IT Proof Submission Format 2011-12 (2)
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Transcript of IT Proof Submission Format 2011-12 (2)
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Affiliated Computer Services of India Pvt Ltd
Emp No. PB0022
Emp Name MANU PANICKER
Department ALLSCRIPTS-BARODA
DOJ 1-Aug-11
PAN AQFPP2541L
Proof submission for the financial year 2011-12
Sl. No. Nature of Exemption
1
2
3
4
5
6 Vehicle Log Book
7
8
9
10
11
12 Declaration-ACS Cab Facility
13
14
15
16 3
17 Housing Loan Interest
18 Contribution to Pension Fund - 80CCC
19 Life Insurance Premium - 80C 1
20 Public Provident Fund - 80C
21 Deposit in Post Office Saving Scheme - 80C
22 Deposit in NSC - 80C
23 ULIP - 80C
24 Principle Loan Repayment - 80C
25 Mutual Funds - 80C
26 NHB Scheme - 80C
27 Fixed Deposit in Banks >5 Yrs - 80C
28 Children Education - 80C
29 Long term infrastructure bonds - 80CCF
30 Mediclaim Insurance Premium - Sec 80D
31 Interest on Education Loan Repayment - Sec 80E
32 Medical Expenses of Handicapped Dependent - Sec 80DD
33 Physically Handicapped Employee - Sec 80U
34 Other Income
Documents to beproduced
No of Documentsattached /enclosed
Leave Travel Assistance - (LTA) Refer Notes
Medical Reimbursement Refer Notes
Telephone Expenses Reimbursement Refer Notes
Books & Periodicals Reimbursement Refer Notes
Vehicle Log Declaration Refer Notes
Refer Notes
VER - Fuel Expenses Reimbursement Refer Notes
VER - Repairs & Maintenances Reimbursement Refer Notes
VER - Vehicle Insurance Reimbursement Refer Notes
VER - Vehicle Parking Reimbursement Refer Notes
VER - Chauffeurs Salary Reimbursement Refer Notes
Refer Notes
Computer Maintenance & Internet Connectivity Reimbursement Refer Notes
Uniform Allowance Refer Notes
Helper Allowance Refer Notes
Rent Receipt Refer Notes
Refer Note No. 6 bel
Refer Notes No. 7 bel
Refer Notes No. 8 bel
Refer Notes No. 9 bel
Refer Notes No. 10 b
Refer Notes No. 11 b
Refer Notes No 12 be
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Refer Notes No 12 be
Affiliated Computer Services of India Pvt LtdMedical Reimbursement - Bills Submission for the year 2011-12
Emp No:
Emp Name:
DOJ:
Sl. No. Bill No Date Patient Name Relationship Age Amou
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total
Date: Signature of the Employee
I here by declare that above information is correct and I certify that the above expenditure is incurred towards medicalexpenses for self and my dependent family
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Affiliated Computer Services of India Pvt Ltd
Leave Travel Assistance - Proof Submission for the year 2011-12
Emp No:
Emp Name:
DOJ:
Places Visited
Date From To Mode of Travel
Details of Dependents traveled & cost incurred
Name Age Relationship Amount
Total
Previous Years Exemption details
Year Company Amount (Optional)
2010
2011
Date: Signature of the Employee
I here by certify that the above mentioned information is correct and I further confirm that I shall be fully responsible for any Income Tax
Liability that may arise if this declaration is defective in any manner.
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Affiliated Computer Services of India Pvt Ltd
Telephone Expense Reimbursement - Bills Submission for the year 2011-12
Emp No:
Emp Name:
DOJ:
Telephone numbers in respect of which the reimbursement is claimed:
Sl. No. Telephone / Mobile Number
1
2
3
4
Sl. No. Bill No Date Name appearing on the bills Phone No Amount
1
2
3
4
5
6
7
8
9
10
Total
I here by certify that the above information is correct and I have incurred the above expenditure for office use.
Date: Signature of the Employee
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Affiliated Computer Services of India Pvt Ltd
Books & Periodicals Reimbursement - Bills submission for the year 2011-12
Emp No:
Emp Name:
DOJ:
Sl. No. Bill No Date Details of Books Purchased Amou
1
2
3
4
5
6
7
8
9
10
Total
I hereby certify that the above expenses are incurred by me for purchasing books only
Date: Signature of the Employee
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Self Declaration
To,
The Payroll Department
Affiliated Computer Services of India Pvt Ltd
Bangalore
For the Financial Year 2011-12
SignatureName:
Emp ID:
WIN ID:
Date:
I (EMP No. ) Son / Daughter of hereby declare that, I am maintaining a log book for the above said period with complete details of Journey
undertaken for official purpose which include date of journey, destination, distance and the amount of expenditureincurred thereon. The same will be produced when requested.
I further declare that the expenditure was incurred wholly and exclusively for the performance of official duties and willbe personally responsible for any Income Tax related issues that may arise on this account while employed with ACS orthereafter.
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Affiliated Computer Services of India Pvt LtdVehicle LOG details for the month of -
Emp No:
Emp Name:
Car Make:
Model:
Car Registration No.
