FORM NO.

12BB
(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192
Employee Investment Declaration Form For the Financial Year 2016-2017
Employee ID *
Employee Name *
PAN No*
Date of Joining
Gender *
Address for claiming HRA:
From Date To Date City Metro PAN of Landlord Rent Paid
Yes/No per month

Section B - Chapter VI A - Deductions from Total Income AMOUNT

Medical Insurance Premium (U/s 80D) - Individual, Spouse & Children (Max Limit INR 25,000 p.a)
Medical Insurance Premium (U/s 80D) - Parents not being Senior Citizens (Max Limit INR 25,000 p.a)
Medical Insurance Premium (U/s 80D) - Parents being Senior Citizens (Max Limit INR 30,000 p.a)
Medical Treatment/Handicapped Dependent (U/s 80DD) <80%
Medical Treatment/Handicapped Dependent (U/s 80DD) >80%
Medical Treatment in case any Disease/ Ailment-Self/Dependent (U/s 80DDB) Senior citizens (> 60
years and < 80 years)
Medical Treatment in case any Disease/ Ailment-Self/Dependent (U/s 80DDB) Super Senior citizens
(> 80 years
Interest )
on Educational Loan (U/s 80E)
Permanent Physical Disability (80U) < 80%
Permanent Physical Disability Severe Disability (80U) > 80%
Rajeev Gandhi Equity Savings Scheme (80CCG)
Interest on Deposit in Savings Account deduction upto Rs.10000 (80TTA)
National Pension Scheme(80CCD)
Total 0
Section C - Chapter VIA Sec 80C
Life Insurance Premium
Public Provident Fund (PPF)
National Savings Certificate (NSC)
Infrastructure Bonds
Children Education Tuition Fees
Mutual Funds / Equity Linked Saving Scheme (ELSS)
Sukanya Samriddhi Scheme
ULIP
5 Year Time Deposit in Post Office
Housing Loan - Principal Amount paid, Registration Fees, Stamp duty
Fixed Deposit Scheme (Block Period of 5 yrs)
NSC Interest (Will be considered as Other Income)
Total (Maximum Limit INR 150,000) 0
Section D - Loss from House Property - SELF OCCUPIED (As per Statement on Income From House
Property)
Total interest paid by me (post construction/possession/ amortized pre-emi) during the financial year
(April 16 to March 17) - Self Occupied
Address of the Property against which Loan taken
City
Date of Occupation (DD/MM/YYYY)
Total (Maximum Limit INR 250,000 - Refer Annexure 1 attached to the document) 0
Section E - Previous Employment - Refer Annexure 2a and 2b attached to the document
Income after Section 10 exemption (Joined after 01/04/2016)
Provident Fund (PF)
Professional Tax (PT)
Tax deducted at source (TDS)
(Please attach Form 16 OR Income Tax Computation Sheet from Previous Employer for FY 0
2016-17along with 12B)
Grand Total 0

Declaration:
I hereby declare that the information given above is correct and true in all respects and I intend to make the
Iinvestments declared
also undertake above the company for any loss/liability that may arise in the event of the above information
to indemnify
being incorrect / declared investments not made
Date:
Place:
Signature of the employee
Signature of the employee
 FORM NO. 12C
[See Rule 26B]
Form for sending particulars of income under section 192(2B) for the year
Year Ending 31st March, 2017
S.No Particulars

1 Name and Address of the Employee.

2 PAN

3 Residential status.
Amounts in Rs. Amounts in Rs.
Particular of income under head of income From
"Salaries" (not being a part received from the Current
4 Employer) received in the Financial Year 2016-17

Particular of income under any head of income other

than "Salaries" (not being a loss under any such head
other than the loss under the head "Income from House
5 Property") received in the Financial Year 2016-17

a Income from house property

(As per Annexure III)

b Profits and Gains from Business or Profession

c Capital Gains

d Income from other Sources

(i) Dividends
(ii) Interest
(iii) FDR Interest
(iv) Other Incomes [Pl. Specify]

6 Aggregate of sub - items (i) to (iv) of item 5

Tax deducted at sources [enclose certificate (s) issued

7 under Section 203.]/ Copy of the 26AS

Place

Date

Signature of the Employee

Verification

I,........................., do hereby declare that what is stated above is true to the best of my knowledge and belief.

Verified today , the ...........................day of............................20

Place

Date

Signature of the Employee

 House Property Declaration Form for FY 2016-17
Information towards the House Properties held by employee
PARTICULARS i) House Property
ii) 1
House Property
iii)2House Property 3Total
House Property A

Address B

Owners Name and Ratio of

C
Ownership
Category (Self occupied/let
D
out/deemed let out)
Amount of Loan taken E

Name and Address of lender

F
(Loan Provider)

Nature of the Lender G

Address of the Lender H
PAN of the Lender I
Interest portion paid/payable
J
in the Financial Year
Principal portion paid in the
K
Financial Year
Gross Annual Rent/Value* L
employee M
30% For Repairs ( Only for Let
N
out Property)
Gross income O=(L-M-N)
Net Income P=(O-J)
Date of Possession N

Note : 1. Provisional Interest certificate from bank is COMPULSORY to attach OTHERWISE NO BENEFIT GIVEN FOR INTEREST OR
PRINCIPAL REPLAYEMNT.

