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 : MANIKANDAN BALASUBRAMANIYAN

2. Permanent Account Number of the employee : BLFPM7636B
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.480000
(ii) Name of the landlord ABINAYA
1. (iii) Address of the landlord 2/170-4, ACT NAGAR-1, aniyapuram Rs.480000 Original House Rent Receipts
Near chef bakers factory
(iv) Permanent Account Number of the BLAPA0353C
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 : sbi
Self Occupied of Property 2 :
Let-Out :
(iii) Address of the lender Provisional Certificate from
3. Rs.-200000.0 Bank/Financial
Self Occupied of : sbi bank, karur Institution/Lender
Property 1
Self Occupied of :
Property 2
Let-Out :
(iv) Permanent Account Number of the lender
Self Occupied of Property 1 : AAACS8577K
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) Housing Loan - Principal Re-payment : Rs.465968

(ii) Section 80CCC :

(iii) Section 80CCD :
Rs. 863476.0 Photocopy of the investment
4.
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A. proofs

(a) 80E - Interest on Educational Loan : Rs.130000

(b) 80DPSCI - Medical Insurance for Parents (>=60yrs) - : Rs.52392

With Insurance
(c) 80EEB - Elec Vehicle Loan Interest Benefit Apr19-Mar23 : Rs.150000

(d) SEC80DDB - Medical Treatment for Specific Disease : Rs.40000

(e) 80DSI - Medical Insurance - Self / Spouse / Children (<60 : Rs.25116

yrs) - With Insurance

Verification
I, MANIKANDAN BALASUBRAMANIYAN, son/daughter of . do hereby certify that the information given above is complete and correct.
Place : Bangalore

Date: 20/04/2023

(Signature of the employee)

Designation : Software Engineer Staff Full Name: MANIKANDAN BALASUBRAMANIYAN

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.