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Age (*)    
Assessee Type (*)
Residing City (*)
Items Actual
Gross Salary (*)  
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
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.1,00,000/-
Public Provident Fund
Employees Provident Fund & Voluntary PF
Pension scheme (sec 80CCC)
Children's Education
Housing loan principal repayment
Insurance premium
Infrastructure Bonds & others (MF, ULIP, FD, etc.)
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)
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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