Page 1 of 4

DCM SHRIRAM LIMITED : NEW DELHIFENESTA BUILDING SYSTEMS

EMP. SAP NO. PAN NO.

Name:Abhijit Purkayastha 39235 BGWPP5640N

DEDUCTIONS U/S 80CCC MOBILE NO. 9804254321

EMAIL ID

1. Pension FundPolicy Type Policy No. Favouring Dt of Deposit/Due on Amount/Rs. (PA)

Jeevan Suraksha/Any otherTotal

2. Any other prescribed Tax Saving Schemes e.g. New Jeevan Dhara, New Jeevan Dhara-I, New Jeevan Akshay, New Jeevan Akahay-I & II, etc.

Investment under the head Receipt No. Date of Deposit Amount (Rs.)

Total Amount

DEDUCTIONS U/S 80C

3. Insurance ( LIC & ULIP)Policy Type Policy No. Favouring Dt of Deposit/Due on Amount/Rs. (PA)

LIC - DIRECT (LIC THROUGH PAY ROLL 428502428 Abhijit Purkayastha 28-Feb 5461NOT TO BE MENTIONED) 428502427 Abhijit Purkayastha 28-Feb 12010

Total 17471ULIP

Total

4. N S C

Certificate No. Date of Purchase NSC VIII OR IX Amount(Rs.)

Total

NSC Certificate No Amount of NSC The year for which interest accrues

Intt. On NSCs

First year

Second year

Third year

Fourth year

Fifth year

Sixth year

Total :

Note: The above interest amount except 5th year for NSC IX and 6th year intt. For NSC VIII Issue respectively would

be treated as re-investment while the entire amount including 5th/6th year intt. would be considered as interest

income reported by the employee.

- For calculation of interest, please refer the annexed file on the subject.

5. Public Provident Fund/ ELSS Nature of Investment Account / Receipt No Date of Deposit Amount (Rs.)

PPFTotal

Total

6. Repayment of House Loan ( Principle Amount only) ; -

Period Amount Paid (Rs.)

From To

Declaration for calculation/deduction of Income Tax for the Financial Year : 2014-2015

abhijit.purkayastha@fenesta.com

(a) New NSC : I propose to purchase National Saving Certificates, details of which are as under :-

(b) Interest Accured on NSC : I am holding following NSCs on which interest accured is as under

Equity Linked Savings Scheme

Name of Institution/Company

Page 2 of 4

Total

annexed file on the subject.

Note : For Claiming deduction on payment of Interest on H.Bldg. Loan, pls. submit the required documents as mentioned in the

Page 3 of 4

7. Tuition Fees (Max. of 2 children)

I have spent/will spend the following amount towards Tuition Fees as per details given below :

Month First Child

Amount (Rs.)

Second Child

Amount (Rs.)Name of School/ Name of School/

College & Class College & Class

AprilMayJuneJuly

AugustSeptember

OctoberNovemberDecember

JanuaryFebruary

March Total : Total :

8. Term Deposits/Post Office Time Deposit for 5 years.

Nature of Investment Receipt No. Favouring Date of Deposit Amount (Rs.)

Note: - Total amount (Point No. 1 to 8) qualifies upto a max.of Rs. 1.5 Lac including PF & Addl. PF from salary.

Deductions under various section Amount/Rs. Interest under Equity Savings - 80CCG

Mediclaim (80D)-For self/Spouse & Children

Mediclaim (80D)-For Parents < 60 yrs. of age

Mediclaim (80D)-For Parents => 60 yrs. of age

Medical Treatment for handicapped dependents (80DD)

Medical Treatment for specified chronic disease (80DDB)

Repayment of Intt. on Higher Education Loan (80E)

Disability U/s 80U

Interest on Saving Bank A/c. (other than Time Deposits - Max. Rs. 10K - U/s 80 TTA

Any other Deduction (Pls. Specify)

Total

EXEMPTIONS

Details of Children Education (To be filled only by those who are in receipt of Children Ed. All.)

I hereby declare that my child/children is/are getting education & exemption may pl. be considered on this account, as under :

Pl. mark _/

For 1 child Rs.100/- p.m.

For 2 Children Rs.200/- p.m.

Besides above, Addl. Exemption of Rs.300/- p.m. per child, subject to a max. 2 children, is available for Hostel

Page 4 of 4

Details of Rented Accommodation I write to inform you that I am residing in the rented/Co. leased accommodation, as per details given below, and any change in this regard would be reported by me immediately :

Particulars of Landlord/Landlady Period Amount(1.4.2014 to 31.3.2015) (Rs./P.M.)

April 7000

Name : May 7000

June 7000

PAN No. : July 7000

(If rented amount exceeds Rs.1.0 lac in a year) August 7000

September 7000

Address of rented house : October 7000

November 7000

December 7000

January 7000

February 7000

March 7000

Please enclose the original rent receipt for the month of April'14 & February, 2015. Pl. note that any change in

the house rent should be reported immediately. Change with retro effect is not possible.

Any other income reported by an employee

Head Amount (Rs.)

Any other income

Total :

Any other information, which has not been covered above but may help in calculation of yourincome tax, pl. attach the details in

the separate sheet.

I, __________________________ (Name of the employee) Solemnly declare that to the best of myknowledge and belief, the information given above are correct, complete and truly stated and inaccordance with the provision of Income Tax Act, 1961.

Date : SIGNATURE OF EMPLOYEE

Interest Income (other than NSC Intt. as shown under Col. 3 (b)