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 : Raju Haveri M
2. [Permanent Account Number or Aadhaar Number] of the employee : AKFPR9033H
3.Financial year : 2020-21
Details of claims and evidence thereof
Sl. Nature of claim Amount Evidence / particulars
No. (Rs.)
(1) (2) (3) (4)
1. House Rent Allowance:
(i) Rent paid to the landlord 99,600.00
(ii) Name of the landlord
(iii) Address of the landlord
(iv) Permanent Account Number of the landlord
Note: [Permanent Account Number or Aadhaar Number] shall be furnished if the
aggregate rent paid during the previous year exceeds one lakh rupees
2. Leave travel concessions or assistance
3. Deduction of interest on borrowing:
(i) Interest payable/paid to the lender
(ii)Name of the lender
iii) Address of the lender
(iv) [Permanent Account Number or Aadhaar Number] of the lender
(a) Financial Institutions(if available)
(b) Employer(if available)
(c) Others
4. Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C
5 Years of Fixed Deposit in Scheduled Bank 50,000.00
Children Tuition Fees 40,000.00
Sukanya Samriddhi Yojana 100,000.00
(ii) Section 80CCC
(iii) Section 80CCD
Contribution to NPS 2015 50,000.00
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
80D - Preventive Health Checkup - Dependant Parents 5,000.00
80D - Medical Bills - Senior Citizen 50,000.00
80D - Medical Insurance Premium - Dependant Parents 25,000.00
80D - Preventive Health Check-up 5,000.00
80EE - Additional Interest on housing loan borrowed as on 1st Apr 2016 50,000.00
80EEA - Additional Interest on Housing loan borrowed as on 1st Apr 2019 60,000.00
80DD - Medical Treatment / Insurance of handicapped Dependant 75,000.00
80DD - Medical Treatment / Insurance of handicapped Dependant (Severe) 125,000.00
5. Deduction under Section 24
Income/Loss from Let Out Property- 1 42,000.00
Verification
I, Raju Haveri M son/daughter of Mahalingappa do hereby certify that the information given above is complete and correct.
Place:
Date: 22-Jun-2020 (Signature of the employee)
Designation: Assistant Manager R&D Full Name: Raju Haveri M
