{ FORM - 12C }

{ FORM - 12C }

< See Rule  26-B >

(Form for sending  particulars of  Income under  Section 192(2B) for the year ending 31.03.2013

1. Name Address of  the Employee        :

2. Designation and Emp.No.                    :

3. Permanent Account Number(PAN)        :

4. Residential Status                   :    Resident

5. Particulars  of Income  under  any   : 

   head of income other than Salaries

   ( not being a loss  under any such  

   head other than the loss under the

   head  "Income from House property"

   received in the  Financial Year. )             

     i) Income  from  House  Property   :        Rs.

        (In  case  of  loss,  enclose          

        Computation thereof)                              

    ii) Profits and gains of business   :           Rs.

        or profession.                                  

   iii) Capital Gains                   :                  Rs.

    iv) Income from other sources(a+b+c):               Rs.

        a) Dividend      : (Rs.                 )

        b) Interest      : (Rs.                  )

        c) Other Income  : (Rs.              )

           ( specify )

6. Aggregate of sub-items (i) to (iv)   :             Rs.

   of Item 5                               

                                      

7. Tax  Deducted  at  Source            :               Rs.

   ( Enclose  certificate(s)

   issued under section 203)                          

Place:  ICF/ PER

Date :   /  /2012.                          Signature of the Employee

______________________________________________________________________

P.T.O

                             VERIFICATION

     I,                                                          . do hereby declare that what is

stated above is true to the best of my knowledge and belief.

     Verified today,  the              day of          2012.

Place:  ICF/ PER

Date :    /    /2012.                                                Signature of the Employee 

     In case  the above  declaration in  Form 12C  contains  any false statement/declaration,  then it may attract penal & prosecution action u/s 277 of the IT Act 1961  which is reproduced below for information.

     Sec.277:  If a person makes a statement in any verification under this  Act or under any rule made thereunder or delivers  an account or  statement  which is false  and  which he  either knows or believes to be false or does not believe to be true,  he shall be punishable :

1.   in a case where the amount of tax which have been evaded  if the statement  or  account had been accepted as true  exceeds  one  hundred  thousand  rupees,  with rigorous  imprisonment  for a term  which  shall not be less than six months but which may extend to seven years and with fine;

2. in any other case,  with  rigorous  imprisonment  for a term  which  shall not be less than 3 months  but which may extend to three years and with fine.  

ANNEXURE TO FORM 12C-I

1)   Name of the Assessee                      :

2)   Designation and Emp.No.                  :

3)   ADDRESS OF THE HOUSE PROPERTY  :

4)   Whether  Permission granted by ICF   :      

     Administration to Construct/

     Own flat /House.                            

5)   HBA  availed  from ICF or Loan from   :

     Financial institutions or both.            

6)   Date of availing loan                          :

7)   INCOME/LOSS FROM THE HOUSE PROPERTY       :

I.  LET-OUT HOUSE PROPERTY - RENTAL VALUE CALCULATION   :

1)   Annual Rental value                          :Rs.

              

2)   Less:  Tax Paid                                 :Rs.

       

3)   Net Annual Rental value                    :Rs.

                                                         

4)   LESS DEDUCTION UNDER SECTION 24(1)

                                                          

     a) Repair Charges 30% of Net annual value :Rs.

     b) Accrued interest on House Building

        Advance Availed from ICF                 :Rs.

     c) Interest on Housing Loan from          :Rs.

         Financial Institutions

5)   Net INCOME/LOSS from house property:Rs.

II.  SELF OCCUPIED HOUSE PROPERTY           

     a) Interest on Housing Loan                :Rs.

                               

     b) Accrued interest on house building  :Rs.

        Advance               

        Loss from House Property                :Rs.           

Place:  ICF/ PER

Date :      /    /2012.                                                    Signature of the Employee 

                                          ANNEXURE-12/C -II

(SELF DECLARATION)

            

   (For employee's who proposed to avail both exempetion of HRA as well as deduction  of Accurred Interest on borrwed amount for House Construction/Ready Build House purchase.)

    I hereby  declare the following, for taking the same  into consideration for computing my Tax Liability for the Assessement Year 2013-2014.

    1.

    2.

    3.

    4.

NOTE: The assessee is  required to furnish the factual  details  as  regards Rental Income/Occupation by dependants with Name,Age,      Relationship,and period of occupation of the said Residential      Accommodation.

          I  also understand that I can be taken up under various sections (140/A(3), 158 BFA,271/(1)(c) of IT ACT 1961 ,for failure to  comply  with statutory provisions.

                          Signature of the Employee:

                          Name of the Employee     :

                          Emp. No.                        :

                          Shop/UNIT/T.No.             :

 Forwarded by: