FORM NO.

12BB
(See rule 26C of Income Tax Rules 1962)

Statement showing particulars of claims by an employee for deduction of tax under section 192

Employee ID Gender
Employee Name Father's Name
Designation Date of Birth
Department Date of Joining
PAN Email ID
Financial Year 2023-24 Mobile
Details of claims and evidence thereof
New Tax Regime Old Tax Regime
Please select the tax regime for the F.Y. 2023-24
Note : In New Tax Regime, Any exemption or deduction is not allowed for tax saving investments i.e. those who are choosing new tax regime need not to fillup
/submit any tax saving proof.
Sl Nature of claim Amount (Rs.) Remarks
No.
(1) (2) (3) (4)
1 House Rent Allowance:
(a) Rent paid to the landlord
(b) PAN of Landlord Name and Address of landlord Rent Per Month Receipts to be enclosed

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 NA
3 Deduction of interest on borrowing: ( Housing Loan)
(a) Interest payable/paid to the lender
(b) PAN of Lender Name and Address of Lender

(a) Financial Institutions

(b) Employer
(c) Others
4 Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(a) Public Provident Fund (PPF)
(b) Life Insurance Premium
(c) Contribution to Pension Fund (80 CCC)
(d) National Saving Certificates (NSC)
(e) Accrued Interest (NSC)
(f) Children Education Tution Fees
(g) Investment in ULIP/Mutual Fund/ELSS
(h) Repayment of Housing Loan (Principal amount only)
(i) Fixed Deposit (Lock in period 5Years)
(j) Sukanya Samriddhi Yojana
(B) Other sections (e.g. 80D, 80E, 80TTA, etc.) under Chapter VI-A.
(a) Mediclaim Insurance Premium (U/S 80D)
(b) Mediclaim Insurance Premium (U/S 80D) for Senior Citizens
(c) Interest on Education Loan (U/S 80E)
(d) National Pension Scheme (NPS)
(e)
Verification

I,…………………….……………….., son / daughter of…………………….…………………….. do hereby certify that the information given above is complete and correct.
Place : Full Name

Date : (Signature of the employee)

 Additional Details
Sl Nature of claim Amount (Rs.) Evidence / particulars
No.
A. Previous Employees Details ( Form 16 or Signed Tax Computation)

(a) Salary paid by the previous Employer after section 10 exemptions

(b) Professional Tax deducted by the previous employer

(c) Provident Fund deducted by the previous Employer

(d) Income Tax (TDS) deducted by the previous employer)

Verification

I,…………………….……………….., son / daughter of…………………….…………………….. do hereby certify that the information given above is complete and correct.
Place : Full Name

Date : (Signature of the employee)