it proof submission format 2011-12 (2)

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Affiliated Computer Services of India Pvt Ltd

Emp No. PB0022

Emp Name MANU PANICKER

Department ALLSCRIPTS-BARODA

DOJ 1-Aug-11

PAN AQFPP2541L

Proof submission for the financial year 2011-12

Sl. No. Nature of Exemption

1

2

3

4

5

6 Vehicle Log Book

7

8

9

10

11

12 Declaration-ACS Cab Facility

13

14

15

16 3

17 Housing Loan Interest

18 Contribution to Pension Fund - 80CCC

19 Life Insurance Premium - 80C 1

20 Public Provident Fund - 80C

21 Deposit in Post Office Saving Scheme - 80C

22 Deposit in NSC - 80C

23 ULIP - 80C

24 Principle Loan Repayment - 80C

25 Mutual Funds - 80C

26 NHB Scheme - 80C

27 Fixed Deposit in Banks >5 Yrs - 80C

28 Children Education - 80C

29 Long term infrastructure bonds - 80CCF

30 Mediclaim Insurance Premium - Sec 80D

31 Interest on Education Loan Repayment - Sec 80E

32 Medical Expenses of Handicapped Dependent - Sec 80DD

33 Physically Handicapped Employee - Sec 80U

34 Other Income

Documents to beproduced

No of Documentsattached /enclosed

Leave Travel Assistance - (LTA) Refer Notes

Medical Reimbursement Refer Notes

 Telephone Expenses Reimbursement Refer Notes

Books & Periodicals Reimbursement Refer Notes

Vehicle Log Declaration Refer Notes

Refer Notes

VER - Fuel Expenses Reimbursement Refer Notes

VER - Repairs & Maintenances Reimbursement Refer Notes

VER - Vehicle Insurance Reimbursement Refer Notes

VER - Vehicle Parking Reimbursement Refer Notes

VER - Chauffeurs Salary Reimbursement Refer Notes

Refer Notes

Computer Maintenance & Internet Connectivity Reimbursement Refer Notes

Uniform Allowance Refer Notes

Helper Allowance Refer Notes

Rent Receipt Refer Notes

Refer Note No. 6 bel

Refer Notes No. 7 bel

Refer Notes No. 8 bel

Refer Notes No. 9 bel

Refer Notes No. 10 b

Refer Notes No. 11 b

Refer Notes No 12 be

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Refer Notes No 12 be 

Affiliated Computer Services of India Pvt LtdMedical Reimbursement - Bills Submission for the year 2011-12

Emp No:

Emp Name:

DOJ:

Sl. No. Bill No Date Patient Name Relationship Age Amou

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Total

Date: Signature of the Employee

I here by declare that above information is correct and I certify that the above expenditure is incurred towards medicalexpenses for self and my dependent family

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Affiliated Computer Services of India Pvt Ltd

Leave Travel Assistance - Proof Submission for the year 2011-12

Emp No:

Emp Name:

DOJ:

Places Visited

Date From To Mode of Travel

Details of Dependents traveled & cost incurred

Name Age Relationship Amount

Total

Previous Years Exemption details

 Year Company Amount (Optional)

2010

2011

Date: Signature of the Employee

I here by certify that the above mentioned information is correct and I further confirm that I shall be fully responsible for any Income Tax

Liability that may arise if this declaration is defective in any manner.

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Affiliated Computer Services of India Pvt Ltd

Telephone Expense Reimbursement - Bills Submission for the year 2011-12

Emp No:

Emp Name:

DOJ:

Telephone numbers in respect of which the reimbursement is claimed:

Sl. No. Telephone / Mobile Number

1

2

3

4

Sl. No. Bill No Date Name appearing on the bills Phone No Amount

1

2

3

4

5

6

7

8

9

10

Total

I here by certify that the above information is correct and I have incurred the above expenditure for office use.

Date: Signature of the Employee

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Affiliated Computer Services of India Pvt Ltd

Books & Periodicals Reimbursement - Bills submission for the year 2011-12

Emp No:

Emp Name:

DOJ:

Sl. No. Bill No Date Details of Books Purchased Amou

1

2

3

4

5

6

7

8

9

10

Total

I hereby certify that the above expenses are incurred by me for purchasing books only

Date: Signature of the Employee

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Self Declaration

 To,

 The Payroll Department

Affiliated Computer Services of India Pvt Ltd

Bangalore

For the Financial Year 2011-12

SignatureName:

Emp ID:

WIN ID:

Date:

I (EMP No. ) Son / Daughter of hereby declare that, I am maintaining a log book for the above said period with complete details of Journey

undertaken for official purpose which include date of journey, destination, distance and the amount of expenditureincurred thereon. The same will be produced when requested.

I further declare that the expenditure was incurred wholly and exclusively for the performance of official duties and willbe personally responsible for any Income Tax related issues that may arise on this account while employed with ACS orthereafter.

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Affiliated Computer Services of India Pvt LtdVehicle LOG details for the month of -

Emp No:

Emp Name:

Car Make:

Model:

Car Registration No.

Date Destination Odometer (KM) Reading Distance Rate per KM Amo

From To Opening Closing (

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Rs.8.00/- Per K M

Total Amount

DECLARATION

I certify that the above travel are for the purpose of Company's business only.

