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Epsf Form12bb 156811

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Dhirengoyal
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18 views2 pages

Epsf Form12bb 156811

Uploaded by

Dhirengoyal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Ecode : 156811

FORM NO.12BB
(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
Dhiren Goyal
1) Name and address of employee 1st Floor, H.No. 213, Street No. 5, New Patel Nagar,
Nabha 147201

2) Permanent Account Number (PAN) of the employee AYSPG7625F

3) Financial year 2023 - 2024

Details of claims and evidence thereof


Sl. No. Nature of claim Amount (Rs.) Evidence / particulars

(1) (2) (3) (4)

1 House Rent Allowance:

Rent receipts / Rental


(i) Rent paid to the landlord 366000.00
Agreement / Bank statement

(ii) Name of the landlord

1. VEENAM RANI

(iii) Address of the landlord

1. GROUD FLOOR, H.NO. 213, STREET NO. 5, NEW


PATEL NAGAR,\r\nNABHA 147201 DISTT PATIALA

(iv)Permanent Account Number of the landlord

1. BLNPR7845F

Note: Permanent Account Number shall be furnished if the aggregate rent paid during the previous year exceeds one
lakh rupees.

2 Leave travel concessions or assistance 0.00

3 Deduction of interest on borrowing (Income from house property) :

(i) Interest payable/paid to the lender

1. Interest on Let-out property (Including Pre-EMI Interest) 0.00

2. Interest on Self Occupied (Including Pre-EMI Interest) 0.00

Deduction under Chapter VI-A

(A) Section 80C,80CCC and 80CCD

(i) Section 80C

Employees Provident Fund (Auto populated through


80184.00
payroll)

Public Provident Fund 140000.00 Photo Copy of passbook

(ii) Life Insurance Pension Scheme (Section 80CCC) 0.00

(iii) Employee's contribution towards NPS (Section 80CCD) 0.00

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-
A.

Photocopy of premium
Medical Insurance Premium for parents (Sec 80D) 12577.00
receipt

VERIFICATION
Ecode : 156811

I Dhiren Goyal son/daughter of _____________________________________________________ do hereby certify that the information given above is complete

and correct

Place :

Date : (Signature of the employee)

Designation : Software Development Consultant II Full Name: Dhiren Goyal

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