Note : 2. Gross Annual Value = HIGHER OF (i) Municipal value or fair rent w.e. is higher subject to maximum of standard rent (ii) Rent
actually received or receivable

Note : 3. Mandatory to furnish 'Possession Certificate' issued by builder/municipal authorities etc.,

I, (Name of the assessee) , do declare that

what is stated above is true. It is hereby further declared and confirmed that in the event of any misstatement
in above stated financial information and in consequence thereof if any shortfall in deduction of tax at source
is arising by Employer and if Employer has to suffer any loss of whatsoever nature under provisions of the
Income tax Act, 1961 I shall indemnify the said loss to Employer immediately on I being called upon by
Employer

Place:

Date

Signature of the Employee

Annexure-1
Interest on Housing Loan for the FY 2016-17.

Note:

1.Interest on Housing loan allowed up to Rs.2,00,000.

2. Additional exemption of INR 50,000 provided the following conditions are satisfied:
a. First Home Buyer/Buyers; and
b. Value of the House is less INR 50 lacs; and
c. Maximum value of the loan is INR 35 lacs.

2. Sanction Letter/Provision Certificate is mandatory for claiming interest on housing loan.

re satisfied:

on housing loan.
 FORM NO. 12 B
[See rule 26A]
ANNEXURE 2a
Form for furnishing details of income under section 192(2) for the year ending 31st March, ____________________

Name of the employee Permanent Account No.

Residential Status
Address of the employee

Particulars of salary as defined in Section Total

17, paid or due to be paid to the employee amoun
Amt
during the year t of tax
deduct
of house rent deduct
ed in
TAN of Perma allowance, ed
respec
the nent Total conveyance Value of during
t of life
employ Accoun Period amount of allowance and perquisites Total of insuran the
Name & Address of er(s) t of salary other and amount of Colum year Remar
Sr No. ce
employer (s) as Numbe Employ excluding allowances to accretion to ns 6, 7 premiu (enclos ks
allotte r of the ment amounts the extent employee's &8 e
m, PF
d by Employ required to chargeable to provident fund certific
etc
the ITO er (s) be shown tax [see account (give ate
(give
in columns section details in the issued
details
7&8 10(13A) read annexure) under
)
with rule 2A sec
and section 203)
1 2 3 4 5 6 7 8 9 10 11 12

Verification

I _________________________________, do hereby declare that what is stated above is true to the best of my knowledge and belief, verified today _______________

Signature of the Employee ___________________________

 ANNEXURE
[ See column 8 of Form No.12B ]
ANNEXURE 2b
Particulars of Value of perquisites and amount of accretion to employee's fund account

Name of the employee Permanent Account N

Period : Year ending

Address of the employee

Whether Estimated
Value of rent-free accommodation or value of any concession in rent for
any Value of value of
the accommodation provided by the employer (give basis of computation)
conveyance free or any other
[See rules 3(a) and 3 (b)
has been concessi benefit or
provided by onal amenity
Interest
Where accommodation is furnished the Remune passage provided by
credited
employer ration s on the
Employer to the
free or at a paid by home employer,
's assessee'
Cost of Value of concessiona employe leave free of cost
contribut s account
furniture perquisi l rate or r for and or at Total of
ion to in
(including te where the domesti other concessiona columns
recognise recognise
television (column employee is c and/or travelin l rate not
d PF In d
9 to 15
TAN/PAN Where Perquisit
Name of the sets, radio Rent, if 3 minus allowed the personal g to the included in
excess of provident
carried
of the e Value
employee accom sets, any, column use of one services extent the
10% of fund in
to
employer modati of or more provide chargea preceding column
refrigerators, paid by 8 or the excess of
furniture
on is Value as if other the column motor cars d to the ble to columns
employee the rate
8 of
(10% of Total of
unfurni accommodati household employ 7 minus owned or employe tax (give
's salary fixed by
Form
column Columns hired by e (give (give details), No.12B
shed on is appliances ee column [See the
5) OR 4 and 6 the details) details) e.g. 'supply
unfurnished and air- 8 as Schedule Central
actual
conditioning may be employer, [See [See of gas,
IV-Part A] Govt [See
hire
plant or applicab estimated rule rule 2B electricity
Schedule
charges value of 3(g)] read or water for
equipment) le) IV-Part A]
payable perquisite with household
OR hire
charges, if (give section consumptio
hired from a details) 10(5) n, free
third party [See rule (ii)] educational
3 faci
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Signature of the Employee________________________
________
Important Information:
For Individuals the Tax Rates as below for the FY 2016-17

Income Rs. Rate of Income Tax

Upto Rs. 2,50,000 NIL

Rs. 2,50,001 to Rs. 5,00,000 10% of Income above Rs. 2,50,000
Rs. 5,00,001 to Rs. 10,00,000 Rs. 25,000 + 20 % of Income Above Rs. 5,00,000
Rs. 10,00,001 and above Rs. 125,000 + 30 % of Income Above Rs. 10,00,000

Note:
1.Education Cess @3% as applicable
2.Tax Rebate of Rs.5,000 for total annual income up to Rs. 5lakh (As per Section 87A)

NOTE:
1.Rent Receipt
2.PAN of the Owner with address is mandatory in case the rent exceeds Rs.8,300/-Per Month
3.Copy of Rental agreent is mandatory if rent payable is more than Rs.8,300/-Per Month
s. 5,00,000
Rs. 10,00,000

Section 87A)

Rs.8,300/-Per Month
300/-Per Month