| Assessment Year | 2015-16 |  | 
                                
                                    | Name (*) |  |  | 
                                
                                
                                    | Assessee Type (*) |  |  | 
                                
                                    | Age (*) | *
                                        Age btw 20 to 99 |  | 
                                
                                    |  | 
                                
                                    | Residing City (*) |  |  | 
                                
                                    |  | 
                                
                                    | Items | Actual |  | 
                                
                                    | Gross Salary /Income (*) |  |  | 
                                
                                    | 
                                            
                                                | Basic Salary (Basic + DA) | (*) |  |  |  | 
                                
                                    | Exemptions under section 10 & 17 | 
                                
                                    | Annual Rent Paid |  |  | 
                                
                                    | Actual HRA Received (From Employer) |  |  | 
                                
                                
                                    | Conveyance Allowance 
 |  |  | 
                                
                                    | Medical Reimbursement |  |  | 
                                
                                    | LTA Exemption |  |  | 
                                
                                    | Children's Education Allowance Exemption |  |  | 
                                
                                    | Vehicle Maintenance (petrol/maint. Bills) only if Conveyance Allowance not claimed 
 |  |  | 
                                
                                    | Other exemptions (gratuity, VRS, etc.) |  |  | 
                                
                                
                                    | Professional Tax |  |  | 
                                
                                
                                    | House/property income or loss (enter loss as negative) 
 |  |  | 
                                
                                    |  | 
                                
                                    | Interest on housing loan (for tax exemption) 
 |  |  | 
                                
                                
                                    |  | 
                                
                                    | Income/Loss on Equity Shares & Equity Linked Mutual Funds (STT Paid) | 
                                
                                    | Short Term Capital Gains, if holding period of shares is less than 1 year (Tax @15%
                                        p.a.) |  |  | 
                                
                                    | Long Term Capital Gains, if holding period of shares is more than 1 year (NIL) |  |  | 
                                
                                
                                    |  | 
                                
                                    | Other Income | 
                                
                                    | Bank (Saving/FD/Rec) |  |  | 
                                
                                    | N.S.C. (Accrued/Recd) |  |  | 
                                
                                    | Post office M.I.S. (6 years) |  |  | 
                                
                                    | Post office Recurring Deposit (5 years) |  |  | 
                                
                                    | Term Deposit (1 to 5 years) |  |  | 
                                
                                    | Saving Bonds (6 years) |  |  | 
                                
                                    | Kisan Vikas Patra |  |  | 
                                
                                    | Any Other Income |  |  | 
                                
                                
                                    |  | 
                                
                                    | Deductions under Chapter VI (sec 80C) upto Rs.1,50,000/- | 
                                
                                    | NSC & NSS |  |  | 
                                
                                    | Public Provident Fund |  |  | 
                                
                                    | Employees Provident Fund & Voluntary PF |  |  | 
                                
                                    | Pension scheme (sec 80CCC) |  |  | 
                                
                                    | Children's Education (Upto RS 200/-) |  |  | 
                                
                                    | Housing loan principal repayment |  |  | 
                                
                                    | Insurance premium (After 1st April 12) |  |  | 
                                
                                    | Infrastructure Bonds & others (MF, ULIP, FD, etc.) |  |  | 
                                
                                    | FD for 5 years |  |  | 
                                
                                    | Post office saving in 10/15 years |  |  | 
                                
                                    | Tuition fees (Excluding donation, development fees upto Rs 24,000/- |  |  | 
                                
                                
                                    |  | 
                                
                                    | Deduction Under 80CCG (Rajiv Gandhi Equity Saving Scheme) | 
                                
                                    | Annual income is < Rs. 10 lakh can invest in this scheme up to Rs. 50,000 and get
                                        a deduction of 50% of the investment |  |  | 
                                
                                    |  | 
                                
                                    | Deductions under Chapter VI-A (sec 80D to 80U) | 
                                
                                    | Medical Insurance Premium for self & family (sec 80D) |  |  | 
                                
                                    | Medical Insurance Premium for parents (sec 80D) 
 |  |  | 
                                
                                    |  | 
                                
                                    | Medical for handicapped dependents (Sec 80DD) 
 |  |  | 
                                
                                    |  | 
                                
                                    | Medical for specified diseases (Sec 80DDB) 
 |  |  | 
                                
                                    |  | 
                                
                                    | Deduction for permanent disability (80U) 
 |  |  | 
                                
                                    | Education Loan Interest Repayment (Sec 80E) |  |  | 
                                
                                    | Donation to approved fund and charities (sec 80G) (Contribution to exempt charities – 25/50/75/100% depending
                                            on the charity & 100% exemption on donation to political parties)
 |  |  | 
                                
                                    |  | 
                                
                                
                                    | Deductions under (Sec. 80TTA) (Interest earned on balance in savings bank account
                                            subject to a maximum of Rs. 10,000 per year.)
 |  |  | 
                                
                                    |  | 
                                
                                    | Deduction under 80RRB section in respect of any Income by way of Royalty of a Patent |  |  | 
                                
                                    | Rent deduction (sec 80GG) only if HRA not received |  |  | 
                                
                                    | Any other deductions |  |  | 
                                
                                    | Interest on up to Rs 1.50 lac Housing Loans Section (Excluding Rs. 1 lac p.a. u/s 80c Saving)
 |  |  | 
                                
                                
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