01420760/BOHPG2484J
INCOME-TAX RULES, 1962
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: Roshni Kumari Gupta
C/o PRADEEP KUMAR SAHU, GAYATRI NAGAR KHUNTI, NEAR
PRADUSHAN KENDRA KHUNTI, KHUNTI, Jharkhand-835210
2. PAN of the employee : BOHPG2484J
3. Financial year : 2024-2025
Details of claims and evidence thereof
Sl. Amount Evidence /
Nature of Claim
No. (INR) particulars
(1) (2) (3) (4)
1. House Rent Allowance:
2. Leave travel concessions or assistance
3. Deduction of interest on borrowing:
4. Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C
(a) Employee Provident Fund 75290.00 Deducted directly in the Payroll.
(b) Payment towards Life Insurance Policy 108000.00
(ii) Section 80CCC
(iii) Section 80CCD
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter
VI-A.
iv) section 80D(05) 7000.00 Deducted directly in the Payroll.
i) section 80D(01) 25000.00
ii) section 80D(03) 25000.00
iii) section 80D(04) 50000.00
v) section 80D(06) 5000.00
vi) section 80D(10) 50000.00
vii) section 80DDB(01) 40000.00
viii) section 80DDB(02) 130000.00
01420760/BOHPG2484J
Verification
I, Roshni Kumari Gupta, son/ daughter of PRADEEP KUMAR SAHU do hereby certify that the information given above is complete and correct.
Place:
Date: 15/01/2025 (Signature of the employee)
Designation: Senior Developer Full Name: Roshni Kumari Gupta
