Form 12BB
Form 12BB
Form 12BB
12BB
(See Rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
1 Emp. Code
Address of Employee
3 PAN of Employee
2019-20
4 Financial Year
May'19 Nov'19
Address of Accommodation June'19 Dec'19
July'19 Jan'20
Aug'19 Feb'20
Sep'19 Mar'20
Note: Permanent Account Number shall be furnished if the aggregate rent paid during the previous year exceeds
one lakh rupees
Loss on Property (First Time Buyer ‐ If Loan sanctioned in 2019‐20 Finance Year)
Condition: Interest paid for loans upto Rs. 35 lakhs with cost of home upto Rs. 50 lakhs.
Nature of Claim Amount Evidence / Particulars
Interest payable/paid to the lender
Name of the lender
Address of the lender
PAN of the lender
(B) Other Sections (80D, 80DD, 80E, 80TTA, etc) under chapter VI‐A
Nature of Claim Amount Evidence / Particulars
(I) 80D ‐ Mediclaim Policy (Self / Spouse / Children)
80D ‐ Mediclaim Policy (Parents) (Kindly mention if
Parents are senior citizen)
80DD ‐ Handicapped Dependents
80DDB ‐ Medical Expenses for Specific Diseases
80E ‐ Loan for Higher Education (Only paid interest
amount)
80G ‐ Donation (Only Govt. Org.)
80GG ‐ Rent Paid (If HRA benefit is not provided by Employer)
Verification
Place
Date- Signature of Employee
Name-