5. I further authorize the drawing & disbursing officer to effect recovery of any
amount found to have been paid to me in excess of this amount from my monthly
salary.

(Signature of the Claimant)

Name : __________________________
Designation:______________________
Place of Posting : _________________

CERFICATE FOR REIMBURSEMENT OF ELECTRCITY CHARGES FOR THE

PERIOD 1-4-2011 TO 31-03-2012.

Certified that I am class ________ employee and entitled for free electricity unit i.e.
________ units per month, which have been fully consumed by me/my family and paid
to the authority concerned/landlord etc.

I undertake that the above declaration given by me is true and correct and nothing has
been concealed therein. I further undertake that I am liable to face disciplinary or other
appreciated legal/penal action, which could involve recovery and penalty, if any of the
aforesaid information is found false or incorrect.

(SIGNATURE OF THE EMPLOYEE)

Date :

Name: __________________________
Designation:______________________
Office:___________________________

CERTIFIED THAT:1. My wife/ husband is not working in the employment of Government of Haryana or
under the Central Government or any other State Government or under any other

organization/institution/body etc. wholly or substantially owned or controlled by

the Central Government or any State Government promising any scheme of
children Education Allowance in nature.
2. My husband/wife is/will not claim/reimburse this amount from his/her employer
under Children Education Allowance Scheme.
3. I am eligible to raise the claim.
4. The claim is permissible under the Children Education Allowance Scheme,
The amount of Rs. ______________ actually paid by me in respect of following
my children may be reimbursed to me:Sr. No.
1.

Name of Child
2.

Relation with
claimant
3.

Date of Birth Mother/Father

Name
4.
5.

Class
6.

(SIGNATURE OF THE EMPLOYEE)

Date :

Name: __________________________
Designation:______________________
Office:___________________________

Note: Please attach the saving proof duly signed.