FORM NO.

12BB
INVESTMENT DECLARTION FORM

Anand Kumar Code-452

1. Name and Emp. Code of Employee
AYYPK8703C
2. Permanent Account Number(PAN) of the employee
2023-24
3. Financial year:
Details of claims and evidence thereof
Sl No. Nature of claim Amount (Rs.) Evidence / particulars
(1) (2) (3) (4)
1 House Rent Allowance:
(i) Rent paid to the landlord 30000/month Bank Transfer + Society
Receipt
(ii) Name of the landlord Mr. Balwant Rai Talwar e-stamp Paper

(iii) Address of the landlord 573, Uma Bhawan, Rent Agreement

Model Town, Panipat,
Haryana-132103
(iv) Permanent Account Number of the landlord
Note: Permanent Account Number shall be
furnished mandatorily if the aggregate rent paid
during the previous year exceeds one lakh rupees.
2 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
3 Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C
(a) Life Insurance Premium 55000

(b) Deposit In NSC 200000

(c) Employees EPF/VPF Contribution 150000

(d) Public Provident Fund 200000

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 FORM NO.12BB
INVESTMENT DECLARTION FORM

(e) Mutual Fund 425000

(f) Deposit In ELSS

(g) Children education 220000

(h) Principal Repayment (Housing Loan)

(I) Deposit In Sukanya Samridi 50000

(j) Fixed Deposit (5 Years)

(ii) Section 80CCC (Contribution to Pension 150000
fund)
(iii) Section 80CCD (NPS) 150000

(B) Other sections (e.g. 80E, 80G,80D, etc.) under

Chapter VI-A.
(i) section 80D (Medical Insurance Premium) 35000

(ii) section 80E Repayment of Education Loan

(iii) section 80U Deduction for self servere disability

Notes :-
1 Please submit the hardcopy only of this declaration form duly filled & Signed.
2 To be submitted latest by Tuesday 25th April 2023 at Accounts Department.
3 Estimated TDS will be deducted Per Month as per the declaration form submitted by you.
All supporting documentary evidences to be submitted latest by 31.12.2023 failing which TDS will
4
be deducted as per Income Tax Slabs for the Financial Year 2023-24 w.e.f Jan 2024 onwards.
Verification

I,…Anand Kumar………………..,son/daughter of………Sh. Sudhir Prasad……………….. do hereby certify

that the information given above is complete and correct.

Place……NOIDA………………………………………...
(Signature of the employee)
Date………30-09-2023……………………………………....
Full Name Anand Kumar
Designation …Principal…………………………….….

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