FORM NO.

12BB

INCOME-TAX RULES, 1962 (See rule 26C)

1. Name and address of the employee: C Manchala, School Assistant, ZPHS Girls Rompicherla, Rompicherla, Chittoor

PAN : BBRPM0705P FY : 2021-22

Details of claims and evidence thereof

SNo. Nature of claim Amount Evidence

1. House Rent Allowance:

i.Rent paid to the landlord 162000

ii.Owner Name:

iii.Address of the landlord:

iv. PAN of the landlord :

2 A. Deduction under Chapter VI-A ((A) Section 80C,80CCC and 80CCD)

i.CPS 34886 Deducted from Salary

ii.APGLI 17280 Deducted from Salary

iii.GIS 1440 Deducted from Salary

iv.LIC Policies premium Yearly 29168 Enclosed

v.Tuition Fee for Two children 0

vi.Repayment of Housing Loan installments 0

vii.PLI (Postal Life Insurance) : 0

viii.Stamp Duty and Registration Charges 0

ix.Fixed deposit in banks more than 5-Years 0

2 B. Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.

i. 80G EWF, SWF & CMRF 70 Deducted from Salary

ii.Interest of Housing Loan U/s 24 81207 Enclosed

iii.80G Donations to Charities 0

iv.80U Disabled Person (PH) ( Rule 11A): 0

v.80D Employees Health Cards Premium in AP 3600

vi.80CCD(2) Employer Contribution to CPS 84886 Enclosed

80E Interest of Educational Loan 0

Additional Benefit CPS Employee U/s 80CCD 50000 Deducted from Salary
(1B)(upto Rs.50,000/-)

Verification

I,C Manchala, School Assistant do hereby certify that the information given above is complete and correct.

Place:ZPHS Girls Rompicherla (Signature of the employee)

Date: C Manchala