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11161201222122990140170

Tax Proof Declaration FY 21 22

RefNo: 116
CHANDRESH KUMAR YADAV
9901401704
Name
Employee Code
PAN NO
ADRPY922AA
BUSINESS OPERATIONS
Department

Life Insurance Premium

Remarks
Proof Cleared
Declared
17976
17976

Amount Total Relations'i

Premium Frequency Number of Number of Amount
Name of Policy No. Date of Sum Installment Installment Paid on or Payable on Amount FY pP
the Commence Assured Amt
Paid on or Payable on after 1st or before 21-22 Paid
Insurance ment
after 1st o r before Apr 21Amt 31st Mar AmtPayabl
Company (dd/mm/ Apr 21 31st Mar 22Amt e Amt
Count 22 Count

990517500 18/03/2020 350000 8988 Half yearly 1 8988 8988 17976 Self
LIC

Interest on Housing Loan (Self occupied)

Cleared Remarks
Declared Proof

131365 131365;

Date of Property Bank Interest Loss onRemarks Loan Loan % of Bank PANo Loan
Self Loan
Account Purpose employee AddresS the Bank availed
occupied owned by Possessio Location Name HP
number s Claim date
self/Joint n
(dd/mm/ (in case
of Joint
www
Loan)
Self- Self 01/12/20 Shree ICIcI 131365 131365 LBPUNOO Construct 100 cici bank AAACI119 01/04/20
OCcupied 20 Nagari 00521434 ion or Ghole 5H 20
Wadgaon Acquisitio Road
n

Housing Loan Principal Repayment

Declared Proof Cleared Remarks

67435 67435

Self Loan owned Property Bank Name Principal Registration Total FY Remarks Loan Loan bf
Occupied/ by Location Paid Fee/Stamp 2022 Account Purpose employees
Let out Duty paid number Claim (in
after 1st Apr case of Joint
21
Loan)
Self- Self Shree Nagari ICICI 67435 0 67435 LBPUNOOO05 Construction 100
OCcupied wadgaon 214348 or
sheri pune
Acquisition

Employee Code:9901401704 Date: 12 Jan 2022

 Page No: 2

Fmlovn' t"

Rent
Landlord Address
Rental Address
Rental Amount Other Location Landlord Pan
Landlord Name
Rent Month
Rental Location Phursung), Hadapsar
Phursungi, Hadapsar
B000
Viresh Koli
Others
April Phursungl, Hadapsar
Phursungi, Hadapsar

Viresh Koli
8000
May Others Phursung, Hadapsar
Phursungl, Hadapsar

Viresh Koli
8000
June Others
Phursung , Hadapsar
Phursung, Hadapsar

Viresh Kolí
8000
July Others
Phursungi, Hadapsa
Phursung, Hadapsar

Viresh Koli 8000

August Others
Phursungl, Hadapsar
Phursungl, Hadapsar

Viresh Koli 8000

September Others
Phursungi, Hadapsar
hursungi, Hadapsar
Viresh Kol 8000
October Others
Phursungi, Hadapsar
Phursungi, Hadapsar
Viresh Koli 8000
November Others
Phursungi, Hadapsar
Phursungi, Hadapsar
Viresh Koli 8000
December Others

Phursungi, Hadapsar
Phursungi, Hadapsar
Viresh Koli 8000
January Others
Phursungi, Hadapsar
Phursungi, Hadapsar
Viresh Koli 8000
FebruarY Others

Phursungi, Hadapsar Phursungi, Hadapsar

Viresh Koli 8000
March Others

Employee Code:9901401704 Date: 12 Jan 2022

 Page No: 3

Pmlovht
FORM NO. 12BB

(See rule 26c)

under sectlon 192
of claims by an employee for deduction of tax
Statement showing particulars
CHANDRESH KUMAR YADAV

Name and address of the employee:

1.

ADRPY9284A
Permanent Account Number of the employee:
2021 2022
3 Financial year:
Details of claims and evidence thereof
Evidence/ particulars
Nature of claim
Amount (Rs.)
SI No. (4)
(2)
(3)
(1)
House Rent Allowance:
96000.0
()Rent paid to the landlord

. (i) Name of the landlord

(i) Address of the landlord

(iv) Permanent Account Number of the landlord

exceeds one lakh rupees
furnished if the aggregate rent paid during the previous year
Note: Permanent Account Number shall be

Deduction of interest on borrowin8:

3. Leave travel concessions or assistance

131365
Interest payable/paid to the lender
(6)
ICICI
(in)Name of the lender
Icici bank Ghole Road
(ii) Address of the lender

Permanent Account Number of the lender

(iv)
AAACI1195H
(a) Financial Institutions(if available)

(6) Employer(if available)

(c) Others
4. Deduction under Chapter V1-A

(A) Section 80C,80CCC and 80CCD

(i) Section 80C

67435
Housing Loan Principal Repayment
17976
Life Insurance Premium

(i) Section 80CCC

(i) Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
Verification

SHANDRESH KUMARYADAV s/daughker udom aSad Jada v_

do hereby certify that the information given above is çomplete anc
of
correct.

Place: Pune
(Signature of the employ ee)
Date: 12/01/2022
Full Name: CHANDRESH KUMAR YADAV
Designation: DEPUTY MANAGER

Date: 12 Jan 20?2

Employee Code:9901401704