FORM 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:

2 Tax Regime ("N" for new tax regime under Section 115BAC
else "O" for old tax regime.
3 Permanent Account Number of the employee:
4 Financial Year

Details of claims and evidence thereof

Sl No Nature of claim
(1) (2)
1 House Rent Allowance
(i) Rent paid to the landlord
(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 Deductions under Chapter VI-A

(A) Section 80C, 80CCC, and 80CCD
(i) Section 80C
(a) Provident Fund
(b) Life Insurance Policy
- Self
- Spouse
- Children
(c ) Public Provident Fund
(d) National Saving Certificate
(e) National Saving Scheme
(f) Tuition Fees
(h) Housing Loan Principal
 (i) Bank Term Deposit
(j) Sukanya Smridhi Yojana
(k) Mutual Funds
(l)
(m)

(ii) Section 80CCC

Contribution to Pension Fund

(iii) Section 80CCD

Contribution to National Pension Scheme

(B) Other Sections

(i) Section 80E
Interest on loan taken for higher education

(ii) Section 80D

Mediclaim Policy

(iii) Section

Verification
I, Ashish Kanyal son of Shankar Singh Kanyal hereby certify that the information given abov

Place:
Date:
Designation:

Note: No benefit allowed under New Tax Regime. Only concessional tax rates will be allowed
 FORM 12BB
(See rule 26C)

e for deduction of tax under section 192

ASHISH KANYAL
K115, MONARCH SERENITY, THANISANDRA, BANGALORE, 560077

O
EJPPK1576R
2021-22

Details of claims and evidence thereof

Amount Evidance / particulars
(3) (4)

22516( FROM MAY 2021 TO JUNE 2021)

ZOLO STAYS RECEIPT PDF ATTACHED
No. 1190,, floor-, , 22nd Cross,, Bengaluru
(Bangalore) Urban, Karnataka, 560102
AAACZ8446N

NA
NA

NA NA

NA NA
 Verification
Shankar Singh Kanyal hereby certify that the information given above is complete & correct.

BANGALORE
6/9/2021
ASHISH KANYAL - RECRUITMENT EXECUTIVE

concessional tax rates will be allowed