Form 12BB

(see Rule 26C)

1. Name & Address of the Employee

1A. Employee Code

2. PAN of the Employee
3. Financial Year 2023-24

Details of Claims and Evidences thereof

Sl.No. Nature of Claim Amount (Rs.) Evidence / Particulars
(1) (2) (3) (4)
1 House Rent Allowance
(i) Rent Paid to Landlord
(ii) Name of the Landlord

(iii) Address of the Land Lord

(iv) PAN of the Landlord

(Note: Permanent Account Number Shall be Furnished if the aggregate of Rent Paid during
the Financial Year Exceeds One Lakh Rupees)

2 Leave Travel Concession or Assistance

3 Deduction of Interest on Borrowings:
(i) Interest Payable / Paid to the Lender
(ii) Name of the Lender
(iii) Address of the Lender
(iv) PAN of the Lender
(a) Financial Institutions
(b) Employee
(c) Others
(v) Certificate from the lender against interest
paid/payable for FY
4 Deduction Under Chapter VIA
(A) Section 80C, 80CCC & 80CCD
(i) Section 80C
(a) Provident Fund (Salary) Do Not Fill
(b) Term Insurance (Salary) Do Not Fill
(c) Voluntary PF Subscription (Salary) Do Not Fill
(d) LIC
(e) Public Provident Fund
(f) National Savings Scheme
(g) National Savings Certificate
(h) Unit Linked Insurance Policy
(i) Post Office Savings
(j) Principal Paid on Housing Loan
(k) Tuition Fees
(l) Tax saving FD
(m) Sukanya Samriddhi Yojana
(ii) Section 80CCC
(iii) Section 80CCD
(B) Other Sections
80D Salary Do Not Fill
(i) 80D Non Senior Citizen Self
(ii) 80D Senior Citizen Self
(iii) 80D Non Senior Citizen Family
(iv) 80D Senior Citizen Family
(v) 80E Interest paid on Educational Loan
(vi) Donations (PAN of the Donee is compulsory)
(vii) Others 1
(viii) Others 2
80EE - Additional deduction w.r.t Interest on loan taken
for residential HP
80EEA - Interest on loan taken for certain house property

80EEB - Interest against purchase of electric vehicle

 VERIFICATION
I, ______________ Son/daughter of _______________________ do hereby certify that the information given above is complete and correct

Place: E.Name:
Date: Designation: Signature
 Conditions to claim deductions briefly
S.No.
1
2
3
4
5
6
7
8

S.No.
1
2
3
4
5
6

S.No.
1
2
3
4
 Conditions to claim deductions briefly
Sec 80EE_ Interest on loan taken for residential house property
Deduction available only for individuals
Interest payable on loan taken to buy residential house property
Deduction shall not exceed Rs. 50,000 p.a. subject to following conditions
Loan sanctioned period should be between 1st Apr 2016 to 31st Mar 2027
Loan sanctioned does not exceed Rs. 35 Lakh
Value of house property shouldn't exceed Rs. 50 Lakh
Assessee does not own any residential house property on the date of sanction of loan
Once deduction claimed under this section, no deduction is allowed under any other section

Sec 80EEA_ Interest on loan taken for certain house property

Deduction available only for individuals who are not eligible to claim deduction u/s 80EE
Interest payable on loan taken to buy residential house property
Deduction shall not exceed Rs. 1,50,000 p.a. subject to following conditions
Loan sanctioned period should be between 1st Apr 2019 to 31st Mar 2022
Stamp duty value of house property does not exceed Rs. 45 Lakh
Assessee does not own any residential house property on the date of sanction of loan

Sec 80EEB_ Deduction in respect of purchase of electric vehicle

Deduction available only for individuals
Loan should be sanctioned between 1st Apr 2019 to 31st Mar 2023
Interest paid against such loan is allowed upto Rs. 1.5 Lakh p.a.
Once deduction claimed under this section, no deduction is allowed under any other section
 INCOME / LOSS FROM HOUSE PROPERTY

(Note Only One Self Occupied House Property is allowed. Declare Notional Rent for other Properties,
where there are Two or More Self Occupied Properties)

Property 1 Address

Property 1 Type Self Occupied

Rent Received (will be Zero in Case of Self Occupied) -
Municipal Tax Paid (will be Zero in Case of Self Occupied) -
Housing Loan Interest
Housing Loan Principal
Name of the Lender
Address of the Lender
PAN of the Lender (Not Compulsory where the Loan is availed from Employer or
Financial Institutions, Compulstory in All Other Cases)

Property 2 Address

Property 2 Type Let out

Rent Received (Enter Annual Rent Received)
Municipal Tax Paid
Housing Loan Interest
Housing Loan Principal
Name of the Lender
Address of the Lender
PAN of the Lender (Not Compulsory where the Loan is availed from Employer or
Financial Institutions, Compulsory in All Other Cases)

Property 3 Address

Self occupied or
Unoccupied but
Property 3 Type
Offerring Notional
rent
Rent Received (Enter The Annual Notinal Rent Receivable, if the Property had
been Let Out)
Municipal Tax Paid
Housing Loan Interest
Housing Loan Principal
Name of the Lender
Address of the Lender
PAN of the Lender (Not Compulsory where the Loan is availed from Employer or
Financial Institutions, Compulsory in All Other Cases)
Self Occupied

Let out

Self occupied or Unoccupied but Offerring Notional rent

Name: Employee Code Life Insurance premium Details

Premium Remarks (In cases where premium is

Relationship with the
payable, subsequent to the date of
Employee (Mention
Sl.No. Name of the Insured Insurance Company Policy Number Sum Assured Declaration, please mention as
Self, Spouse or
"Provisional. Receipt will be Submitted on
Children Etc) Date Amount Payment")