Haryana Power Generation Corporation Ltd.

Income tax statement of Sh./Smt. ______________________________ for the financial year 2011-12 (Assessment Year 2012-13).Employee Code: _______________________________Bank Account No: ______________________________Permanent Account No:__________________________

Sr. No.

Pay &Allowances

Rate Period Rs. Rs.

From To To be filledin by the

Employee

For Officeuse

1. PayPay Arrear

2. Grade Pay incl. arrear

3. PersonalPay/SpecialPay/BOE

4. HardshipAllowance

5. Cash Medical Allowance

6. ProjectAllowance/Const.Allowance

7. Rent freeConcession

8. Honorarium9. Production Bonus10. Electricity

Allowance11. Shift Duty Allowance

12. DA

13. Reimbursement of School Fee

14. Leave Travel Allowance (OneMonth Salary)

15. Othercomponent

16. Total (A)17 A (a) when Accomodation is owned by PGCS

Add 15% of Total (A) above where Rent Free Accommodation or on Concessional Rent was provided in the above period in a city of population exceeding 25 lakhs as per 2001 census. OR @ 10% if the accommodation so provided in a city of population more than 10 lacs but not exceeding 25 lac as per 2001 census. OR 7.5% population not exceeding 10 lakhs as per 2001 census. (ii) Less : Rent Deducted in case of accommodation on concessional rate. (b) When accommodation is taken lease by HPGCL Amt of lease rent paid on 15 % of salary Less: Rent Deduction.

Sr. No. Particulars To be filledIn by theEmployee

For Office Use.

17(B) Add interest concession on Loans (Annexure–A

attached)

18. Any other income (To be specified)

19. Add: Actual House Rent Allowance received

from the Corporation during the above period.

Less: Deduction being least of the following

(i) Actual HRA received during the period

(ii) 40% of the Salary (Pay+GP+DA) during the

above period

(iii) HRA paid in excess of 10% of salary during

the period (Salary here means Pay+GP+DA).

20. Total (Income chargeable under the head “Salaries”)

21. Any other income:

(i) Income from Bank Interest/ Accrued int on NSC’s

(ii) income from House Property

(iii) Less from House Property

( Accrued Interest on HBA)

22. Gross Total Income (20+21)

23. Net Taxable Income

24 Deductions under Section 80(c)

25. Amount deposited in GPF/CPF (Account

No. _________________________)

26. Amount deposited in Mutual Fund*

27. Life Insurance Premium

28. GIS

29. Investment made in the NSCs

30. Tuition Fee of Children (Restricted to two

Children only)

31. Amount deposited in PPF (Account

No. ___________________________) up to

100000/- as per PPF scheme

32. Repayment of Housing Loan towards cost of

construction/purchase of residential property.

33. CTD Deposit in 10 years account or 15 years

account in post office

34. Term Deposit for the period of 5 years or more

with schedule bank.

35. Any other deduction(s) if any allowable u/s

80(c) of income tax.

36. Deductions under Section-80 CCC

LIC Jeewan Suraksha/Pension Plan

Sr. No. Particulars To be filledIn by theEmployee

For Office Use.

37. Total Deductions (Subject to a maximum of

Rs. 1,00,000/- u/s 80C & 80CCC) total of 25 to 36

38 Deduction u/s 80 CCF Long Term-Infrastructure

Bonds ( Subject to maximum Rs 20000/-)

39. Deduction u/s 80-D Medi-claim policy/Central

Govt. Health Scheme)

(i) For Senior Citizen – Maximum Rs. 20,000/-

(ii) For Others – Maximum Rs. 15,000/-

40. Deduction u/s 80-DD Mtc. of handicapped dependent.

41. Total Deduction (37+38+39)

42. Total Income (23-41)

43 Tax on total Income

For Women assessee:

Up to 1,90,000/- Nil

From 1,90,001/- to 5,00,000/- @ 10%

From 5,00,001/- to 8,00,000/- @ 20%

Above Rs. 8,00,001/- @ 30%

For Senior Citizen Assessess :

Up to Rs. 2,50,000/- Nil

From 2,50,001/- to 5,00,000/- @10%

From 5,00,001/- to 8,00,000/- @ 20%

Above Rs. 8,00,001/- @ 30%

For other Assessees :

Up to Rs. 1,80,000/- Nil

From 1,80,001/- to 5,00,000/- @10%

From 5,00,001/- to 8,00,000/- @ 20%

Above Rs. 8,00,001/- @ 30%

44. Net Tax Payable

45. Add : Education Cess @ 2% (to be calculated on 44)

46. Add : Higher Education @ 1% (to be calculated on 44)

47. Total Tax payable (43+44+45+46)

48. Less : Tax deducted at source

49. Balance to be Recovered/Refunded

Special Notes with regard to certain investments/contributions/payments:

PPF : Must specify the PPF Account No. Also attach the proof of deposit in the PPF

MUTUAL FUND: Please provide the following details.

