Certificate for claiming Income Tax rebate for the re-payment of House Building Advance during the Year 2012 - 2013

Certificate for claiming  Income Tax rebate for the   re-payment  of

House  Building Advance  during the  Year 2012 -  2013

1. Name                                      :

2. Employee Number.                   :

3. Designation/Bill Unit                 :

4. Location  (address of the           :

                   residential house/flat

               purchased/constructed)

5. House or Flat and Area               :

6. From whom purchased               :

7. In whose name the above property  :

   has been purchased/built.

8. Cost of the property excluding cost  :

   of land  share  and initial deposit

9. Reference to the permission granted  :

   by  the Admn, may be furnished

(copy of permission letter to be enclosed)

10.Whether construction has been  completed   in   all respects:

11.Whether used for own residence or rented out :

12.If rented out,  partly or fully the

   rental income   per  month and year       :

   (please see note 3).

13.Details of Advance/Borrowing               :

  (a) House Building Advance from Govt.    :

      (copy of O.M. to be enclosed)

  (b) Borrowing from Bank(produce proof)  :

  (c) Borrowing from LIC/other financial     :

      Institutions (produce the proof)

  (d) Own savings and other sources          :

                              T O T A L                   :

                                                                                        Cont.2/-

                  -   :  Page :   2    : -   

14.Recovery of principal against HBA :

  (i) Monthly recovery                       :

 (ii) Outstanding loan as on 1st March:

      (Copy  of  Feb  pay  slip to be  enclosed)

15.Re-payment of loan towards principal :

   only during the year

          { for 13 (b) and   (c) only }

16.Whether you are an Income Tax assessee,

   if so the Number given by the Income Tax   :

   Officer/ Department.

17.Date of retirement                        :

          I  declare that on my being allowed rebate under Section 80-C at source for repayment  of House Building Loan  as  mentioned  against serial  No.14 and 15 above. I shall not claim these separately in my income tax return and pay the tax as due.

Place:                          Signature :

Date :                          NAME      :

                                EMP.NO.   :

Forwarded to APO/Bills.

N O T E:

          1.  In the 1st year of availing the above rebate, all

                   the 17 columns must be filled up.

         2. In subsequent years col.5 to 10 and 13 need  not be filled