Form No.12Bb: Details of Claims and Evidence Thereof

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FORM NO.

12BB
(See rule 26C)

1. Name and address of the employee: Rajesh Kumar Sharma


2. Permanent Account Number of the employee: EWGPS5505A
3. Financial year: 2021-2022

Details of claims and evidence thereof


Sl No. Nature of claim Amount (Rs.)
(1) (2) (3)
1 House Rent Allowance:
(i) Rent paid to the landlord 96000 / PA
(ii) Name of the landlord Mr. Shashi Sharma
(iii) Address of the landlord House no. 22,Swiss
City Dandra Pin
code -141116
Ludhiana (Punjab)

(iv) Permanent Account Number of the landlord

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


3 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
4 Deduction under Chapter VI-A
(A) Section 80C,80CCC and 80CCD
(i) Section 80C
(a) NSC 50,000
(b) ….....................
(c) ………………..
(d) ………………..
(e) ………………..
(f) ………………..
(g) ………………..
(ii)  Section 80CCC
(iii) Section 80CCD
(iii) Section 80D
(B) Other sections (e.g. 80E, 80G, 80TTA, etc.)
under Chapter VI-A.
(i) section……………….
(ii) section……………….
(iii) section……………….
(iv) section……………….
(v) section……………….
Verification
I, Rajesh Kumar Sharma ,son of Sh.Parkash Chand Sharma do hereby certify that the information given above is
complete and correct.
Place Noida
Date 27-08-2021 (Signature of the employee)
Designation Sr. Engineer Full Name Rajesh Kumar Sharma
mar Sharma
5A

e thereof
Evidence / particulars
(4)
eby certify that the information given above is

e of the employee)
e Rajesh Kumar Sharma

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