Statement showing particulars of claims by an employee for deduction of tax under section 392(5)(b)
Part A: Details of the employee | |||
1. | Name of the employee | (refer Note 1) | |
2. | Address | (refer Note 2) | |
3. | Permanent Account Number | ||
4. | Email id | ||
5. | Contact number | Country Code | Number |
6. | Tax Year | ||
Part B: Details of claims and evidence thereof | ||
Nature of claim | Particulars | |
1. | House Rent Allowance: | |
(i) Name of the landlord | ||
(ii) Address | ||
(iii) Permanent Account Number (refer Note 3) | ||
(iv) Aadhaar Number | ||
(v) Relationship with the landlord, if any | ||
(vi) Rent paid to the landlord | ||
(repeat details of Row No. 1 if required) | ||
2. | Leave travel concessions or assistance | |
3. | Deduction of interest on borrowing: | |
(i) Name of the lender | ||
(ii) Address | ||
(iii) Permanent Account Number of | ||
(a) Financial Institutions (if available) or | ||
(b) Employer (if available) or | ||
(c) Others | ||
(iv) Interest payable/paid to the lender | ||
(repeat details of Row No. 3 if required) | ||
4. | Deduction under Chapter VIII-A and B of the Act | |
|
(a) Section 123 A B C (b) Section 124 (c) Section 130 (d) Section 131 | ||
(e) Other sections (e.g. 129, 133, 137, 153, etc.) un- der Chapter VIII- A and B of the Act (a) Section (b) Section (c) Section | ||
5. | Other details to be attached as annexure | (refer Note 4) |
DECLARATION
I, … … … … … … … .., having Permanent Account Number … … … … … . do hereby certify that the information given above is complete and correct.
Place: Signature of the employee: … … … … … …
Date: Name:
Notes:
1. In case of individual, the first, middle and last name shall be provided in full without any abbreviations.
2. The address shall contain i. Country/Region, ii. Flat/Door/Block number iii. Road/Street/Block/Sector, iv. PIN/ZIP Code, v. Post Office, vi. Area/locality, vii. District, viii. State.
3. Permanent Account Number shall be furnished if the aggregate rent paid during the Tax Year exceeds one Lakh rupees.
4. The following details shall be provided as annexures, namely:
Annexure | Particulars |
A-1 | House rent agreement |
A-2 | Documents in support of claim of Leave travel concessions or assistance |
A-3 | Loan agreement |
A-4 | Documents in support of claim of deduction under Chapter VIII-A and B of the Act |
5. Amounts to be filled in ₹ unless otherwise provided.