Date Destination Odometer (KM) Reading Distance Rate per KM Amo
From To Opening Closing (
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Rs.8.00/- Per K M
Total Amount
DECLARATION
I certify that the above travel are for the purpose of Company's business only.
Date:
Location:
Note: Rate is fixed at Rs. 8/- per KM
Travelled(KM)
(Rate is Fixed atRs.8/- per KM)
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Affiliated Computer Services of India Pvt Ltd
Fuel Expense Reimbursement - Bills submission for the year 2011-12
Emp No:
Emp Name:
VER * Start Date:
Car Registration No.
Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
Total Amount
I certify that the above expenses are incurred for the purpose of Company's business only.
Date: Signature of the Employee
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Affiliated Computer Services of India Pvt Ltd
Repairs & Maintenance Reimbursement - Bills submission for the year 2011-12
Emp No:
Emp Name:
VER * Start Date:
Car Registration No.
Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
Total Amount
I certify that the above expenses are incurred for the purpose of Company's business only.
Date: Signature of the Employee
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Affiliated Computer Services of India Pvt Ltd
Vehicle Insurance Reimbursement - Bills submission for the year 2011-12
Emp No:
Emp Name:
VER * Start Date:
Car Registration No.
Sl. No. Policy Number Date of Premim paid Amount
1
2
3
4
Total Amount
I certify that the above expenses are incurred for the purpose of Company's business only.
Date: Signature of the Employee
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Affiliated Computer Services of India Pvt Ltd
Vehicle Parking Reimbursement - Bills submission for the year 2011-12
Emp No:
Emp Name:
VER * Start Date:
Car Registration No.
Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun
1 11
2 12
3 13
4 14
5 15
6 16
7 17
8 18
9 19
10 20
Total Amount
I certify that the above expenses are incurred for the purpose of Company's business only.
Date: Signature of the Employee
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Affiliated Computer Services of India Pvt Ltd
Chauffeur's Salary Reimbursement - Proof submission for the year 201
To,
The Payroll Department
Affiliated Computer Services of India Pvt Ltd
Bangalore
Sub: Reimbursement of Chauffeur Salary for the Month of ……………………….
Dear Sir,
I request you to reimburse the salary paid to the Chauffeur. The relevant receipt from the Chauffeur is attached herew
Date: …………………….
Employee ID: …………………………………………..
Employee Name: ………………………………………
Employee Signature: ………………………………….
Salary Receipt
Received Rs. …………….……………/- towards salary for the month of ……………….…………………….
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Affiliated Computer Services of India Pvt Ltd
Declaration form for claiming Income Tax rebate on Vehicle Expense Reimbursement for the year (2011 - 2012
Emp No :
Emp Name :
DOJ :
Month ACS Transport facility availed Signature of Employee Signature of LOB Head Remarks
Aug 2011
Sep 2011
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
DECLARATIONI hereby declare that the above information is correct
Location
Date
Signature
Please note,
1 This template will applicable only to employees who are availing ACS Transport facilities.
2 If employee has availed the ACS transport facility for any of the above said months, then the Tax Exemption towards VER for that period will not be prov
Y
E NN
YE N Y
E N
YE N Y
E N
YE N Y
E N
YE N Y
E N
YE N Y
E N
YE N Y
E N
YE N Y
E N
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Affiliated Computer Services of India Pvt Ltd
Computer Maintenance & Internet Connectivity Reimbursement - Proof submission for the year 2011-12
Emp No:
Emp Name:
DOJ:
Sl. No. Bill No Date Details of items Purchased Amount
1
2
3
4
5
6
7
89
10
Total
I hereby certify that the above expenses are incurred by me are towards official / business purposes only
Date: Signature of the Employ
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Affiliated Computer Services of India Pvt Ltd
Uniform Allowance Reimbursement - Proof submission for the year 20
To,
The Payroll Department
Affiliated Computer Services of India Pvt Ltd
Bangalore
Sub: Reimbursement of Uniform Allowance for the Month of ……………………….
Dear Sir,
I hereby certify that I have incurred an expense of Rs.___________ towards the Uniform expenses for the month of _
Please reimburse the same.
Date: …………………….
Employee ID: …………………………………………..
Employee Name: ………………………………………
Employee Signature: ………………………………….
I further declare that the expenditure was incurred wholly and exclusively for the performance of official duties anresponsible for any Income Tax related issues that may arise on this account while employed with ACS or thereaft
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Affiliated Computer Services of India Pvt Ltd
Helper Allowance Declaration - Proof submission for the year 2011
To,
The Payroll Department
Affiliated Computer Services of India Pvt Ltd
Bangalore
Sub: Helper Allowance for the Month of ……………………….
Dear Sir,
Date: …………………….
Employee ID: …………………………………………..
Employee Name: ………………………………………
Employee Signature: ………………………………….
Salary Receipt
Received Rs. …………….……………/- towards salary for the month of ……………….…………………….
I hereby certify that the entire amount of Helper Allowance received by me of Rs.___________ has been fully spent inofficial obligations.
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Date:
Rent Receipt
Received Rs. _______________ from ______________________________________ by
Cash / Cheque / DD no__________________ dated _______________ towards rent for
for the month of ________________________
Address of the House:
Signature of the House Ow
Name:
Address:
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