Sr. No. Name Relationship Amount invested

CTD Deposit: Please provide the following details.Sr. No. Name Relationship Amount invested

Life Insurance premium Details: Aggregate of the total premium worked out in the following columns should be indicated in the column No. 26 above.

Sr. No. Policy No. Amount ofInsurance

Amount ofInsurancePremium

(b) Certified that I had purchased the following National Saving Certificates VIII issue in my name or in the name of my spouse or my minor children out of my savings. These have not been en-cashed so far and the interest accrued thereof is to be treated as re-invested. I am entitled for deductions under Sec-88 of the Income Tax Act as under:-

Sr. No.of NSC

Date ofPurchase

Face Valueof Certificate

The Year Ist/2nd/3rd/4th/or 5th completed Year

Amount ofInterestDeemed to be Invested.

Note:- Interest on issue of NSCs to be calculated onThe basis of table ‘A’ attached: Total Rs.______________

Children Fee : The concession of children fee is available for payment made to a recognized institute towards the tuition fee not being fund or development fund etc. the concession is available only for two elder children in case of more than two children.

Note:

(i) Certified that I have not been provided with any Motor-Car, Motor cycle, Scooter or other moped for use otherwise than wholly or exclusively to the performance of my official duties.

(ii) Certified that the Local Outdoor Duty Allowance/Special allowance paid to me for the period _________ to __________ has been fully spent on the performance of my official duties within a radius of 8 Kms from the place of my duty and has not resulted to be source of profit.

(iii) I am residing in Board’s accommodation/quarter/Kothi No. __________________ field hostel Since ____________________.

(iv) Certified that the deposits under NSS were made out of income chargeable to tax and deposits, if any or previous years en-cashed during the year 2009-2010 have been made included in the income along with interest thereon.

(v)(vi) Certified that deposits under NSC/CTD/ULIP/LIC/mutual Funds/ULI/PPF/PLI

etc. were made out of income chargeable to tax.

(Signature of Assessee)

Name:_____________________

Designation:________________

Address : __________________

To, The Chief Accounts Officer,Pay & Accounts Section,HPGCL, Panchkula.

CERTIFICATE FOR THE DRAWL OF LOCAL OUTDOOR DUTY ALLOWANCE FOR THE PERIOD OF 1-4-2011 TO 31-03-2012

Certified that:-1. I have not been provided with corporation’s vehicle.

2. I will not use any vehicle of the corporation for the performance of journeys within a radius of 8 kms.

3. In the event of my availing any leave other than casual leave I shall inform the drawing & Disbursing Officer.

4. I a maintaining a Motor-Car/Motor cycle/Moped No. _________________ Which is duly registered in my name and the same is being used for corporation’s work.

5. I further authorize the drawing & disbursing officer to effect recovery of any amount found to have been paid to me in excess of this amount from my monthly salary.

(Signature of the Claimant)

Name : __________________________

Designation:______________________

Place of Posting : _________________

CERFICATE FOR REIMBURSEMENT OF ELECTRCITY CHARGES FOR THE PERIOD 1-4-2011 TO 31-03-2012.

Certified that I am class ________ employee and entitled for free electricity unit i.e. ________ units per month, which have been fully consumed by me/my family and paid to the authority concerned/landlord etc.

I undertake that the above declaration given by me is true and correct and nothing has been concealed therein. I further undertake that I am liable to face disciplinary or other appreciated legal/penal action, which could involve recovery and penalty, if any of the aforesaid information is found false or incorrect.

(SIGNATURE OF THE EMPLOYEE)

Date : Name: __________________________

Designation:______________________

Office:___________________________

CERTIFIED THAT:-

1. My wife/ husband is not working in the employment of Government of Haryana or under the Central Government or any other State Government or under any other organization/institution/body etc. wholly or substantially owned or controlled by the Central Government or any State Government promising any scheme of children Education Allowance in nature.

2. My husband/wife is/will not claim/reimburse this amount from his/her employer under Children Education Allowance Scheme.

3. I am eligible to raise the claim.4. The claim is permissible under the Children Education Allowance Scheme,

The amount of Rs. ______________ actually paid by me in respect of following my children may be reimbursed to me:-

Sr. No. Name of Child Relation with Date of Birth Mother/Father Class claimant Name

1. 2. 3. 4. 5. 6.

(SIGNATURE OF THE EMPLOYEE)

Date : Name: __________________________

Designation:______________________

Office:___________________________

Note: Please attach the saving proof duly signed.