Ecode : 215322

FORM NO.12BB
(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
ANIL KUMAR
1) Name and address of employee
31/b sahib kunj, ghitorni, New Delhi(110030)

2) Permanent Account Number (PAN) of the employee CQTPK5621A

3) Financial year 2020 - 2021

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 360000.00
Agreement / Bank statement

(ii) Name of the landlord

1. Sunil

(iii) Address of the landlord

1. 143,charkhi,charkhi dadri, haryana, 127306

(iv)Permanent Account Number of the landlord

1. FXAPS2103G

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

81846.00
payroll)

Photo copy of Payment

Mutual Funds / ULIP 70000.00 receipt / Account statement /
Certificate / Bond

(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.
VERIFICATION
I ANIL KUMAR son/daughter of _____________________________________________________ do hereby certify that the information given above is complete
and correct

Place :

Date : (Signature of the employee)

Designation : PRINCIPAL/ASSOC DIR SOFTWARE ENGINEER Full Name: ANIL KUMAR