"TAX DECLARATION FORM"

COSMIC STRUCTURES LTD.

"TAX DECLARATION FORM"

F.Y.2013-14 (April 2013 to March 2014)

NAME & FATHERS NAME:

EMPLOYEE ID :

DATE OF BIRTH:

DATE OF JOINING :

DESIGNATION :

LOCATION :

DEPTT. :

EXTN. NO. :

PAN No. :

E-MAIL ADDRESS :(OFFICIAL)

RESIDENTIAL ADDRESS :

All above details are mandatory

PART A: - TO BE FILLED BY EMPLOYEES WHO HAVE JOINED AFTER 1ST APRIL 2013

INCOME EARNED FROM PREVIOUS EMPLOYER. Taxable salary income from 01.04.2013 to the date of joining Cosmic): attach Form 12B / Form 16 issued by previous organization.

Previous Employers Name & Address :

Income after section 10

Professional tax deducted

PF deducted

Tax deducted

INVESTMENT PLAN FOR THE YEAR

I here by declare that my Investment plan for the current financial year is as follows:

Investments proposal under Section 80 C:

S.NO.TYPE OF INVESTMENTSAMOUNTPROOF REQUIRED LATER

1Life Insurance Premium Paid for self/spouse/children Copy of Premium Receipt

2Public Provident Fund subscriptions for self/spouse/children Deposit Receipt for PPF Account

3NSC (Only in name of self) Copy of NSC certificate

4NSC Accrued Interest Please mention the NSC purchased date and the amount by a separate note. Copy of NSC certificate

5ULIP Copy of Premium Receipt

6Principal repayment on Housing Loan Certificate of Principal repayment from the Financial Institution

7Equity Linked Saving Scheme (ELSS) / Mutual FundsProof of investment made

8Education Expense (Please mention number of children going to school/college)Proof of expenses incurred (only the school fees, excluding donations/building fund)

9Any other (under sec 80C)Acknowledgement copy of payment

TOTAL

Section PARTICULARSREMARKSAMOUNTPROOF

1

Section 80CCC

Pension Plan (Section 80 CCC)Investments made in pension plan.Copy of premium paid receipt

2

Section 80D

Mediclaim Insurance Premium

Copy of premium paid receipt

3Any others

S.NOPARTICULARSREMARKSAMOUNTPROOF REQUIRED

1HRA Rebate u/s 10 (13A)Rent paid per month Rent receipts for each month/quarter.Duly stamped

Name & Address of the rented house Name of the owner

To rent paid

2Interest on Housing Loan (Section 24)Mention whether the property is (self occupied / let out) Certificate from

Lender

Verification

I, _______________________________, do hereby declare that what is stated above is true to the best of my knowledge and belief.

Verified today, the ____________ Day of _______________________________.

Place:

Signature of the Employee

Date: