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Form 12BB

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FROM NO.

12BB
(See Rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192

1 Emp. Code

2 Name of the Employee

Address of Employee

3 PAN of Employee
2019-20
4 Financial Year

Details of Claims and Evidence thereof


S.No. Nature of Claim Month Amount Month Amount Evidence / Particulars
1 House Rent Allowances
Rent Paid to Landlord Apr'19 Oct'19 Receipts enclosed

May'19 Nov'19
Address of Accommodation June'19 Dec'19
July'19 Jan'20
Aug'19 Feb'20
Sep'19 Mar'20

Name of the Land Lord


Address of Land Lord

PAN of Land Lord

Name of the Land Lord


Address of Land Lord

PAN of Land Lord

Name of the Land Lord


Address of Land Lord

PAN of Land Lord

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


From (Location) To (Location) Date of Journey Amount Evidence / Particulars
(i)
(ii)
(iii)
(iv)
3 Deduction of interest on borrowing (Housing Loan u/s 24):
Nature of Claim Amount Evidence / Particulars
Interest payable/paid to the lender
Name of the lender
Address of the lender

PAN of the lender

Nature of Claim Amount Evidence / Particulars


Interest payable/paid to the lender
Name of the lender
Address of the lender
PAN of the lender

Income From Let out Property


If property is owned and
If Property is owned and on Loan
Without Loan
Gross Annual Value
Less: Muncipalty Taxes
Net Annual Value
Less: Standard Deduction @ 30%
Less: Interest on borrowed capital
Net Income from House Property

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

Income from Previous Employer


Nature of Claim Amount (Rs) Evidence / Particulars
Total Income
TDS
PF
P. Tax

Nature of Claim Amount Evidence / Particulars


Other Income
Income from other sources
Business Income
Any other Income
TDS (Others)
4 Deduction under Chapter VI‐A
(A) Section 80C,80CCC and 80CCD
(I) Section 80C
Nature of Claim Amount Evidence / Particulars
LIC Premium
ULIP
PPF
Fixed Deposit (5yrs Scheme of Bank / Post Office)
Tuition Fees
Repayment of Housing Loan Principal
NSC
Pension Fund (80CCC)
Interest on NSC
Mutual Fund / ELSS
Sukanya Samridhi Scheme

(II) Section 80CCD


Nature of Claim Amount Evidence / Particulars
NATIONAL PENSION SCHEME (80CCD) (ii)

(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)

80TTA ‐ Interest on Saving Bank Account (Exemption up to


Rs. 10,000/‐ Interest.)

Verification

I am ________________________, son/Daughter of _________________________ do hereby certify that


the information given above is complete and correct.

Place
Date- Signature of Employee
Name-

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