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COVID Childcare Program Self-Declaration

This self-declaration form is for claims under Deloitte's COVID Childcare Program. The employee, Siva Sagar Jagga, is claiming reimbursement of Rs. 19,470 for childcare services in October and November. Services included caregiving for their 3.9 year old child by Rama Devi on specified dates. Documentation of payment must be uploaded to support the claim. The employee declares the information provided is accurate to the best of their knowledge.

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Siva Sagar Jagga
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19 views2 pages

COVID Childcare Program Self-Declaration

This self-declaration form is for claims under Deloitte's COVID Childcare Program. The employee, Siva Sagar Jagga, is claiming reimbursement of Rs. 19,470 for childcare services in October and November. Services included caregiving for their 3.9 year old child by Rama Devi on specified dates. Documentation of payment must be uploaded to support the claim. The employee declares the information provided is accurate to the best of their knowledge.

Uploaded by

Siva Sagar Jagga
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Self-declaration Form for claims under the COVID Childcare Program - USI

Thank you for taking the time to submit your reimbursement request and supporting documentation. Before you
submit, please review the COVID Childcare program document and FAQs on DeloitteNet and comply with the
expense reimbursement guidelines.

Reimbursement under the COVID Childcare program will be considered taxable and will be taxed as per
applicable income tax rules.

If you have any general questions before submitting the form, please contact the CoRE Contact center at 1800
2582 2222.

Expense Details

Employee Details

1. Employee Name: Siva Sagar Jagga


2. Employee ID: 350231
3. Email ID: sijagga@[Link]
4. Claim Details:

Total Days for


Services Month Dates on which the services were availed Total which
availed Name
Age in Mention each date consecutively (eg- 1, 3, 5 etc) current reimbursemen
S. (Care giver of
of which (weekends are not covered) Claim t has been
N services/ Service
the service Amount claimed thus
o Tutors/Online Provide
child s were for the far
academic r
platforms/activit availed month (max- 60 days
y classes) * (eg- Aug (INR) excluding
etc) weekends)
1 3.9Y Care Giver Rama Oct 1,5,7,8,9,12,13,15,16,19,20,21,22,23,28,29,30 9,870 17 days
Services Devi
2 3.9Y Care Giver Rama Nov 2,3,4,5,6,9,16,17,18,19,20,23,25,26,27,30 9,600 33 days
Services Devi
*In case of more than one service provider, please enter details of all services within the claim limits permissible as
per COVID Childcare Program guidelines
The charges cannot be claimed on an hourly or for a partial day service and are reimbursable on a per day basis.
Any costs incurred for services availed on weekends and firm holidays will not be eligible for reimbursement

Documents to be uploaded along with this self-declaration:

 Transaction proof of payment (to be uploaded in DTE) is required for both formal and informal
providers.
 This can be a receipt in case of Debit Card / Credit Card and cash payments and where receipts
are not available owing to the recipient being an informal provider, transaction proof of online
payment will be required (please refer to FAQ document for clarifications).
Declaration

I hereby declare that Rs. 19,470 (total amount) has been paid by me for services permissible as per the
details outlined in the COVID Childcare program and am claiming reimbursement for the same. If I am
returning from rotation from US or other Member Firms, I affirm that I am submitting this claim as per
the guidelines applicable to Rotators.

I also declare that the information given herein above is true and correct to the best of my knowledge
and I will be solely held responsible for any discrepancy noted later.

Employee Name: Siva Sagar Jagga

Signature / Date:

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