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All the proofs have to be uploaded using the scan image option using the link "Upload IPSF Proof Images". Any proofs that are
dropped in the IPSF drop-bo !ill not be accounted. Please ensure to consolidate all the images of your investment proofs scan
the duly signed IPSF form # anneures $i f any% create a &IP file # upload.
'itachi (onsulting Soft!are Services India Pvt )td IPSF ID : 0102200757
Investment Proofs Submission Form for the *ear +,-+,/
Employee ID * 06137 Gender * M Date of Jonn! 0"#11#2010
$ame * %&tta $aya' $o( of %&ldren !on! to S)&ool * 2
P$ * D+P$,150- $o( of %&ldren !on! to .o/tel * 2
As Per )ast
0eclarationSection 1 - (hapter 2I A - 0eductions from 3otal Income 2alue of Proof Attached.
0 Med)al In/ran)e Premm #/ "0D 0(00
0 Med)al In/ran)e Premm #/ "0D 4 Parent/ not en! Senor %ten/ 0(00
0 Med)al In/ran)e Premm #/ "0D 4 Parent/ en! Senor %ten/ 0(00
0 Med)al reatment#.and)apped Dependent #/ "0DD 8 "09 0(00
0 Med)al reatment#.and)apped Dependent #/ "0DD "09 0(00
0 Intere/t on Ed)atonal ;oan #/ "0E 0(00
0 Permanent P&y/)al D/alty "0 8 "09 0(00
0 Permanent P&y/)al D/alty Se<ere D/altty "0 "09 0(00
0 -a=< Gand& E>ty Sa<n!/ S)&eme "0%%G 0(00
0 Med)al reatment of Spe)fed D/ea/e/ "0DD? 0(00
0 ddtonal $PS Employee %ontrton"0%%D1? 0(00
Section ( - (hapter 2IA - Section 4,(
0 %ontrton to Pen/on Fnd "0%%% 0(00
0 ;fe In/ran)e Premm Jee<an D&ara@ Jee<an '/&ay et) ,21"(00
0 Pl) Pro<dent Fnd PPF 0(00
0 $atonal Sa<n!/ %ertf)ate $S% 0(00
0 Infra/tr)tre ?ond/ 0(00
0 %&ldren Ed)aton ton fee/ 0(00
0 E>ty ;n'ed Sa<n!/ S)&eme E;SS 0(00
0 Mtal Fnd/ 0(00
0 nt ;n'ed In/ran)e Plan 0(00
0 5 Aear Depo/t nder Senor %ten Sa<n! S)&eme 0(00
0 %mlat<e erm Depo/t/ 0(00
0 5 Aear me Depo/t n Po/t Bff)e 0(00
0 $PS Employee %ontrton 0(00
0 S'anya Samrdd& S)&eme 0(00
150000 .o/n! ;oan 4 Prn)pal mont pad@ -e!/traton Fee/@ Stamp dty 1"675C(5,
0 Fed Depo/t S)&eme ?lo)' Perod of 5 yr/ 0(00
0 $S% Intere/t ll al/o e )on/dered a/ Bt&er In)ome 0(00
Section 0$b% - )oss from 'ouse Property - S5)F 6((UPI50
4200000 ;o// from .o/e Property 4 SE;F B%%PIED 4510C3(C1
Section 7 - 6ther Income
0 ?an' Intere/t e) ldn! ntere/t on /a<n!/ a))ont 0(00
0 Intere/t on Depo/t/ n Sa<n!/ ))ont %on/dered a/ ded)ton #/ "0 pto -/(10000 0(00
0 Pen/on 0(00
0 Bt&er/ 0(00
De)laraton:
1( I &erey de)lare t&at I &a<e read and nder/tood t&e !delne/ pro<ded n Proof/ Bpton Do)ment and t&at@ all nformaton@do)ment/ pro<ded
ao<e / tre and )orre)t n all re/pe)t/(
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2( I al/o nderta'e to ndemnfy t&e )ompany for any lo//# lalty t&at may ar/e@ n t&e e<ent of any n)orre)t nformaton @do)ment/
pro<ded y me(
Date:
Pla)e: S!natre of Employee *
* Ind)ate/ mandatory feld/ a/ per or dataa/e( Plea/e <erfy t&e /ame and f lan'@ plea/e fll and /mt t&e form(
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0eclaration for availing 8oint 'ousing )oan 1enefit $Self 6ccupied%
5mployee Id 9 06137
5mployee :ame 9 %&tta $aya'
'ousing )oan A;c :o 9
1ank :ame 9
Address of the Property 9 G41001@ l)o<e@ Pmple Sada!ar
I@ (hitta :ayak @ &erey de)lare t&at t&e ao<e loan &a/ een n t&e Jont name and t&e EMI / en! pad y me n t&e eloH
mentoned pattern(
I declare that the above details furnished are correct to the best of my kno!ledge and !ill be personally responsible
for any Income 3a related issues arising out of this declaration in the future.
3he details are as given belo!9
:ame of o!ner %&tta $aya'
< of 5=I distribution9 ,,
Signature
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Self declaration given for possession of 'ousing property$in the absence of
Possession certificate% - Self 6ccupiedppl)ale f &o/n! loan ntere/t #prn)pal ded)ton eneft / )lamed #/ 2C
&/ / to de)lare t&at I %&tta $aya'@ &a<e !aned t&e oHner/&p# po//e//on of my &o/e property lo)ated at t&e folloHn!
addree/@ on 2"#10#2013DD#MM#AAA A(
ddre//:
G41001@ l)o<e@ Pmple Sada!ar
P$E@ M.-S.-
;oan ;ender# ?an' $ame: S?I
;oan San)ton Date : 2"#10#2013
Date: ((((((((((((((((((((((((( S!natre
:ote9 Se)ton 2C of t&e )t alloH/ ded)ton from n)ome from &o/e property on ntere/t on orroHed )aptal a/
nder:4
&e ded)ton / alloHed only n )a/e of &o/e property H&)& / oHned and n t&e o))paton of t&e employee for &/
oHn re/den)e( .oHe<er@ f t / not a)tally o))ped y t&e employee n <eH of &/ pla)e of t&e employment en! at ot&er
pla)e@ &/ re/den)e n t&at ot&er pla)e /&old not e n a ldn! elon!n! to &m(
&e &o/e /o a)>red or )on/tr)ted /&old e )ompleted Ht&n3 year/ from t&e end of t&e FA n H&)& t&e )aptal
Ha/ orroHed( .en)e t / ne)e//ary for t&e DDB to &a<e t&e )ompleton )ertf)ate of t&e &o/e property a!an/t H&)&
ded)ton / )lamed et&er from t&e lder or t&ro!& /elf4de)laraton from t&e employee(
Payroll 0eduction
Particulars Amount Pro<dent Fnd 7C520(00
Payroll 0eduction - 3otal >?+,.,,