Hi, You can use below format for Rent & Investment Declaration from Employees. Please collect document as per below: 1. Medical Reimbursement Bills 2. LTA Bills 3. VI A investment proof- PPF,LIC,Bank Certificate for Principal & Interest payment 80 CC- up to 150000 4. Medical Insurance -80 D 5. NPS -Sec 80 CD To Whomsoever It May Concern Declaration to be provided by Landlord as per Circular No.5/2011 dated 16.08.2011 issued by Central Board of Direct Taxes (CBDT) I, ________________________________________________ hereby declare that I own a residential house located at _________________________________________________ which has been rented to Mr.________________________________________________ from __/__/____ to __/__/_____ for a monthly rental of Rs.______. As per Circular no.5/2011 dated 16.08.2011 issued by CBDT, I hereby also declare that I receive rent which exceeds Rs. 100,000/- per annum and I do not have a valid Permanent Account Number (PAN). Name of the Landlord : - ______________________________________ Address :-_______________________________________ ________________________________________ Signature of Landlord: Date : FORM NO. 12B [See rule 26A] Form for furnishing details of income under section 192(2) for the year ending 31st March, 2014 Name and address of the employee ………………………………………………………………………………………………………………………… Sapient ID ……………………………………………………………………………………………………………………………………………….. Permanent Account No. ………………………………………………………………………………………………… Residential Status ………………………………………………………………………………………………… Particulars of salary as defined in section 17, paid or due to be paid to the employee during the year Serial Name and address TAN of the Permenent Period of Total amount Total amount Value of Total of Amount Total amount Remarks Number of employer(s) employer(s) Account employment of salary of house rent perquisites and columns deducted of tax deducted as allotted Number exculding allowance, amount of 6, 7 and 8 in respect during the by the ITO of the amounts conveyance accretion to of life year (enclose employer(s) required to allowance and employee's insurance certificate be shown in other allowances provident fund premium, issued under columns 7 to the extent account provident fund section 203) and 8 chargeable to (given details contribution, tax [See section in the Annexure) etc, to which 10(13A) read section 80C with Rule 2A Applies (Give and section details) 10(14) 1 2 3 4 5 6 7 8 9 10 11 12 ……………………………………. Signature of the employee Verification I,…………………………….. do hereby declare that what is stated above is true to the best of my knowledge and belief. verified today, the ……………….. day of …………………..200 Signature of the employee ANNEXURE [See column 8 of Form No. 12B] Particulars of value of perquisites and amount of accretion to employee's provident fund account Name and address of the employee ………………………………………………………………………………………………………………………… Permanent Account No. ………………………………………………………………………………………………… Name of the employee TAN/PAN Value of rent-free accomodation or value of any concession in rent for the accommodation provided by the employer (give basis of computation) of the [See rule 3(a) and 3(b)] employer Where accommodation is furnished Where acco- Value as if Cost of furniture Perquisite value Total of Rent, if any Value of mmodation accummodation (including Television of furniture (10% of columns paid by the perquisite is unfurnished is unfurnished sets, radio sets, column 5) OR 4 and 6 employee (column 3 refrigerators, other actual hire minus household appliances charges column 8 or and air-conditioning payable column 7 minus plant or equipment) column 8 as OR hire charges,if as may be hired from a third applicable party 1 2 3 4 5 6 7 8 9 ANNEXURE (Contd.) Whether any conveyance has been provided by the employer free or at a concessional rate or whre the employee is allowed the use of one or more motor cars owned or hired by the employer, estimated value of perquisite (give details) [See rule 3 (c )] Remuneration paid by employer for domestic and/or personal services provided to the employee (give details) [See rule 3(g)] Value of free or concessional passages on home leave and other travelling to the extent chargable to tax (give details) [See rule 2B read with section 10(5)(ii)] Estimated value of any other benefit or amenity provided by the employer, free of cost or at concessional rate not included in the preceding column (give details), e.g., supply of gas, electricity or water for house hold consumption, free educational facilities, transport for family, etc, (See rule 3(d), 3(e) and 3(f)] Employer's contribution to recognised providend fund in excess of 12% of the employee's salary (See Schedule IV- Part A Interest credited to the assessee's account in recognised providend fund in excess of the rate fixed by the Central Government [See Schedule IV - Part A] Total of columns 9 to 15 carried to column 8 of Form No. 12B 10 11 12 13 14 15 16