Вы находитесь на странице: 1из 3

FORM NO.

12BB
(See rule 26C)
1. Name and address of the employee:

2. Employee Code :
3. Name of the Company :
4. Permanent Account Number of the employee:
5. Financial year: 2019-20
Details of claims and evidence thereof
Sr. No. Nature of claim Amount (Rs.) Evidence / particulars
(1) (2) (3) (4)
1 Details of Actual Rent paid :
( a) Rent Period : From - To -
(i) Rent paid to the landlord per month :
(ii) Name of the landlord :
(iii) Address of the landlord :

(iv) Permanent Account Number of the landlord :

(b) Rent Period : From - To -


(i) Rent paid to the landlord per month :
(ii) Name of the landlord :
(iii) Address of the landlord :

(iv) Permanent Account Number of the landlord :

Note: Permanent Account Number shall be furnished if the aggregate rent paid during the previous year ( i.e. .FY
2019-20 ) exceeds one lakh rupees
2 Leave travel concessions or assistance :
PL availed : From - To -
3 Deduction of interest on housing loan :
(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


(b) Employer
(c) Others
Annual Rent Received for let out property

Section 80 EE - Repayment of interest on hosing


loan .( Max 50000, Please read the instructions) loan
sanctioned during FY 2016-17

Section 80 EEA - Repayment of interest on hosing


loan .( Max 150000, Please read the instructions) loan
sanctioned during FY 2019-20

4 Deduction under Chapter VI-A


(A) Section 80C,80CCC and 80CCD
(i) Section 80C
(a) Payment towards LIC
(b) Contribution to ULIP
(c) Contribution to certified Central Govt.Security
(d) Contribution to PPF ( Max 150000)
(e) Contribution to NSC VIII issue
(f) Contribution to notified ULIP of LIC Mutual Fund
(g) Repayment of Housing Loan ( Principal Amt )
(h) Interest on NSC VIII issue
(i) Contribution to notified annuity plan of LIC
(j) Contribution to notified mutual fund
(k) Contribution to notified pension Fund
(l) Tuition Fees - Child 1 - Only Tuition Fees
(m) Tuition Fees - Child 2 - Only Tuition Fees
(n) Term deposit under section 80C
(o) Section 80 C - 5 yrs. term deposit under Post
Office Time deposit rule 1981
(p) Section 80 C - Sr.Citizen savings scheme Rule
2004
(q) Sukanya Samriddhi Account
(r) Any other Exemption under section 80C ( Please
specify )

(ii) Section 80CC - Contribution to pension


Fund not claimed under any other section
(iii) Section 80CCD - Contribution to NPS

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


under Chapter VI-A.

(i) Section 80D

(a) Medical insurance premium including Preventive


Health check-up (Max 5000) for parents (non
Sr.Citizen) - Max 25000

(b) Medical insurance premium including Preventive


Health check-up (Max 5000) for parents (Sr.Citizen) -
Max 50000

(c) Medical insurance premium including Preventive


Health check-up (Max 5000) for self and family (non
Sr.Citizen) - Max. 25000
(d) Medical insurance premium including Preventive
Health check-up (Max 5000) for self and family
(Sr.Citizen) - Max 50000
(ii) Section 80DD

(a) Deduction for dependent with severe disability -


Max 125000

(b) Deduction for dependent with disability - Max


75000
(iii) Section 80U

(a) Deduction for self with severe disability - Max


125000

(b) Deduction for self with disability - Max 75000


(iv) Section 80E - Repayment of interest on loan for
higher education
(v) Section 80DDB

(a) Medical Treatment( Max 40000 for Non Sr. Citizen)

(b) Medical Treatment ( Max 100000 for Sr. Citizen )

(c) Medical Expenditure ( Max 50000 for Self Sr.


Citizen )
(d) Medical Expenditure ( Max 50000 for Parents Sr.
Citizen )
(vi) Section 80TTA - Interest on savings bank
account (Max - 10000).For Non Sr.Citizen employee
(vii) Section 80TTB - Interest on Bank Deposit
(savings or fixed ) (Max - 50000).For Sr.Citizen
employee only .
( viii) Section 80GG - Deduction in respect of Rent
paid ( In case no HRA paid as part of CTC ) - Max
5000 per month
(ix) Section 80EEB -Repayment of interest on loan
for purchase of electric vehicles in FY 2019-20

(x) Any other Exemption ( Please specify )

Verification
I,…………………………..………….,son/daughter of……..…………………………. do hereby certify that the information
given above is complete and correct.
Place………………………………………………
Date…………………………………………….... (Signature of the employee)
Designation ……………………………….…. Full Name :

Оценить