FORM NO.

12BB
(See rule 26C)
Organisation Name: Bank Of Baroda
Employee Tax Saving Investment Declaration for the year: 2022-2023

1. Employee Name: K PRABHA 4. Financial year: 2022-2023

2. Employee ID: 62248 5. Date of Joining: 10-Jul-91
3. PAN of the employee: AKTPP8639F 6. Tax Regime: Old Regime

Details of claims and evidence thereof

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

1 House Rent Allowance/Leased accommodation:

(i) Rent paid to the landlord

(ii) Name of the landlord
(iii) Permanent Account Number of the landlord
(iv) Address 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:

Self-Occupied Property/Let Out Property

(i) Interest payable/paid to the lender
(ii) Name of the lender
(iii) Address of the lender
(iv) Permanent Account Number of the lender

4 Chapter VI-A,80CCC
Contribution TO Pension Fund (80CCC) 0

5 Chapter VI-A,80C
1)Life Insurance Premium ( Jeevan Anand, ETC) 50000
2) Public Provident Fund (PPF) 150000
3)National Savings Certificate (NSC) 0
4) Interest Accrued on National Savings Certificate (NSC) 0
5) National Savings Scheme, 1992 (NSS) 0
6) NHB Deposit Scheme 0
7) Child Education - Tuition Fee 0
8) Mutual Funds / Equity Linked Savings Scheme (ELSS) 0
9) Unit Linked Insurance Plan 0
10) Notified Post Office Savings Scheme 0
11) Housing Loan - Repayment of Principal Amount, 0
Registration Fees, Stamp Duty
12) Infrastructure Bonds
13) Fixed Deposit Scheme (Block Period of 5 Yrs) 0
14) Senior Citizen Savings scheme 0
15) NPS Voluntary Contribution -80CCD 1B (Other than 50000
 Salary)
16) Sukanya Samriddhi Scheme 0
6 Chapter VI-A,Others
1) Medical Insurance Premium (U/s 80D) 41334
2) Maintenance of Handicapped Dependent (U/s 80DD) - 0
Disabled - 75000, Severely Disabled - 125000
3) Medical Treatment for Certain Diseases(U/s 80DDB) 0
4) Interest on Education Loan (U/s 80E) 0
5) Permanent Physical Disability (U/s 80U) 0
6) Tax Rebate
7) Medical Insurance Parents 80D 0
8) Long term infrastructure bond
9) Equity Savings Scheme 80CCG 0
10) Tax relief for affordable housing - 80EEA 0
11) Tax relief for interest paid on purchase of electric vehicle 0
12) Medical Health Check up - 80D 0

7 Other Income
1) Income from House Property
2) Loss from House Property 0
3) Income from Capital Gains
4) Income from Other Sources 0
5) Interest on loan taken for Residential House Property 0
(Section 80EE)
6) Interest earned on Savings Deposits (80TTA/80TTB) 0
7) NSC Interest Income 0

Verification

I, K PRABHA , son/daughter of …………………………………………… do hereby certify that the information given

above is complete and correct.

Place: ……………………………………………...

Date: ……………………………………………....
(Signature of the employee)
Designation: K PRABHA