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["FORM NO.12BB"]
["(See rule 26C)"]
[]
["1. Name and address of the employee: "]
["2. Permanent Account Number of the employee: "]
["3. Financial year:"]
[]
["Details of claims and evidence thereof"]
["Sl No.","Nature of claim",null,"Amount (Rs.)","Evidence / particulars"]
["(1)","(2)",null,"(3)","(4)"]
[1,"House Rent Allowance:"]
[null,"(i) Rent paid to the landlord"]
[null,"(ii) Name of the landlord"]
[null,"(iii) Address of the landlord"]
[null,"(iv) Permanent Account Number of the landlord"]
[null,"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:"]
[null,"(i) Interest payable/paid to the lender"]
[null,"(ii) Name of the lender"]
[null,"(iii) Address of the lender"]
[null,"(iv) Permanent Account Number of the lender"]
[null,"(a)   Financial Institutions(if available)  "]
[null,"(b)   Employer(if available)"]
[null,"(c)    Others"]
[4,"Deduction under Chapter VI-A"]
[null,"(A) Section 80C,80CCC and 80CCD"]
[null,"     (i) Section 80C"]
[null,"(a)","……………….."]
[null,"(b)","……………….."]
[null,"(c) ","……………….."]
[null,"(d)","……………….."]
[null,"(e)","……………….."]
[null,"(f)","……………….."]
[null,"(g)","……………….."]
[null,"    (ii)  Section 80CCC"]
[null,"    (iii) Section 80CCD"]
[null,"(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A."]
[null,"(i) section………………."]
[null,"(ii) section………………."]
[null,"(iii) section………………."]
[null,"(iv) section………………."]
[null,"(v) section………………."]
["Verification"]
["I,…………………..,son/daughter of……………………….. do hereby certify that the information given above is complete and correct."]
["Place……………………………………………..."]
["Date……………………………………………....",null,null,"(Signature of the employee)"]
["Designation ……………………………….….",null,null,"Full Name"]

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