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 : SOUMYA RANJAN SWAIN
2. Permanent Account Number of the employee : CSEPS7256L
3. Financial year : 2022-2023
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.216000
(ii) Name of the landlord RAJALAXMI SINGH
1. (iii) Address of the landlord Plot no-2/2257,Nuasahi Rs.216000 Original House Rent Receipts
Bidanasi,Cuttack, Odisha-753014
(iv) Permanent Account Number of the CGXPS3526E
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.
Property 1
Self Occupied Interest of :Rs.
Property 2
Let-OutInterest :Rs.0.0
(ii) Name of the lender
Self Occupied of Property 1 :
Self Occupied of Property 2 :
Let-Out :
(iii) Address of the lender Provisional Certificate from
3. Rs.0.0 Bank/Financial
Self Occupied of : Institution/Lender
Property 1
Self Occupied of :
Property 2
Let-Out :
(iv) Permanent Account Number of the lender
Self Occupied of Property 1 :
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) Mutual Funds : Rs.120000
(b) Life Insurance Premium : Rs.80000
(c) Equity Linked Savings Scheme : Rs.12000
(ii) Section 80CCC :
Rs. 437000.0 Photocopy of the investment
4.
(iii) Section 80CCD : proofs
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
(a) 80DSSCI - Medical Insurance - Self / Spouse / Children : Rs.50000
(>=60 yrs) - With Insurance
(b) SEC80DDB - Section 80 DDB benefit for senior citizen : Rs.100000
(c) NPS Tier 1 - Employee Contribution (U/s 80CCD1B) : Rs.50000
(d) 80DSI - Medical Insurance - Self / Spouse / Children (<60 : Rs.25000
yrs) - With Insurance
Verification
I, SOUMYA RANJAN SWAIN, son/daughter of BHARAT CHANDRA SWAIN. do hereby certify that the information given above is
complete and correct.
Place : Hyderabad
Date: 16/01/2023
(Signature of the employee)
Designation : Sr IPT Project Coord Full Name: SOUMYA RANJAN SWAIN
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.
