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Income Tax Declaration Form For Financial Year 2021-2022

Siddharth Das has submitted an income tax declaration form for the 2021-2022 financial year. The form details various deductions and exemptions including contributions to pension funds, rent payments, home loan interest, insurance premiums and deposits in savings accounts. It notes that supporting documents must be submitted by February 10, 2022 to claim exemptions. Siddharth signs to agree that failing to provide proof will result in the bank cancelling exemptions/deductions claimed and recovering additional taxes owed.

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76 views1 page

Income Tax Declaration Form For Financial Year 2021-2022

Siddharth Das has submitted an income tax declaration form for the 2021-2022 financial year. The form details various deductions and exemptions including contributions to pension funds, rent payments, home loan interest, insurance premiums and deposits in savings accounts. It notes that supporting documents must be submitted by February 10, 2022 to claim exemptions. Siddharth signs to agree that failing to provide proof will result in the bank cancelling exemptions/deductions claimed and recovering additional taxes owed.

Uploaded by

Siddharth Das
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Income Tax Declaration form for Financial Year 2021-2022

TO BE SUBMITTED BY 10-Feb-2022 POSITIVELY

Name: SIDDHARTH DAS Emp No.: 53625


PAN No.: AOPPD7268A Mobile No.: 9051210530
Designation: Chief Manager Department: MADHYAMGRAM - KOLKATA

Declaration *Receipt(s) / Proof(s) Section Section Group Sub Applicable


to be submitted Total(Rs.) Amount(Rs.)
Employee Contribution Payment Receipt (if 80CCD(1B) 80CCD(1B) 175175.60 50000.00
to NPS** available)
Total of Section-Group: 175175.60 50000.00
Excess Rent Exemption Apr,Jul,Oct,Jan rent 10(13A) 10(13A) 44796.00 44796.00
receipts
Total of Section-Group: 44796.00 44796.00
Interest on Home Loan Interest Certificate 24 24 300000.00 200000.00
Total of Section-Group: 300000.00 200000.00
GSLI Premium 80C 80C_80CCC 5100.00 5100.00
PPF/Sukanya Samriddhi Deposit receipt or 80C 80C_80CCC 150000.00 150000.00
Account Statement
Employee Contribution 80CCD 80C_80CCC 125175.60 125175.60
to NPS
Total of Section-Group: 280275.60 150000.00
Mediclaim (Senior Premium Payment 80D(2) 80D 14000.00 14000.00
Citizen upto 65 Receipt
years)
Total of Section-Group: 14000.00 14000.00

**Employee contribution to NPS(80CCD[1B], 80CCD) includes Voluntary NPS contribution,arrear NPS contribution from
salary,legacy NPS contribution and salary NPS contribution , if any.

*Please enclose self attested copy of proof(s)/receipt(s) as mentioned above.

For the purpose of calculation of Income Tax payable by me from my salary income for the current financial
year, I furnish above the necessary particulars in respect of payment directly made or to be made by me.

I, hereby, undertake to invest and produce to the Bank, for the purpose of verification, the receipts or other
satisfactory proof(s)/evidence(s), in confirmity with my declaration made by me, by 10-Feb-2022

I also agree that failing to produce satisfactory evidence within the specified period, the Bank will be free to
cancel the exemption/deduction from income/rebate in tax, that has been allowed to me, and recover from me
the additional income-tax and surcharge as penalty/interest (if any).

Signature :

Full Name : SIDDHARTH DAS

Date :07-05-2021 10:00:23 AM

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