PllForm12bb

FORM NO.12BB

FORM NO.12BB
(See rule 26C)
1. Name of the employee:
2. Permanent Account Number of the employee:
3. Financial year 2025-26
Details of claims and evidence thereof
Sl No. Nature of claim Amount (Rs.)
1 House Rent Allowance:  
  (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 and copy of PAN 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 Home 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
4 Deduction under Chapter VI-A  
  Sec. 80C -LIC/PPF/Housing Loan/Tution Fee etc. up to Rs. 1,50,000/-
  Sec.80CCD (1)b - NPS up to Rs. 50000/-
  Sec. 80D - Medical Insurance & Expenses on Preventive Health Check-up
  Sec. 80DD - Expenses of Rehabilitation of Handicapped dependent
  Sec. 80DDB - Medical Expenses for Self or Dependent (For certain specified diseases only)
  Sec. 80E - Repayment of Interest on Loan for Higher Education
  Sec. 80EE - House Loan Interest Deduction over & above 2 Lacs(Low Cost Housing Loans)
  Sec. 80U - Deduction for Disabled Individual
B Telephone /Mobile/Internet Bills Amount
I, do hereby certify that the information given above is complete and correct.
Place:
Date: 04/05/2025 Full Name:
Designation: Father name:





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