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

Name Bidri,Nilesh Gopal Empl ID 387997

Address Dhayri Sr No 13, 5/6 Lane B 30/31
Oakwood County Flat A101 Pune Maharashtra - 411041
City Pune State Maharashtra
Country India
Grade BII Location WNS India SEZ Pune-4 SP Infoci
Financial Year 04/01/2022 To 03/31/2023 Department Convex-F&A-Offshore-VAT
House Rent Allowance
Effective Date Landlord Name PAN No. Proof Submitted Location Landlord Address Evidence/Particulars

609 Shaniwar Peth,

Anil Laxman
1 04/30/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
2 05/31/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
3 06/30/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
4 07/31/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
5 08/31/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
6 09/30/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
7 10/31/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
8 11/30/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
9 12/31/2022 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
10 01/31/2023 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
11 02/28/2023 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4
609 Shaniwar Peth,
Anil Laxman
12 03/31/2023 ABUPC2625E 13000 Non-Met. Shriniketan Apt 2nd  
Chandrachud
Floor Flat No. 4

Leave travel concessions or assistance

Amount Payable Evidence/Particulars

1    

Deduction of interest on borrowing

Lender Name PAN No. Declared Amount Address Evidence/Particulars

1          

Deduction under Chapter VI-A

Declarations Proof Submitted Evidence/Particulars

1 Life Insurance Premium 23760.00  

2 Public Provident Fund 12000.00  
3 Principal Loan Repayment 15975.00  
4 Mutual Funds 90000.00  
5 Medical Ins Premium 80D Self 34812.00  

I, Nilesh Bidri, hereby confirm that I have submitted the scanned copy of tax proofs in the payroll
database to avail tax benefits as prescribed under the Income Tax Act, 1961. I have the original/
digitally signed documents of these tax proofs in my possession. I would submit these documents
in original within 7 days from the date the same are requested for submission to government
authorities or for internal use. I will keep WNS Global Services (P) Ltd indemnified against any
consequential liability in case of non-submission of the document within this time limit of 7 days.
Due to the ongoing COVID 19 pandemic, and my consequential working from home, I am unable to
take a print of the Form 12BB and hence, please consider this as my confirmation of the tax proofs
submitted.

PRINT