[HEADER — replace with your organisation’s letterhead, if used]
Employee Declaration of Deductions and Allowances
For computing tax to be deducted from salary
Collect this at the start of the financial year, with evidence by a stated cut-off, and recompute the withholding when it arrives. An employer that accepts declarations without evidence, or never reconciles the two, carries the exposure for short deduction — not the employee.
[COMPANY NAME] TAN: [TAN] [ADDRESS]
1. Particulars of the Employee
| Item | Detail |
|---|
| Name | [NAME] |
| Employee identification number | [ID] |
| Permanent account number | [PAN] |
| Address | [ADDRESS] |
| Financial year | [YEAR]–[YEAR] |
| Date of joining, where joined during the year | [DATE] |
| Tax regime elected for the year | [New regime / Old regime] — see Part 6 |
| Declaration submitted on | [DATE] |
| Evidence due by | [DATE] |
2. House Rent Allowance
Claim only where rent is actually paid for residential accommodation occupied by you and which you do not own.
| # | Particular | Detail |
|---|
| 1 | Rent paid during the year | ₹ [AMOUNT] |
| 2 | Period of tenancy | [FROM] to [TO] |
| 3 | Address of the rented accommodation | [ADDRESS] |
| 4 | Name of the landlord | [NAME] |
| 5 | Address of the landlord | [ADDRESS] |
| 6 | Permanent account number of the landlord | [PAN] |
| 7 | Whether the aggregate rent for the year exceeds the threshold above which the landlord’s PAN must be furnished | [YES / NO] |
| 8 | Whether the city of residence is one for which the higher exemption limit applies | [YES / NO] |
| 9 | Whether tax is required to be deducted by you on the rent paid | [YES / NO — see the notes] |
Evidence to be furnished: rent receipts for the period, and the rent agreement. Where the annual rent exceeds the prescribed threshold, the landlord’s permanent account number is mandatory and the claim will be disallowed without it.