Date:

Location:

Note: Rate is fixed at Rs. 8/- per KM

Travelled(KM)

(Rate is Fixed atRs.8/- per KM)

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Affiliated Computer Services of India Pvt Ltd

Fuel Expense Reimbursement - Bills submission for the year 2011-12

Emp No:

Emp Name:

VER * Start Date:

Car Registration No.

Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun

1 11

2 12

3 13

4 14

5 15

6 16

7 17

8 18

9 19

10 20

Total Amount

I certify that the above expenses are incurred for the purpose of Company's business only.

Date: Signature of the Employee

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Affiliated Computer Services of India Pvt Ltd

Repairs & Maintenance Reimbursement - Bills submission for the year 2011-12

Emp No:

Emp Name:

VER * Start Date:

Car Registration No.

Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun

1 11

2 12

3 13

4 14

5 15

6 16

7 17

8 18

9 19

10 20

Total Amount

I certify that the above expenses are incurred for the purpose of Company's business only.

Date: Signature of the Employee

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Affiliated Computer Services of India Pvt Ltd

Vehicle Insurance Reimbursement - Bills submission for the year 2011-12

Emp No:

Emp Name:

VER * Start Date:

Car Registration No.

Sl. No. Policy Number Date of Premim paid Amount

1

2

3

4

Total Amount

I certify that the above expenses are incurred for the purpose of Company's business only.

Date: Signature of the Employee

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Affiliated Computer Services of India Pvt Ltd

Vehicle Parking Reimbursement - Bills submission for the year 2011-12

Emp No:

Emp Name:

VER * Start Date:

Car Registration No.

Sl. No. Bill No Date Amount Sl. No. Bill No Date Amoun

1 11

2 12

3 13

4 14

5 15

6 16

7 17

8 18

9 19

10 20

Total Amount

I certify that the above expenses are incurred for the purpose of Company's business only.

Date: Signature of the Employee

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Affiliated Computer Services of India Pvt Ltd

Chauffeur's Salary Reimbursement - Proof submission for the year 201

 To,

 The Payroll Department

Affiliated Computer Services of India Pvt Ltd

Bangalore

Sub: Reimbursement of Chauffeur Salary for the Month of ……………………….

Dear Sir,

I request you to reimburse the salary paid to the Chauffeur. The relevant receipt from the Chauffeur is attached herew

Date: …………………….

Employee ID: …………………………………………..

Employee Name: ………………………………………

Employee Signature: ………………………………….

Salary Receipt

Received Rs. …………….……………/- towards salary for the month of ……………….…………………….

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Affiliated Computer Services of India Pvt Ltd

Declaration form for claiming Income Tax rebate on Vehicle Expense Reimbursement for the year (2011 - 2012

Emp No :

Emp Name :

DOJ :

Month ACS Transport facility availed Signature of Employee Signature of LOB Head Remarks

Aug 2011

Sep 2011

Oct 2011

Nov 2011

Dec 2011

 Jan 2012

Feb 2012

Mar 2012

DECLARATIONI hereby declare that the above information is correct 

Location

Date

Signature

Please note,

1 This template will applicable only to employees who are availing ACS Transport facilities.

2 If employee has availed the ACS transport facility for any of the above said months, then the Tax Exemption towards VER for that period will not be prov

Y

E NN

YE N Y

E N

YE N Y

E N

YE N Y

E N

YE N Y

E N

YE N Y

E N

YE N Y

E N

YE N Y

E N

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Affiliated Computer Services of India Pvt Ltd

Computer Maintenance & Internet Connectivity Reimbursement - Proof submission for the year 2011-12

Emp No:

Emp Name:

DOJ:

Sl. No. Bill No Date Details of items Purchased Amount

1

2

3

4

5

6

7

89

10

Total

I hereby certify that the above expenses are incurred by me are towards official / business purposes only

Date: Signature of the Employ

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Affiliated Computer Services of India Pvt Ltd

Uniform Allowance Reimbursement - Proof submission for the year 20

 To,

 The Payroll Department

Affiliated Computer Services of India Pvt Ltd

Bangalore

Sub: Reimbursement of Uniform Allowance for the Month of ……………………….

Dear Sir,

I hereby certify that I have incurred an expense of Rs.___________ towards the Uniform expenses for the month of _

Please reimburse the same.

Date: …………………….

Employee ID: …………………………………………..

Employee Name: ………………………………………

Employee Signature: ………………………………….

I further declare that the expenditure was incurred wholly and exclusively for the performance of official duties anresponsible for any Income Tax related issues that may arise on this account while employed with ACS or thereaft

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Affiliated Computer Services of India Pvt Ltd

Helper Allowance Declaration - Proof submission for the year 2011

 To,

 The Payroll Department

Affiliated Computer Services of India Pvt Ltd

Bangalore

Sub: Helper Allowance for the Month of ……………………….

Dear Sir,

Date: …………………….

Employee ID: …………………………………………..

Employee Name: ………………………………………

Employee Signature: ………………………………….

Salary Receipt

Received Rs. …………….……………/- towards salary for the month of ……………….…………………….

I hereby certify that the entire amount of Helper Allowance received by me of Rs.___________ has been fully spent inofficial obligations.

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Date:

Rent Receipt

Received Rs. _______________ from ______________________________________ by

Cash / Cheque / DD no__________________ dated _______________ towards rent for

for the month of ________________________ 

Address of the House:

Signature of the House Ow

Name:

Address:

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