DECLARATION FOR INSURANCE PREMIUM, INVESTMENTS & RENT DUE AFTER 1st
JANUARY 2025
Employee Name:
Employee Code:
PAN
I hereby confirm that the following investments are due for payment after the cut-
off dates laid out by you for proof submission and therefore request you to
consider the same for the tax computation purpose for the financial year 2024 –
2025. I undertake that I will be depositing these premium /investment/rent
payments and obtain the receipts as per the due dates or by 31 st March 2025. I will
be held responsible for any consequences of not remitting these payments and any
liabilities arise out of this.
Particulars Policy No. / Amount Remarks
Folio No. /
Account No.
Insurance Premium:*
MF - ELSS (SIP)
80CCC (Pension plan)*
80CCD (NPS)
Tuition Fees
80 D (Medical
Insurance)*
January 2025 February 2025 March 2025
Rs. Rs. Rs.
Rent payable
Declaration: I certify that all the above details are true and correct and I am fully
aware of the relevant income tax laws in force regarding the nature of proof
required to claim exemption under the above heads.
Signature of the employee
Date:
*Encl: For all investments, please attach the relevant receipt of previous (FY 24-25) financial year /
premium notice to prove that the policy is in force. Exemption will be provided only in case of the
premium receipt provided for the previous year and not otherwise.
