(To be submitted by 25/03/2014)

WAPCOS LIMITED ( A GOVERNMENT OF INDIA UNDERTAKING )

76-C, SECTOR-18, GURGAON.

INCOME TAX DECLARATION FOR THE FINANCIAL YEAR 2014- 2015 1. Name & Designation: Anmol Jassal/ Engineer RRW No. 1010 2. Residential Address: H.No. H14/14, Malviya Nagar, New Delhi -17 3. Permanent Account No. (PAN): BQLPK3405 R 4. Date of Joining WAPCOS FN/AN: 29.09.2010(F.N)

Proposed Savings/Investments/Expenditure for claiming Income Tax Deduction:- 1. a) Amount of monthly Rent paid, if living in rented house,

for claiming rebate under section 10 (13)(A)

b) Address and PAN No of land lord (please attach original rent receipt duly stamped indicating the address of both tenant & owner for the current Financial Year Rs. 10,000/- PER MONTH latest by 15th May’14, failing which rebate would not be admissible, w.e.f May’14. The second rent receipt has to be submitted by 15th Aug’14 & the last rent receipt by 15/03/15.)

2. Investments made for claiming deduction u/s 80C

(Please mention only savings other than salary deduction):- (i) Repayment of Housing loan (only principal portion) (ii) Annual contribution to pension fund scheme which are eligible for deduction

under section 80(CCC)(I) (iii) L.I.C/P.L.I Premium other than salary deductions : Rs. 80,000/- (iv) NSC/PPF/ULIP (v) Reinvestment of old NSCs

( Please attach photocopies) Date NSC No. Amount Interest Reinvested

Contd..2..

…..2….

(vi) Information regarding school going childrens:-

a) No. of children (Maximum two) b) Tuition fees (excluding development fee/

Donation etc.) paid/payable. (Please attach photocopies)

(vii) Term /Fixed deposit for more than 5 Years.

(viii) V.P.F 3. Rajiv Gandhi Equity Savings Scheme U/S 80 CCG: N/A

4. Amount of Interest on borrowed capital U/S 24(b) : N/A

• Date of Sanction of Housing Loan • Date of Possession of the property.

5.Medi Claim U/S 80 D N/A

a) For self ,spouse and children b) For parents

6 CERTIFICATE / UNDERTAKING a) Certified that Insurance premium are paid up to date. Photocopy of receipt is

enclosed. b) I undertake to furnish related proofs of investments etc., by 15st January 2015 failing

which no deduction on that account would be available/considered and refund of tax, if any deducted, would have to be claimed by me from the Income Tax Department upon filing of tax return.

c) I declare and undertake that in the event of my not making investments as shown

above. I would keep WAPCOS Limited indemnified against all liabilities that may accrue to WAPCOS for short deduction of TDS as provided under the Income Tax Act, 1961.

d) I further declare that WAPCOS shall be unilaterally empowered to adjust the above

amounts against my salary or from any amounts that may be payable to me from WAPCOS and I shall not dispute to any such deduction.

SIGNATURE:- NAME :- ANMOL JASSAL DATE :- 13/03/2014