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(Kindly visit : https://incometaxindia.gov.in/Pages/Deposit_TDS_TCS.

aspx for details and clarification)


Declaration Form for the F.Y. 2022-23 (A.Y. 2023-2024)
(Only for individuals (Contractual staff drawing Salary > Rs 3 lacs)
NAME: DEPARTMENT:
Sr. Citizen: Yes/No DESIGNATION: PAN NO.:
Tax Calculation (please tick one option) Old Tax Regime New Tax Regime

Particulars Amount in Rs

Part A Gross annual Salary (after 0


deducting Rs 50000 standard Deduction)
(March 2022 to February 2023)

Particulars of Investments/Deduction Amount in Rs

1. 10(13A) Rent Paid (For HRA exemption, employees should provide self-attested copy of rent
agreement and rent receipts/Bank statement for all months i.e. from April 2022 to March 2023).
Enclose photocopy of PAN of Landlord where Rent per month is above Rs. 8333/-
2. 24(1)(b) Interest on Housing Loan up to Rs.2,00,000/- (Rs.3,00,000 for senior citizen)
3. 80C Particular Investment Amount in Rs.
PPF/GPF
LIC (Certify that the policy/policies is/are
paid by self only)
Sukanya deposit
GIS/NSC
Tuition Fee (other than reimbursed by office)

NPS (other than deducted by office)


Post office time deposits
Repayment of principal amount of housing loan/HBA

Any other allowed Investment if any, specify

Additional Deduction u/s. 80CCD(1B) (upto


Rs. 50,000/-)

(Maximum limit up to Rs. 2,00,000/-).


4. 80D 1) Medical Insurance Premium, including premium for parents (Max. Limit Rs.25,000/-). If self or parents are
senior citizen then max limit of Rs. 50,000/-
2) Payment for Preventive Health Check-up (Max. Limit Rs. 5,000/-)
Note: (a) Maximum limit of (1) will be reduced to the extent claim in (2) has been availed.
(b) Total of (1) and (2) not to exceed Rs. 50,000.

5. 80DD Maintenance / Treatment of Handicapped dependent or deposit for maintenance of Handicapped


dependent who is person with disability (max. Rs.75,000/- for disability and Rs.1,25,000/- for severe disability
80% and above).

6. 80E Interest on a loan taken for higher education max. 8 years.(no limit).

7. 80EEA Additional Deduction for Interest on Home Loan sanctioned first time during 01.04.2019 to 31.03.2022 (Max
Rs. 150,000/-)

8. 80EEB Deduction for Interest on Loan taken to Buy Electrical Vehicle during 01.04.2019 to 31.03.2023
(Max Rs. 150,000/-)
9. 80G Donation should be made only to specified Fund (Prime Minister’s Relief Fund, Chief Minister’s
Relief Fund or Lt. Governor’s Relief Fund). Rebate for any other donation should be claimed directly.

10. 80GG Rent paid in excess of 10% of total income for furnished/unfurnished residential accommodation (subject to
maximum of Rs. 5,000 p.m. or 25% of total income, whichever is less)
11. 80U Physical Disability (max. Rs.75,000/- for disability and Rs.1,25,000/- for severe disability 80%
or more) please attach certificate.

Part B Total deduction


0

Part C Net Salary (A-B)

Part D Any other income:


1) Salary Income (other Than PSeGS) :
2) Income from House Property (If let out) :
3) Income from other sources (Honorarium or Professional
income from other Institutes) :

Part E Part (C+D) Total Taxable Income: 0


Part F Total tax due on (Part E):
Part G Total TDS Deducted till date:
Part H Part(F-G) Balance TDS Payable:

DECLARATION
1.I hereby declare that the particulars given on pre-page/above are correct and complete in all
respect of Financial Year 2022-23 (Assessment Year 2023-24).

2.The self-attested documentary proof for claiming the benefits of various savings / investments already made or likely to be made, will be
submitted by 20th January 2023, failing which the tax may be recovered from me by nullifying the savings / investments stated in declaration
form.

3.I hereby state that the claim of deduction shown above is in my name and if it is in joint account then it is declared herewith that the other claimant
will not claim it in his/her ITR.
4.In case of payment/ contribution/ investments, I will produce the original document for verification,whenever it will be asked for.

Last date of submission of Declaration Form: 7th January, 2023


Note: Tax (tentative) will be deducted on the basis of above declaration up to January 2023. For F ebruary 2023, tax will be deducted as
per applicable rates, if details of savings supported with self-attested documentary proof are not submitted by 20th January 2023.

Signature of the Employee


Date:

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