FORM 12C

(See Rule 26B)

Form for sending particulars of Income under section 192(2B) for the year ending 31st March 2022

1. Emp Code, Name and Address of the employee

2. Permanent Account Number

3. Residential status

4. Particulars of income under any head of income other than 'Salaries'

(not being a loss under any such head other than the loss under the
head "Income from house property") received in the financial year

i) Income from house property (enclose computation) Rs.

ii) Profits and gains of business or profession Rs.
iii) Capital Gains Rs.
iv) Income from other sources
a) Dividends Rs.
b) Interest Rs.
c) Other Income (specify) Rs.
Total
5. Aggregate of sub-items (I) to (iv) of item 4 Rs.
6. Tax deducted at source (enclose certifcate(s) issued under Sec 203) Rs.

Place:

Date : Signature of employee

Verification

I ------------------------------------------------ do hereby declare that what is stated above is true to the best of my knowledge
and belief.

Verified today, the -----------------day of ---------------------------------------

Signature of employee
 INCOME / LOSS FROM HOUSE PROPERTY - Apr 21 - Mar 22

Name :
Emp Code :
Address / Location of the House Property 1 :

Address / Location of the House Property 2 :

Propety 1 Property 2 Total

Rental Income for the period (specify the period) (A) 0 0 0

Less : Taxes -Property Tax (B) 0 0 0

Less: Repairs 30% of the Rental Income earned (C) 0 0 0

Income from House Property D= (A-B-C) 0 0 0

Less : Interest Payable to (Bank) *( E) 0 0 0

Income / Loss from House Property (F = D - E) 0 0 0

*Please enclose the Certificte issued by the Bank