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Assessment Year 2015-16
Name (*)  
Assessee Type (*)  
Age (*)  
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)