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T705604 Jan 2023 FY20238137021

Tax Proof FY 22-23

RefNo:7056
Employee Code 8137021 Name Raghavendra M R

Department 400 PAN DPYPR4870B

Rent

Landlord
Rental Other Rental Rental Landlord Landlord PAN Landlord Landlord Landlord Address
Rent Month Location Location Amount Address Name 1 1 Address 1 Name 2 PAN 2 2

August Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

September Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

October Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

November Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

December Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

January Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -

Employee Code : 8137021 Date : 04 Jan 2023

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560049 560049

February Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

March Others Bangalore 35000 hayigriva Reddappa AWVPR1835K hayigriva

Nilya, 3rd MV Nilya, 3rd
cross, greens cross, greens
residency, residency,
chimasandra, chimasandra,
bangalore - bangalore -
560049 560049

I hereby digitally accept that the investments/expenses provided have been incurred by me out of my income chargeable to
income-tax during the financial year. I also certify that the attachments provided are true and correct to the best of my knowledge
and understanding. I confirm they are not claimed elsewhere. I understand that the Company reserves the right to conduct
investigation and take appropriate action in case any supporting documents are ascertained to be un-true or incorrect.

I will be solely and wholly responsible to handle any queries from any competent officials and / or to submit all relevant original
documents to Income Tax/Competent Authorities. I am fully aware of the relevant income tax laws in force regarding the nature of
proof required to claim the tax exemption and I will be held responsible for any consequences and any liabilities arise out of this.

This declaration is made in electronic form by filling information on the portal after login and hence deemed signed by you on
submission.

Employee Code : 8137021 Date : 04 Jan 2023

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FORM NO. 12BB

(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192

1. Name and address of the employee: Raghavendra M R

658, Venkateshwara Nilaya, 5th Cross, Nisarga Layout,
Basavanpura Main Road, K R Puram, Bangalore Bangalore
560035

2. Permanent Account Number of the employee: DPYPR4870B

3. Financial year: 2022 - 2023

Details of claims and evidence thereof

SI.No Nature of claim Amount Evidence / particulars

(Rs.)

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

1. House Rent Allowance:

(i) Rent paid to the landlord 280000

(ii) Name of the landlord

1. Reddappa M V

(iii) Address of the landlord

1. hayigriva Nilya, 3rd cross,
greens residency,
chimasandra, bangalore -
560049

(iv) Permanent Account Number of the landlord

1. AWVPR1835K

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

(ii)Name of the lender

(iii) Address of the lender

(iv) Permanent Account Number of the lender

(a) Financial Institutions(if available)

(b) Employer(if available)

(c) Others

Employee Code : 8137021 Date : 04 Jan 2023

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4. Deduction under Chapter VI-A

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

(i) Section 80C

(ii) Section 80CCC

(iii) Section 80CCD

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

Verification

I, Raghavendra M R ,son/daughter of ____________________ do hereby certify that the information given above is complete and correct.

Place : BLR ATC

Digitally accepted by 8137021, Raghavendra M R, 04/01/2023,
Date : 04/01/2023 116.75.83.181
(Signature of the employee)
Designation : Lead Consultant - Technology Full Name: Raghavendra M R

Employee Code : 8137021 Date : 04 Jan 2023