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 : ABHISHEK SHUKLA

2. Permanent Account Number of the employee : BMXPA5561J
3. Financial year : 2023-2024

Details of claims and evidence thereof

Sl. No. Nature of claim Amount(Rs.) Evidence / particulars
(1) (2) (3) (4)
House Rent Allowance:

Property No : 1
(i) Rent paid to the landlord Rs.270000
(ii) Name of the landlord Ankita Mishra
1. Rs.270000 Original House Rent Receipts
(iii) Address of the landlord H 68 Fardidabad
(iv) Permanent Account Number of the EVBPM0948D
landlord

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

Original Travel
2. Leave travel concessions or assistance Rs.0
Receipts/Tickets
Deduction of interest on borrowing:

(i) Interest payable/paid to the lender

Self Occupied Interest of :Rs.-200000

Property 1
Self Occupied Interest of :Rs.
Property 2
Let-OutInterest :Rs.0.0
(ii) Name of the lender
Self Occupied of Property 1 : MOnika Gaur
Self Occupied of Property 2 :
Let-Out :
(iii) Address of the lender Provisional Certificate from
3. Rs.-200000.0 Bank/Financial
Self Occupied of : Mahavir Enclam part 1 Institution/Lender
Property 1
Self Occupied of :
Property 2
Let-Out :
(iv) Permanent Account Number of the lender
Self Occupied of Property 1 : AABCP0471C
Self Occupied of Property 2 :
Let-Out :

(a) Financial Institutions(if available)

(b) Employer(if available)
(c) Others
 Deduction under Chapter VI-A

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

(i) Section 80C

(a) 5 Year Time Deposit in Post Office : Rs.10000

(b) Fixed Deposit Scheme (Block Period of 5 yrs) : Rs.50000

(c) Housing Loan - Principal Re-payment : Rs.200000

(d) Mutual Funds : Rs.150000

(e) Life Insurance Premium : Rs.50000

(f) Sukanya Samriddhi Account Deposit Scheme : Rs.50000

(g) Public Provident Fund : Rs.50000

(h) Equity Linked Savings Scheme : Rs.150000

(ii) Section 80CCC :Rs.50000

(iii) Section 80CCD
Rs. 2510000.0 Photocopy of the investment
4.
(a) NPS Tier 1 - Employee Contribution (U/s 80CCD) : Rs.50000.0 proofs
(b) Atal Pension Yojana - Employee Contribution (U/s : Rs.50000.0
80CCD)
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.

(a) 80DSSCNI - Medical Insurance - Self / Spouse / Children : Rs.100000

(>=60 yrs) - Without Insurance
(b) 80E - Interest on Educational Loan : Rs.500000

(c) 80DSSCI - Medical Insurance - Self / Spouse / Children : Rs.200000

(>=60 yrs) - With Insurance
(d) 80DPI - Medical Insurance for Parents (<60yrs) - With : Rs.400000
Insurance
(e) SEC80DDB - Section 80 DDB benefit for Very Senior : Rs.100000
Citizen
(f) NPS Tier 1 - Employee Contribution (U/s 80CCD1B) : Rs.50000

(g) 80DSI - Medical Insurance - Self / Spouse / Children (<60 : Rs.300000

yrs) - With Insurance

Verification
I, ABHISHEK SHUKLA, son/daughter of Radhey Shyam Shukla. do hereby certify that the information given above is complete and
correct.
Place : GURGAON

Date: 04/05/2023

(Signature of the employee)

Designation : Lead Business Analyst Full Name: ABHISHEK SHUKLA

Note: The information/details above, as required for deduction of tax u/s 192 of the Income Tax Act, has been entered by the employee through an
authorized login on the portal. The information submitted above is deemed to be e-signed by the employee.