Employees Proofs Submission Form 2013 -14

( Please read the instructions / guidelines attached carefully before filling up the form )

NAME OF COMPANY GYANSYS INFOTECH PRIVATE LIMITED

EMPLOYEE CODE *

NAME *

PAN NUMBER*

LOCATION

No of Children *

* Mandatory

S. No. Particulars Remarks

A Rent Receipts ( Pls mention the no. of months to be claimed)

From Date To Date Rent P.M.

1

2

3

4

B Loss / Income from House Property (attach Computation Statement( Auditor Certificate - Mandatory for let out properties)

Housing Loan Interest Amount (upto 30k or 150k)

Pl. mention whether loan was taken before 01/04/99 or after 01/04/99

C Income from Other Sources, if any

D Deduction under Chapter VI A

1 80D (Mediclaim- upto Rs. 15000 for Self, Spouse and Children)

(upto Rs.15000 for Parents & Addl. Rs.5000 for Senior Citizen Parents)

2 80DD - Medical treatment for handicapped dependent

(with < 80% disability or > 80% disability, pl. specify)

3 80 E - Repayment of Interest on Education loan taken for

E Deduction under section 80C

1 Life Insurance Premim ( LIC )

2 Pension Plans u/s 80CCC

(Jeevan Suraksha / Pension schemes of any other insurer)

3 Public Provident Fund ( PPF )

4 Equity Linked Saving Scheme (ELSS)

5 Housing Loan Principal Repayment/Stamp Duty & Reg. Charges

6 Deposit in NSC

7 Interest on NSC - Accrued

8 Deposit in ULIP of UTI/LIC

9 Tax Saving Mutual Funds eligible for deduction u/s 80 C

10 Infrastructure Bonds / Tax saving bonds

11 Fixed Deposit in Banks eligible for Tax Saving u/s 80C

12 Children Education expenditure

- Pl.mention number of children studying in School/College

13 Tax Saving Systematic Investment Plan (SIP)

14 Deposit in Senior Citizen Saving / 5 year Time Deposit Scheme

TOTAL

G Previous Employment Salary ( Salary Earned from 01/04/2013 till Date of Joining)

( Applicable only if you have joined …Gyansys Infotech after 01/04/2013 )

If you have joined Gyansys Infotech Private Limited after 1st April 2013, and you were working with some other organisations before joining.

Pl. enclose the copy of Form 16 / Statement Certifying Earnings and Deductions from your previous employer's, which is mandatory.

1) I hereby declare that what is stated above is true to the best of my knowledge and belief.

2) I also undertake to indemnify the company for any loss/liability that may arise in the event of the above information

being incorrect.

Date :

Place: Signature of the Employee

Proofs Submitted Amount (to be filled by employee) ( Rs. )

Amount ( to be filled by Finance)

PAN of the landlord / house owner is

mandatory, if the annual rent paid

exceeds Rs.100000. Self decl form in case

PAN not available.

Higher Education for SELF, SPOUSE AND CHILDREN

FORMAT OF RENT RECEIPT

RENT RECEIPT

Name of the owner : LATHA M REDDY

PAN of the owner

Address of the owner

( SIGNATURE OF THE OWNER )

Note:PAN of the landlord / house owner is mandatory, if the annual rent paid exceed Rs.100000.In case PAN is not available, self declaration of the house owner is mandatory as per the enclosed format.

Received from Mr. Anil Ganduri of GyanSys Infotech Pvt. Ltd.[Name of the company]

a sum of Rs. 1,20,000/-( Rs. One Lakh Twenty Thousand Only)

towards rent for the period From April 2014 To Jan 2014 for the

property situated at No. 41, Flat No.105, 1st Floor, “Deeksha Blossom”, 15th Cross, Green Garden Layout, Next to Church, Shirdi Sai Nagar, Munnekolala, Marathahalli(post), Bangalore – 560037(Address of the property)

: No.17, 5th Cross, 1st Main, ‘A’ Block, Vinayaka Nagar, Konena Agrahara, HAL Post, Bangalore - 560017.

Document

In case PAN is not available, self declaration of the house owner is mandatory as per the enclosed format.

Computation of Loss from Self Occupied Property:

Name of the employee

Employee Code

Address of the Self Occupied House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction

Date of Occupation (Taken Possession)

Interest paid during the period Apr 13 to Mar 14(Should match with the amount appearing in the certificate given bythe Bank / Financial Institution)

1/5th of pre-construction interest, if any(Should also mention the year of instalment)

Total Interest paid for the year 2013-14 0

I am the registered sole owner of the property situated at the above address.I hereby declare that what is stated above is true to the best of my knowledge and belief.Please considered the above Loss from Self Occupied House Propertywhile computing the tax on salary income.

Employee Signature:Date:

Note: If it is a joint property, please sign the attached declaration along with computation

Declaration for J oint House Propert

Computation of Income / (Loss) from Let Out Property - Rented property

(Do not disturb the formulas)

Name of the employee

Employee Code

Address of the Let Out House Property

Date of Loan Borrowed

Date of Acquisition/Completion of Construction

Date of Occupation (Taken Possession)

COMPUTATION OF INCOME / LOSS FROM HOUSE PROPERTY ( RENTED OUT)

Annual Rental Income

Net Annual Rental Income 0

0

0

Less:

Interest paid on borrowed Loan (From Apr 13 To Mar 14)(Should match with the amount appearing in the certificate given bythe Bank / Financial Institution)

1/5 th of Pre-Contruction Interest (if any)(Should also mention the year of instalment)

Net Income / (Loss) from House Property 0

I am the registered sole owner of the property situated at the above address.I hereby declare that what is stated above is true to the best of my knowledge and belief.Please considered the above Income / (Loss) from Let Out House Propertywhile computing the tax on salary income.

Employee Signature:Date:

Note: If it is a joint property, please sign the attached declaration along with computation

Less: Municipal Tax paid during the financial year 2013-14

Less: 30% for Repairs & Maintenance on Net Annual Income

Document

Document

FORM No. 12C[See rule 26 B]

Form for sending particulars of income under section 192 (2B) for the year ending 31st March, 2014

1 Name and address of the employee

2 Permanent Account Number

3 Residential status RESIDENT / NON RESIDENT

4 Particulars of income under any head of income other than "salaries" (not being a lossunder 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(a) Dividends Rs.

(b) Interest Rs. (c) Other Income (specify) Rs.

Total Rs.

5 Aggregate of sub-items (i) to (iv) of item 4. 0

6 Tax deducted at source [enclose certificate(s) issued under section 203]

Place _______________________________

Date ________________________________Signature of the employee

Verfication

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

Verified today, the __________________ day of _____________________ 20________.

Place _______________________________

Date ________________________________Signature of the employee