Form No.

12BB
(See rule 26C)

Statement showing particulars of claims by an employee for deduction of tax under section 192

Employee Code: 26514

Name and address of the employee: Abhishek Singh Chauhan

Permanent Account Number of the employee: BDYPC8228C

Financial year: 2022-2023

Details of claims and evidence thereof

S.N. Nature of claim Amount In(Rs.) Evidence / particulars

1. House Rent Allowance:

(i) Rent paid to the landlord null/- P. M. From 01 April, 2022 To 31 March, 2023
(ii) Name of the landlord ABC
(iii) Address of the landlord ABC
Delhi
(iv) Permanent Account Number of the landlord / Declaration AAAPA1111A
Note: Permanent Account 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: Let Out Property

(i) Interest payable/paid to the financial institution / lender

(ii) Name of the financial institution / lender
(iii) Address of the financial institution / lender
(iv) Permanent Account Number (PAN) of the financial institution
/ lender
(v) Employer

4. Deduction of interest on borrowing: Self Occupied Property

(i) Interest payable/paid to the financial institution / lender

(ii) Name of the financial institution / lender
(iii) Address of the financial institution / lender
(iv) Permanent Account Number (PAN) of the financial institution
/ lender
(v) Employer
B. Income From House Property
1- Interest on Housing Loan (Letout) 0.0/-
2- Interest on housing loan(Self) 0.0/-
C. Income from Other Sources

5. Deduction under Chapter VI-A:

A. Section 80C,80CCC and 80DDC

(1) Section 80C
(a) Public Provident Fund
(b) Pension Fund
(c) Life Insurance Premium (LIP)
(d) Unit Linked Insurance plan ( ULIP )
(e) National Saving Certificates
(f) Tuition fees for any of two children
(g) Fixed deposits (FD) 5 Years and above
(h) Mutual Fund
(i) Post office Savings Bank(Cumulative time deposit)
(j) Sukanya Samriddhi Scheme (For girl child only)
(k) Repayment of Principal Amount of Housing Loan

Page 1 of 2
 (l) Equity Linked Saving Scheme ( ELSS )
(m) Accrued NSC Interest
(n) National Saving Scheme (NSS)
(o) CT-D
(p) Previous Employer PF
(q) Others (Please provide details)
(2) Section 80CCC - Contribution to Pension Fund 0.0/-
(3) Section 80CCD (1) - Contribution made by employee towards NPS up to 10%
0.0/-
of Salary
(3.1) 80CCD(1B) – Additional Employee Contribution to National Pension Scheme
- up to Rs. 50000/-
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
(1) Section 80CCG: Rajiv Gandhi Equity Saving Scheme (50 % deduction to new
retail investors with investment up to 50,000/- with annual income up to 12
lakh)
(2) 80D - Mediclaim Premium of Self, Spouse and Children - upto Rs. 25000/-
(3) 80D - Mediclaim Premium of Parent (of the age less than 60 years) -
25000/-
(4) 80D - Mediclaim Premium of Parent (Sr Citizen of the age 60 years and
0.0/-
below 80 year) - up to Rs. 50000/-
(5) 80D - Medical Expenditure for Parent (Very Sr Citizen of the age 80 years
and above) - up to Rs. 50000/-
(6) 80DD - Maintenance including medical treatment of a dependent family
member with disability (If disability is above 40% but less than 80%) - up to Rs. 0.0/-
75000/-
(7) 80DD - Maintenance including medical treatment of a dependent family
member with disability (Rs. 1,25,000/- if disability is 80% or more) - up to 0.0/-
Rs.125000/-
(8) 80DDB - Medical treatment of Specified Diseases for self or dependent of age
less than 60 years - up to Rs. 40,000/-
(9) 80DDB - Medical treatment of Specified Diseases for self or dependent of age
60 years and above but below 80 years- up to Rs. 60,000/-
(10) 80DDB - Medical treatment of specified diseases for self or dependent of
age 80 years and above - up to Rs. 80, 000/-
(11) Section 80E: Payment of Interest On Loan Taken For Higher Education
(12) Section 80 EE: {For fist time home buyers with additional deduction up to
50,000/- (over and above Section 24B)}
(13) Section 80 GGA refers to Deductions in respect of certain donations for
scientific research or rural. - up to Rs. 9999999999/-
(14) Section 80TTA: Interest on Savings Bank Account is exempted up to
Rs.10,000 per year - up to Rs. 10000/-
(15) 80U - Deduction in case of self physical disability (Rs. 75,000/- if disability is
0.0/-
above 40% but less than 80%)
(16) 80U - Deduction in case of self physical disability (Rs. 1,25,000/- if disability
0.0/-
is 80% or more)
(17) 80EEA
(18) 80EEB

Verification

I Abhishek Singh Chauhan, son/daughter of Mr. PRATAP SINGH CHAUHAN do hereby certify that the information given above is complete and correct.

Place :
Date : 2022-12-27
(Signature of the employee)
Designation : Technical Lead Abhishek Singh Chauhan

Page 2 of 2