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T368601 Jan 2023 FY20238123110

Tax Proof FY 22-23

RefNo:3686
Employee Code 8123110 Name Mohanraj Balamurugan

Department 400 PAN CSOPM9778D

Life Insurance Premium

Declared Proof Cleared Remarks

48000 48000

No of
Inst
Paid Amount
on or
Number of Payable
after
Installment Amount on or Total
Name of 1st Payable on Paid on before Amount FY
the Date of Apr or before or after 31st 22-23 Paid
Insurance Policy Commencement Sum Premium 22 31st Mar 1st Apr Mar AmtPayable
Company No. (dd/mm/yyyy) Assured Amt Frequency Count 23 Count 22 Amt 23Amt Amt Relationship

HDFC 2439863 24/06/2021 100000 48000 Monthly 6 6 288000 288000 10000 Self
Life

80E - Education Loan

Declared Proof Cleared Remarks

90000 90000

Interest
Amount
Payable
on or
Name of before
Name of the Loan Account Repayment Start Interest Amount Paid 31st Total Amount FY 22-23 Relationshi
the Bank borrower No. Date (dd/mm/yyyy) on or after 1st Apr 22 Mar 23 Paid AmtPayable Amt p

Corporatio Mohanraj 086442400039500 16/12/2021 81000 9000 90000 Self

n Bank

Unit Linked Insurance Plan

Declared Proof Cleared Remarks

30000 30000

Employee Code : 8123110 Date : 01 Jan 2023

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Name of No. of No.of Amt Amt Total Amt

the Date of Inst Inst Paid Payable FY 22-23
Insurance Policy Commencement Sum Premium Paid Payable on or on or Paid
Company No. (dd/mm/yyyy) Assured Amt Frequency on or on or after before AmtPayable Relationship

Employee Code : 8123110 Date : 01 Jan 2023

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after
1st before
Apr 31st 1st 31st
22 Mar 23 Apr Mar
Count Count 22Amt 23Amt Amt

HDFC 24356929 10/11/2022 150000 2500 Monthly 11 1 27500 2500 30000 Self

Sukanya Samiriddhi Account Scheme

Declared Proof Cleared Remarks

0 8500

Name of the Investor Name of Girl Child Post Office Name Account No Amount

Mohanraj Priyadharshini Madipakkam Branch 010022525939 8500

80CCD - Contribution to NPS under Tier-I Account

Declared Proof Cleared Remarks

30000 30000

No. of
Inst
Paid No. of
on or Inst
after Payable
1st on or
Name Permanent Apr before Total Amt FY
of the Name of Retirement 22 31st Mar Amt Paid on Amt Payable on 22-23 Paid
Pensio the Account Amoun Frequenc Relationshi Coun 23 or after 1st or before 31st AmtPayable
n Fund Investor Number t y p t Count Apr 22Amt Mar 23Amt Amt

NPS Mohanraj 110071184983 30000 Yearly Self 1 0 30000 0 30000

Rent

Landlor
Rental Other Rental Landlor Landlor d
Rent Locatio Locatio Amou d Name Landlord d Name Landlor Addres
Month n n nt Rental Address 1 PAN 1 Landlord Address 1 2 d PAN 2 s2

April Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

May Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th

Employee Code : 8123110 Date : 01 Jan 2023

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streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

June Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

July Chennai 19000 No 9, Subramanian abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

August Chennai 19000 No 9, Subramanian abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

Septembe Chennai 19000 No 9, Subramanian abinash CSSPA2619 No 9, Subramanian

r Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

October Chennai 19000 No 9, Subramanian abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

November Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

December Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

January Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

February Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

March Chennai 19000 No 9, Subramanian Abinash CSSPA2619 No 9, Subramanian

Nagara 8th H Nagara 8th
streetMadipakkamChen streetMadipakkamChen
nai - 600091 nai - 600091

I hereby digitally accept that the investments/expenses provided have been incurred by me out of my income chargeable to
income-tax during the financial year. I also certify that the attachments provided are true and correct to the best of my knowledge
and understanding. I confirm they are not claimed elsewhere. I understand that the Company reserves the right to conduct

Employee Code : 8123110 Date : 01 Jan 2023

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investigation and take appropriate action in case any supporting documents are ascertained to be un-true or incorrect.

I will be solely and wholly responsible to handle any queries from any competent officials and / or to submit all relevant original
documents to Income Tax/Competent Authorities. I am fully aware of the relevant income tax laws in force regarding the nature of
proof required to claim the tax exemption and I will be held responsible for any consequences and any liabilities arise out of this.

This declaration is made in electronic form by filling information on the portal after login and hence deemed signed by you on
submission.

Employee Code : 8123110 Date : 01 Jan 2023

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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: Mohanraj Balamurugan

No 9 Subramanian nagar 8th street Chennai
Madipakkam 600091

2. Permanent Account Number of the employee: CSOPM9778D

3. Financial year: 2022 - 2023

Details of claims and evidence thereof

SI.No Nature of claim Amount Evidence / particulars

(Rs.)

(1) (2) (3) (4)

1. House Rent Allowance:

(i) Rent paid to the landlord 228000

(ii) Name of the landlord

1. Abinash

(iii) Address of the landlord

1. No 9, Subramanian
Nagara 8th
streetMadipakkamChenn
ai - 600091

(iv) Permanent Account Number of the landlord

1. CSSPA2619H

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

Employee Code : 8123110 Date : 01 Jan 2023

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(A) Section 80C,80CCC and 80CCD

(i) Section 80C

Life Insurance Premium 48000

Sukanya Samriddhi Account Scheme 8500

Unit Linked Insurance Plan 30000

(ii) Section 80CCC

(iii) Section 80CCD 30000

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

(i) Section 80E - Deduction for Interest on Education Loan 90000

Verification

I, Mohanraj Balamurugan ,son/daughter of Balamurugan do hereby certify that the information given above is complete and
correct.

Place : CHE SEZ

Digitally accepted by 8123110, Mohanraj Balamurugan, 01/01/2023,
Date : 01/01/2023 49.37.219.234
(Signature of the employee)
Designation : Consultant - Technology Full Name: Mohanraj Balamurugan

Employee Code : 8123110 Date : 01 Jan 2023