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Employee Investment Declaration Form For the Financial Year 2018-2019 Employee IDEmployee NamePAN NumerDate o! oinin# A$$ress%etro &Yes'No(PAN o! )an$lor$*ection + - ,hapter I A - De$uctions !rom .otal Income A%/N. Medical Insurance Premium (U/s 80D) - Individual, Spouse & Children (Ma !imi I#$ %,000 P')Medical Insurance Premium (U/s 80D) - Paren s no ein* Senior Ci i+ens (Ma !imi I#$ %,000 P')Medical Insurance Premium (U/s 80D) - Paren s ein* Senior Ci i+ens (Ma !imi I#$ 0,000 P')Medical rea men /andicapped Dependen (U/s 80DD) .80Medical rea men /andicapped Dependen (U/s 80DD) 80Medical rea men 1or Disease/ilmen -Sel1/Dependen (U/s 80DD2) (Senior ci i+ens 30 4rs and .80 4rs)Medical rea men 1or Disease/ ilmen -Sel1/Dependen (U/s 80DD2) Super Senior ci i+ens ( 80 4rs )In eres on 5duca ional !oan (U/s 805)Permanen Ph4sical Disaili 4 (80U) . 80Permanen Ph4sical Disaili 4 Severe Disaili 4 (80U) 80#a ional Pension Scheme(80CCD) .otal0 *ection , - ,hapter IA *ec 80, !i1e Insurance Premium Pulic Providen 6und (PP6)#a ional Savin*s Cer i7ica e (#SC)Children 5duca ion (ui ion 6ees nl4)a Savin* Mu ual 6unds / 59ui 4 !in:ed Savin* Scheme (5!SS)Su:an4a Samriddhi Scheme U!IPa Savin* ;ear erm 6ied Deposi ousin* !oan - Principal moun paid, $e*is ra ion 6ees, S amp du 4 hers (Please men ion i1 an4) hers (Please men ion i1 an4) hers (Please men ion i1 an4) hers (Please men ion i1 an4) hers (Please men ion i1 an4) .otal &%aimum )imit IN 1304000(0 5ran$ .otal0 o al in eres paid durin* he 7inancial 4ear (pril <8 o March <=) - Sel1 ccupiedddress o1 he Proper 4 a*ains >hich !oan a:en .otal &%aimum )imit IN 2004000-e!er Anneure 1(0 Income a1 er Sec ion <0 eemp ion (?oined a1 er 0</0@/%0<8)Providen 6und (P6)Pro1essional a (P)a deduc ed a source (DS) .otal0 Declaration: Da eAPlaceA *i#nature o! the employeeFrom Date.o Date,ityent Per %onth*ection D - )oss !rom 6ouse Property - *E)F /,,PIED Ci 4Da e o1 ccupa ion (DD/MM/;;;;) *ection E - Previous Employment &Please attach Income .a ,omputation *heet !rom Previous Employer !or FY 2018-19 ( I here4 declare ha he in1orma ion *iven aove is correc and rue in all respec s and I in end o ma:e he inves men s declared aove' nd I also under a:e o indemni14 he compan4 1or an4 loss/liaili 4 ha ma4 arise in he even o1 he aove in1orma ion ein* incorrec / declared inves men s no made' Anneure-1Interest on 6ousin# )oan !or the FY 2018-197Note <'In eres on ousin* loan allo>ed up o $s'%,00,000'B' ddi ional eemp ion o1 I#$ 0,000 provided he 1ollo>in* condi ions are sa is7iedA a' he home loan should have een sanc ioned in 6; %0<3-<' ' !oan amoun should e less han $s B !a:h' c' he value o1 he house should no e more han $s 0 !a:h d' he home u4er should no have an4 o her eis in* residen ial house in his name'B' Sanc ion !e er/Provision Cer i7ica e is manda or4 1or claimin* in eres on housin* loan' Important In!ormationFor In$ivi$uals the .a ates as elo !or the FY 2018-19Income in s7ate o! Income .a Applicale Up o $s' %,0,000#I!$s' %,0,00< o $s' ,00,000$s' ,00,00< o $s' <0,00,000%0 ($s'<%,00%0 aove $s' ,00,000)$s' <0,00,00< and aoveB0 ($s'<<%,00B0 aove $s' <0,00,000) Note <' 5duca ion Cess E@ as applicale %' a $ea e o1 $s'%,00 1or o al aale income up o $s' B' !a:h (s per Sec ion 8)B' o Claim $ 1ollo>in* suppor in*s should e provided in ?anuar4 %0<='a' $en $eceip s' P# o1 he >ner >i h address is manda or4 in case he ren eceeds $s'8,BBB/-Per Mon hc' Cop4 o1 $en al a*reen is manda or4 i1 ren pa4ale is more han $s'8,BBB/-Per Mon h@' Medical Insurance is disallo>ed i1 i is paid 4 cash' Should e paid 4 che9ue/#56/nline'