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1/24/13

IT Proof Submission - 201200044874

IT Declaration Form - FY 2012-2013
21 04 8 4 0 2 04 7 0
Imp: Please do not fold near the barcode

Employee No :

825033

Employee Name :

Aman Gupta

Company Name Wipro Infotech : Employee PAN ASYPG0896Q : A) Exemptions Under Section 10/17 1) Housing Rent Directly Paid B) Deduction Under Chapter VIA a) Section 80C and 80CCC 1) Insurance Premium 2) PF/VPF

Company Code WI01 : Date of Joining 19-MAY-2011 : Declared Amount 96000 Declared Amount 60714 10830 Verified Amount Verified Amount

I hereby declare that the information furnished is true and that the company can rely on it for deducting income tax at source from salary income. If the above information is found inaccurate as a result of which my claim for exemption is not admissible, I under take to keep the company fully indemnified in respect of all costs, charges and consequences thereof. I also understand that the company will be free to take further action as it may deem appropriate.
Subm ission ID : 201200044874 Date Of Subm ission : 23-JAN-2013 Signature of the Em ployee

INSURANCE PREMIUM DETAILS
NAME OF THE EMPLOYEE EMPLOYEE NO BUSINESS UNIT /DEPARTMENT LOCATION Aman Gupta 825033 WI01 GDC
1/2

https://gateway.wipro.com/NASApp/hrweb/payroll/,DanaInfo=tedapplb.wipro.com+pay_emp_savings_print.jsp

1/24/13

IT Proof Submission - 201200044874

1. Premiums paid during 2012-2013
SL NO Policy No 1 2 164453542 165097380 Mode (Q/H/Y) Half Yearly Yearly Prem ium Am ount (Rs) 6337 48040 Total Am ount (Rs) 12674 48040

TOTAL Prem ium paid Grand TOTAL

60714 60714

2. Details of premium due in Jan, Feb & Mar
SL NO 1 Policy No Mode (Q/H/Y) Prem ium Am ount (Rs) 0 Total Am ount (Rs) 0 Due On (DDMON-YYYY)

TOTAL Prem ium Due Grand TOTAL

0 60714

I here by declare that the premiums due in the months of Jan, Feb & March 2013 will be paid as per due date.

Submission ID : 201200044874 Date Of Submission : 23-JAN-2013

Signature

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