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:

Ramesh Jaiswal (PW9560)
jaiswal enterprises mankapur road Lal ganj puliya utraula district Balrampur
271604,

2. Permanent Account Number of the employee:

BRFPR0256Q

3. Financial year: 2023 -

2024

4. Submission Stage: Submitted with

proofs

Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence /

(Rs.) particulars

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

1 House Rent Allowance:

Rent 1

(i) Rent paid to the landlord 240000.00

(ii) Name of the landlord Smriti

1
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence /

(Rs.) particulars

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

r business centre
near bada
(iii) Address of the landlord
hanuman mandir
khurram nagar

(iv) Permanent Account Number of

ODNPS9286Q
the landlord

Note: Permanent Account Number shall be furnished

if the aggregate rent paid during the previous year
exceeds one lakh rupees

2 EXEMPT U/S 80C, 80CCC & 80 CCD

(i) Investment in ELSS (Mutual Funds) 120000.00

3 LTA

(i) LTA Claim 70000.00

Verification

I, Ramesh Jaiswal , son/daughter of N/A do hearby certify that the information given above is
complete and correct.

Place: Vidyapeeth - YMCA Compound - Lucknow

- UP, Lucknow

Date: 19-01-2024

2
 Details of claims and evidence thereof

Sl.No Nature of claim Amount Evidence /

(Rs.) particulars

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

Designation: Professor Ramesh Jaiswal

(PRF_ACD_VP_NEET_CHEM_TEACHING)

This has been submitted online from the IP 103.190.252.26