406821 - 1

CISCO INDIA PAYROLL

TAX Proof Submission Form

Employee Details

Name Dhananjoy Deb

Employee ID

406821
Particulars Declared Particulars Submitted Particulars

House Rent Allowance

Rental Property 1

Rent paid per month 20475

Occupied From April 2018

Occupied To March 2019

Located in Others

Total Income/Loss from House Property 0

Eligible Income/Loss from House Property 0

Investments Under Other Sections

Exemption under Section 80D

Cost Preventive Health check up for Self, Spouse & Children 5000

Medical Insurance Premium Paid for Parents 8456

Senior Citizens YES

Cost of Preventive Health check up for Parents 5000

Exemption under other Section of Chapter VI A

Sec 80DD - Medical Treatment of a Disabled Dependent 125000

Declaration:

I hereby declare that the above mentioned details are true to my knowledge. In case the information provided is false, I am liable for the
taxes, interest and penalty.

Signature of the Employee

 Form No 12BB
(See Rule 327C)

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

1 Name and address of the employee: Dhananjoy Deb - BANGALORE

2 Permanent Account Number of the employee: AMDPD2377G

3 Financial year FY 2018 - 2019

Details of claims and evidence thereof

Sl No. Nature of claim Amount (Rs.) Evidence / particulars

(1) (2) (3) (4)

1 House Rent Allowance:

Rent Property1

(i) Rent paid to the landlord 245700

(ii) Name of the landlord MR TUSHAR MITTAL

(iii) Address of the landlord 2362 SECTOR E,

SUDAMA NAGAR
INDORE, MADHYA
PRADESH, 452009
(iv) Permanent Account Number of the landlord AMOPM8004E

Note: Permanent Account Number shall be furnished if the

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 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

(ii) Section 80CCC

(iii) Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under

(1) Section 80D-01 5000

(2) Section 80D_02 13456

(3) Section 80DD 125000

Verification
I, Dhananjoy Deb, son/daughter of....................................... do hereby certify that the information given above is complete and correct.

Place : ..............................

Date : ................................ (Signature of the employee)

Designation : .................... Full Name