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 : Mulpuri Vijaya Kumar

Room No 105, Svs Pg, Near Kodandarama Temple, Doddenekundi,
Bengaluru, Karnataka 560037
2.Permanent Account Number of the employee : CJFPM1791L
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 135,000.00
(ii) Name of the landlord
(iii) Address of the landlord
(iv) Permanent Account Number of the landlord
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
Equity Linked Savings Scheme ( ELSS ) 150,000.00
(ii) Section 80CCC

(iii) Section 80CCD

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.
80E - Interest on Loan of higher Self education 10,000.00
5. Deduction under Section 24
Verification
I, Mulpuri Vijaya Kumar son/daughter of do hereby certify that the information given above is complete and correct.
Place:
Date: (Signature of the employee)
Designation: Associate Consultant Full Name: Mulpuri Vijaya Kumar
 TRINITYPARTNERS INDIA LLP
POI for the period of Apr 2022 To Mar 2023

Name : Mulpuri Vijaya Kumar Employee No : DC1028

Date Of Join : 19 Jul 2022 Permanent Account Number : CJFPM1791L

Sl.No Month Location Rent per month Approved Status Remarks

Indicator (Rs.) Amount
1 Jul 2022 Non Metro 15,000.00 DRAFT
2 Aug 2022 Non Metro 15,000.00 DRAFT
3 Sep 2022 Non Metro 15,000.00 DRAFT
4 Oct 2022 Non Metro 15,000.00 DRAFT
5 Nov 2022 Non Metro 15,000.00 DRAFT
6 Dec 2022 Non Metro 15,000.00 DRAFT
7 Jan 2023 Non Metro 15,000.00 DRAFT
8 Feb 2023 Non Metro 15,000.00 DRAFT
9 Mar 2023 Non Metro 15,000.00 DRAFT

Sl.No Particulars Amount Approved Status No Proof Remarks

(Rs.) Amount of
Doc
House Rent Paid
1 House Rent Paid 135,000.00 DRAFT 0 No

Deduction Under Chapter VI A

1 80C - Equity Linked Savings Scheme 150,000.00 DRAFT No
( ELSS )
2 80E - Interest on Loan of higher Self 10,000.00 DRAFT No
education
Deduction Under Section 24

Note: