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 : Archana V Telkar

#2 ,1st floor, Chackanical, 2nd cross,2nd main,Brindavan layout,
Kavalbyrasandra,RT nagar PostBengaluruKarnataka
2.Permanent Account Number of the employee : AFUPT9890A
3.Financial year : 2022-23

Details of claims and evidence thereof

Sl. Nature of claim Amount Evidence / particulars
No. (Rs.)
(1) (2) (3) (4)
1. House Rent Allowance:
(i) Rent paid to the landlord 182,700.00
(ii) Name of the landlord Jacob Varghese
(iii) Address of the landlord
(iv) Permanent Account Number of the landlord BAEPJ4709C
Note: Permanent Account Number shall be furnished if the aggregate rent paid during the
previous year exceeds one lakh rupees
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
Children Tuition Fees 60,000.00
Sukanya Samriddhi Yojana 100,000.00
(ii) Section 80CCC

(iii) Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
80EEA - Additional Interest on Housing loan borrowed as on 1st Apr 2019 150,000.00
80TTA - Interest on Deposits in Savings Account, FDs, Post Office And Cooperative 16,973.00
Society
5. Deduction under Section 24
Interest on Housing Loan ( Self Occupied) 0.00
Verification
I, Archana V Telkar son/daughter of Venkatesh Telkar do hereby certify that the information given above is complete and correct.
Place:
Date: (Signature of the employee)
Designation: Senior Solution Specialist/Consultant Full Name: Archana V Telkar
 POWERSCHOOL INDIA PRIVATE LIMITED
POI for the period of Apr 2022 To Mar 2023

Name : Archana V Telkar Employee No : 079683

Date Of Join : 25 Mar 2019 Permanent Account Number : AFUPT9890A

Sl.No Month Location Rent per month Approved Status Remarks

Indicator (Rs.) Amount
1 Apr 2022 Non Metro 15,225.00 DRAFT
2 May 2022 Non Metro 15,225.00 DRAFT
3 Jun 2022 Non Metro 15,225.00 DRAFT
4 Jul 2022 Non Metro 15,225.00 DRAFT
5 Aug 2022 Non Metro 15,225.00 DRAFT
6 Sep 2022 Non Metro 15,225.00 DRAFT
7 Oct 2022 Non Metro 15,225.00 DRAFT
8 Nov 2022 Non Metro 15,225.00 DRAFT
9 Dec 2022 Non Metro 15,225.00 DRAFT
10 Jan 2023 Non Metro 15,225.00 DRAFT
11 Feb 2023 Non Metro 15,225.00 DRAFT
12 Mar 2023 Non Metro 15,225.00 DRAFT

Sl.No Particulars Amount Approved Status No Proof Remarks

(Rs.) Amount of
Doc
House Rent Paid
1 House Rent Paid 182,700.00 DRAFT 7 Yes

Deduction Under Chapter VI A

1 80C - Children Tuition Fees 60,000.00 DRAFT 4 Yes
2 80C - Sukanya Samriddhi Yojana 100,000.00 DRAFT 2 Yes
3 80EEA - Additional Interest on Housing 150,000.00 DRAFT 2 Yes
loan borrowed as on 1st Apr 2019
4 80TTA - Interest on Deposits in Savings 16,973.00 DRAFT 2 Yes
Account, FDs, Post Office And Cooperative
Society
Deduction Under Section 24
1 Interest on Housing Loan ( Self Occupied) 0 DRAFT Yes
Lender's Name : Lender's PAN :
Income from Let-out Property
b Total Income/Loss From Let Out Property 0.00
c Total Exemption 0.00
If (b - a) is less than -200000 then -200000
will be exempted else c will be exempted.

Note: