Form for furnishing details of income under section 392(4)(a) for the purposes of making deduction where income is chargeable under the head "Salaries"

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.... Sl. No. Name of other employer (s) Permanent Account Number of other employer (s) Tax Collection and Account Number of other employer (s) Period of employment Particulars of salary as defined in section 16, 17 and 18, paid or due to be paid to the employee during the year Total of column s 6, 7 and 8 Amount deducted in respect of life insurance premium, provident fund contribution, etc., to which section 123 applies (give details) Total amount of tax deducted during the year [enclose certificate issued under section 395(4)] Total amount of salary excluding amounts required to be shown in columns 7 and 8 Total amount of house rent allowance, conveyance allowance and other allowance s to the extent chargeable t....

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....ress of deductor Tax Deduction and Collection Account Number of deductor Amount of tax deducted Amount of income received/ credited Whether amount mentioned in column (f) is included in Sl. No. 2 above (Yes/ No) Any other relevant details (a) (b) (c) (d) (e) (f) (g) (h)                   4. Details of Tax Collected at Source - Section under which tax collected at source Name of collector Address of collector Tax Deduction and Collection Account Number of collector Amount of tax collected Any other relevant details (a) (b) (c) (d) (e) (f)   DECLARATION  I, .................

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....and 4 (1) (2) (3) (4) (5) (6) (7)                                                         *(including television sets, radio sets, refrigerators, other household appliances and air- conditioning plant or equipment) ANNEXURE (Contd.) Whether any conveyance facility has been provided by the employer free or at a concessional rate, or where the employee is allowed the use of one or more motor cars owned or hired by the employer, the estimated value of perquisite (give details) [See rule 15] ....