INVESTMENT DECLARATION FORM (Option- 1/ Option-2) (Please √ any one)
FORM NO. 12BB
(See Rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
1. Name of the Employee: Yogender Singh
Address of the Employee: T5-404, GLS Arawali Homes, Sector 4, Sohna, Gurugram
2. Permanent Account Number of the Employee: BDGPS4506P
3. Financial Year. 2025-26
Details of claims and evidence thereof
Sl.N Nature of Claim Section Amount (Rs.) Evidence/Particulars
(1) (2) (3) (4)
HOUSE RENT ALLOWANCE :
(i) Rent Paid to Landlord ( Rs. X Months)
(ii) Name of the Landlord:
1 (iii) Address of the Landlord: 10 (13A)
………………………………………………………………………………………………………………………
………………………………………………………………
(iv) PAN Number of the Landlord:
Note: Permanent Account Number shall be furnished if the aggregate rent paid
during the previous year exceeds on lakh rupees.
2 LEAVE TRAVEL CONCESSIONS OR ASSISTANCE
Deduction of interest on borrowing:
(i) Interest payable/paid to the lender or Bank
ICICI Bank 157801 Income tax certificate
(ii) Name of the lender/Bank :………………………………………………………………
(iii) Address of the lender/bank:
………………………………………………………………………………………………………………………
3 ………………………………………………………………………………
(iv) Permanent Account Number of the lender;……………………………………..
(a) Financial Institutions(if available)
(b) Employer(if available)
(c) Others
DEDUCTIONS UNDER CHAPTER VI-A
(A) Sections 80C, 80CCC and 80CCD
(i) Section 80C
(A) PENSION FUND SCHEMES-MUTUAL FUND / UTI
4 80 C
(B) HOUSING LOAN PRINCIPAL REPAYMENT
(C) PPF - PUBLIC PROVIDENT FUND
(D) LIFE INSURANCE PREMIUM DIRECTLY PAID BY EMPLOYEE 12000 LIC Slip
(E) ULIP LINKED INSURANCE PLAN FROM UTI / LIC MUTUAL FUND
(F) NSC - NATIONAL SAVING CERTIFICATE/ Sukanya samridhi Yojana
(G) SUBSCRIBTION TO NOTIFIED BONDS OF NABARD
80 C
(H) INFRASTRUCTURE INVESTMENT - DEBENTURES / EQUITY SHARES / MUTUAL
FUNDS
80 C
(I) ELSS - EQUITY LINK SAVING SCHEME OF MUTUAL FUNDS
(J) TUITION FEES FOR FULL TIME EDUCATION TO INDIAN SCHOOL, UNIVERSITY 107900 Fee slip
(K) FIXED DEPOSITS IN BANK FOR MORE THAN 5 YRS.
(ii) PENSION SCHEME NOTIFIED BY CENTRAL GOVERNMENT 80 CCD
(iii) ANNUITY PLAN OF LIC / ANY OTHER 80 CCC
(B) Other Sections (e.g. 80E, 80G, 80TTA, 80D, 80DD, 80DDB etc) under
4 chapter VA-A
(i) MEDICLAIM PREMIUM (For Self, Spouse, Dependent Children & Parents) 80 D
(ii) MEDICAL EXPENSES proposed to be incurred on specified diseases (AIDS,
Cancer, Thalassaemia, Hemophilia, Chronic Renal Failure, Chronic Neurological 80 DDB
Diseases)
(iii) Maintainence of depandant disabled 80 DD
(iv) INTEREST ON EDUCATION LOAN 80 E
(v) DONATIONS TO CERTAIN FUNDS, CHARITABLE INSITUTIONS etc 80 G
(vi) Interest income from deposit in a savings accounts(80TTA) 80 TTA
(vii) Any Other Taxable Income (Other than interest income)
(vii) Please specify if any,
Verification
Yogender Singh
I, Shri/Smt/Kumari/…………………………………………………………………………….,son/daughter Late. Surender Singh
of…………………………………………………do hereby certify that the
information given above is complete and correct.
Gurugram
Place…………………………………………………………
30 - 04- 2025 (Signature of the Employee)
Date:………………………………………
Music Teacher Yogender Singh
Full Name…………………………………………………………
Designation………………………………………………………
