00839073/GATPS7638F

INCOME-TAX RULES, 1962

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: VIPUL SHARMA

VILLAGE GALOG POST OFFICE BAROG, DISTRICT AND TEHSIL SOLAN,
SOLAN, Himachal Pradesh-173211

2. PAN of the employee : GATPS7638F

3. Financial year : 2021-2022

Details of claims and evidence thereof

Sl. Amount Evidence /
Nature of Claim
No. (INR) particulars
(1) (2) (3) (4)
1. House Rent Allowance:

2. Leave travel concessions or assistance

3. Deduction of interest on borrowing:

4. Deduction under Chapter VI-A

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

(i) Section 80C

(a) Employee Provident Fund 34918.00 Deducted directly in the Payroll.

(b) 80CCD(1) 43178.00 Deducted directly in the Payroll.

(ii) Section 80CCC

(iii) Section 80CCD 46876.00 Deducted directly in the Payroll

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter
VI-A.
i) section 80CCD(1B)(01) 11763.00

ii) section 80CCD(2)(01) 46876.00 Deducted directly in the Payroll.

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

Place:
Date: (Signature of the employee)
Designation: Full Name: VIPUL SHARMA
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