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:

Santosh Prasad Ulpi (QQA0345)
Apt#G1,Palm Breeze Villas,Gowra Hallmark,Hanuman nagar, Manikonda,
Hyderabad, Telengana-500089, Manikonda, Shridi Sai Nagar, Hyderabad,
Telangana, India, 500089

2. Permanent Account Number of the employee:

ACLPU6118Q

3. Financial year: 2023 -

2024

4. Submission Stage:
Declared

Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

1 House Rent
Allowance:

Rent 1

(i) Rent paid to

48000.00
the landlord

1
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

(ii) Name of the

landlord Laxmi Subburu

Apt#G1,Palm Breeze
(iii) Address of
Villas,Manikonda,Hyderabad,Telangana-
the landlord
500089

(iv) Permanent
Account
BLGPS9475R
Number of the
landlord

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

Section 80D -
2 Medical Insurance
for Parents

(i) Health
Insurance
47977.00
Premium for
Parents

Section 24 -
3 Interest paid on
Housing Loan for a
let-out Property

2
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

(i) Home Loan

Interest Paid for 225052.00
Let-out Property

(a) Interest
payable/paid to -225052
the lender

(b) Name of the

Bank of India
lender

(c) Permanent
Account
ACLPU5874J
Number of the
lender

(d) House
New
property type

(e) Possession
Yes
Completed

(j)
225052
Income/Loss

4 Section 10

(i) Children
Education 2400.00
Allowance Bills

(ii) Books and

1250.00
Periodicals Bills

3
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

(iii) Driver
900.00
Allowance Bill

(iv) Telephone
Reimbursement 3000.00
Exemption

(v) Fuel
Reimbursement 2400.00
Bills

5 EXEMPT U/S 80C,

80CCC & 80 CCD

(i) Life Insurance

100000.00
Premium

(ii) Tuition Fees

for Children (Upto 250000.00
2)

(iii) Contribution
to Sukanya
60000.00
Samriddhi
Scheme

80 GGC -
6 Donations towards
political parties

4
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

(i) Donations
towards political
25000.00
parties with 100%
exemption

(a) Name of the

Telangana Rashtra Samithi
Donee

(b) Permanent
Account
36AAPFB4287R1ZH
Number of the
Donee

c/o Telangana Bhavan, Bhavani Nagar,

(c) Address of
Banjara Hills Hyderabad, Telangana
the Donee
500034

(d) Amount 25000

Verification

I, Santosh Prasad Ulpi , son/daughter of N/A do hearby certify that the information given
above is complete and correct.

Place: Gachibowli,
Hyderabad

Date: 19-05-2023 Santosh Prasad Ulpi

Designation: Delivery
Manager (DES_QQ1_2)

5
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence / particulars

(Rs.)

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

Note: This is a system generated form 12BB, hence signature not required.

This has been submitted online from the IP 103.95.173.110