FORM NO.

12BB 1
WALTER P MOORE ENGINEERING INDIA PRIVATE LIMITED
Statement showing particulars of claims by an employee for deduction of tax under section 192

Employee Code & Name : 260028 PARAG KUSALKAR

Employee Address :
PAN No. : ASZPK2443A Financial Year. : 2020-2021

Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence/Particulars
(1) (2) (3) (4)
1. House Rent Allowance
(i) Rent paid to the landlord
(ii) Name of the landlord

(iii) Address of the landlord

(iv) PAN No of the landlord

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

3. Deduction of interest on borrowing :

(i) Interest payable / paid to the lender -200,000.00
(ii) Name of the lender
647660358;
HDFC LTD.;

(iii) Address of the lender

Ramon House, Churchgate, Mumbai-400020;

(iv) PAN No of the lender

AAACH0997E;

(a) Financial Institutions(if available)

(b) Employer(if available)
(c) Others
4. Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C

(a) Life Insurance Premium 65,386.00

(b) Payment in respect of non-commutable deffered annuity
(c) Deposit in Public Provident Fund (PPF)
(d) U L I P
(e) National Saving Certificates (NSC)
 FORM NO.12BB 2
WALTER P MOORE ENGINEERING INDIA PRIVATE LIMITED
Statement showing particulars of claims by an employee for deduction of tax under section 192

Employee Code & Name : 260028 PARAG KUSALKAR

Employee Address :
PAN No. : ASZPK2443A Financial Year. : 2020-2021

Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence/Particulars
(1) (2) (3) (4)
(f) Interest on NSC Purchased in Previous Years
(g) Children Education Fee (Tuition Fee Only) 14,940.00
(h) Approved Debentures/ Shares/ Mutual Funds
(i) Fixed Deposit for 5 years or more
(j) Payment of Equity linked Mutual Fund
(k) Repayment of Housing Loan (only Principal Amount) 68,321.00
(l) Deposit in Sukanya Samridhi Account

(ii) Section 80CCC

(iii) Section 80CCD
(iv) Section 80CCD(1B)
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
(i) Section 80D
(ii) Section 80DD
(iii) Section 80DDB
(iv) Section 80E
(v) Section 80EE 45,971.00
(vi) Section 80EEA
(vii) Section 80EEB
(viii) Section 80TTA
(ix) Section 80TTB
(x) Section 80U
(xi) Section 80G
(xii) Section 80GGA
5. Interest on other savings or any other kind of interest is fully taxable
 FORM NO.12BB 3
WALTER P MOORE ENGINEERING INDIA PRIVATE LIMITED
Statement showing particulars of claims by an employee for deduction of tax under section 192

Employee Code & Name : 260028 PARAG KUSALKAR

Employee Address :
PAN No. : ASZPK2443A Financial Year. : 2020-2021

Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence/Particulars
(1) (2) (3) (4)
Verification

I , PARAG KUSALKAR son/daughter of do hereby certify that the information given above is complete and correct.

Place..............................................
(Signature of the employee)
Date................................................

Designation...................................... Full Name: PARAG KUSALKAR