INCOME TAX DECLARATION FORM - F.Y.

2023-24
(To be used to declare investment that will be made during the period from 01/04/2022 to 31/03/2023 for Income Tax purpose)

Company Name Agraga Emp ID

HAXPM6503A
Employee Name Meshak . A PAN of Employee
(compulsory)

As per section 206AA, in case PAN is not submitted, TDS will be deducted at flat rate of 20%

ITE PARTICULA MAXIMUM LIMIT DECLARED

MS RS AMOUNT
DEDUCTION U/S 10

I am staying in a rented house and I agree to submit Leave &

METRO /
HOUSE RENT Licence A'ment when required.The Rent Paid is
NON METRO
(Rs.
X months) & the house is located in
a METRO / NON METRO (Tick whichever is applicable)
Max Limit Declared Amount
Sec 80D - Medical Insurance Premium (If the policy covers a
senior citizen then exemption is Rs.50,000/-) -
Sec 80DD - Handicapped Dependent -

Sec 80E - Repayment of Loan for higher education (only Interest) -

Sec 80GG - Rent Paid 60,000.00
DEDUCTION UNDER CHAPTER
- VI A Sec 80U - Handicapped -
Sec 80CCG - Rajeev Gandhi Equity Saving Scheme
(Investment max upto Rs.50,000, would get a deduction of 50%
on the amount invested) 25,000.00
Sec 80TTA / 80TTB - Interest on saving a/c 10000 / 50000
Any other Deduction (Please specify)
Max Limit Declared Amount
Contribution to Pension Fund (Jeevan Suraksha) 1,50,000.00
Life Insurance Premium on life of self/spouse/child only 1,50,000.00
Deferred Annuity 1,50,000.00
Public Provident Fund in own name/spouse/child only 1,50,000.00
ULIP of UTI/LIC in own name or spouse and child only 1,50,000.00
Repayment of Housing Loan (Only principal) 1,50,000.00
Contribution to Pension Fund or UTI or Notified Mutual Fund 1,50,000.00
DEDUCTION U/S 80C Investment in ELSS made in units of Notified Mutual Fund 1,50,000.00
Children Tuition Fee: Restricted to a max of 2 Children 1,50,000.00
Deposit in home loan account scheme of NHB/HDFC 1,50,000.00
5 yrs. Term deposit in a Sch.Bank 1,50,000.00
Others (please specify) 1,50,000.00
Others (please specify) 1,50,000.00
DEDUCTION U/S 80CCC Annuity/Pension Plan 1,50,000.00
DEDUCTION U/S 80CC (1b) Employee Contribution 50,000.00
DEDUCTION U/S 80CCD Notified Pension Scheme 1,50,000.00
Aggregate Deduction U/S 80C, 80CCC & 80CCD cannot exceed Rs. 150000/-
Additional Deduction U/S 80CCD (1b) of Rs. 50000/-
Max Limit Declared Amount
Interest on Housing Loan on fully constructed accomodation
only 200,000.00
DEDUCTION U/S 24
Interest if the loan is taken before 01/04/99 on fully
constructed 30,000.00
accomodation only

DECLARATIONS:
1. I hereby declare that the information given above is correct and true in all respects. I am also aware that the company will be considering the above
details in utmost good faith based on the details provided by me and that I am personally liable for any consequences arising out of errors, if any, in
the above information.

2. I am also aware that any person making a false statement / declaration in the above form shall be liable to be fined and prosecution u/s 277 of the
Income Tax Act, 1961
3. The proof of payment / Supportings for claim, will be provided latest by

Note -

Date : A.Meshak
Place:Chennai A.Meshak
SIGNATURE OF THE EMPLOYEE
 Form 12c
PARTICULARS OF INCOME U/S 192 (2B) FORM 12-C

FORM NO. 12C

[See rule 26B]

Form for sending particulars of income under section 192 (2B) for the year
ending 31st March, 2023
1 Name and address of the employee : A. Meshak
2 Permanent Account Number: HAXPM6503A
3 Residential Status: Own House
4 Particulars of income under any head of
income other than "salaries" (not being a loss
under any such head other than the loss under
the head "Income from house property")
received in the financial year. Rs.
(I) Income from house property
(in case of loss, enclose computation thereof)
(ii) Profits and gains of business or profession
(iii) Capital gains
(iv) Income from other sources
Rs.
(a) Dividends

(b) Interest

(c) Other incomes (specify)

Total
5 Aggregate of sub-items (I) to [(iv)] of item 4
6 Tax deducted at source [enclose certificate(s) issued under
section 203]
Place
Date A. Meshak
Signature of the employee

1 Inserted by the IT (Eighth Amdt.) Rules, 1987.

2 Substituted by the IT (Fourteenth Amdt.) Rules, 1998, w.e.f. 14-9-1998. Prior to its
substitution, item 4, as inserted by the IT(Eighth Amdt.) Rules, 1987, read as under:
3 Substituted for "(v)" by the IT (Fourteenth Amdt.) Rules, 1998. w.e.f. 14-9-1998

Form 12C 1.428

INCOME-TAX RULES, 1962
Verification
I, Meshak ,do hereby declare that what is stated above is true to the best
of my knowledger and belief.
Verified today, the 26th day of july 2023
Place Chennai
Date 26/07/2023 A.Meshak
Signature of the employee

ACTION POINTS
 Form 12c
1 This form is to be used by an assesse-employee when he desires that his income from
sources other than "salaries" may also be taken into account by the employer for purposes
of deduction of tax of source. This form may be submitted by the assessee employee to his
employer.

2 Once the Form is submitted by the assessee employees, the employer has to take into
account the other income disclosed by the assesse and the tax deducted at source thereon
while computing the tax deductible at source from the assessee's salary.

3 From the assessment year 1999-2000, the assessee is permitted to furnish particulars in
respect of any loss under the head 'Income from house property' to his employer. The Form
has consequently been enlarged, so as to enable the assessee-employee to furnish
particulars of such loss. Employees having loss under the head 'Income from house
property' will find it to their advantage to furnish such loss (if any) to the employer, since
the tax deductible at
source will get corresponsdingly reduced. This apart, such employees will also be saved from
the botheration of filing a return of income just for the purpose of obtaining tax refund.

4 The assessee-employee cannot however furnish particulars of loss (if any) under any head
of income other than 'Income from house property'.