FORM NO.

12BB
(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192

Valeo India Private Limited

Employee IN04100282 - Naresimhon G Declaration No 2

Employee Address Chennai

F.Y. 2017 - 18 Declaration Dt. 12-Jan-2018

Chapter VI-A (80CCE)

Deducted Actual
Description Section
From Salary Investments
Provident Fund 80C 130680 0

Life Insurance Premium 80C 0 41172

Rct No RctDate Name Relation IssuedBy Paid Amount
717619148 26-Dec-2017 Naresimhon G Self LIC Yes 41172

Chapter VI-A 80 CCD 80C 0 50000

Total ( 221852 ) 130680 91172

House Rent
Land Lord Name Land Lord PAN From Date To Date Rent Per Month Metro City
K M KOTHAI avjpk6407H 30-Mar-2017 26-Mar-2018 30250 Yes
Address : 52/3 Manimekalai Street, Mahalakshmi Nagar, Selaiyur, Chennai. 600073

Income from House Property

Self Occupied Property
Interest on Housing Loan Purchased after 1999 (Limit: 200,000) 0 212625
Lender Name : HDFC LIMITED Lender Address : HDFC LTD, Second floor ITC Centre, 760 Anna Salai,
Chennai 600002
Lender PAN No. : AAACH0997E

I, Naresimhon G ,son/daughter of...................................................... do hereby certify that the information given above
is complete and correct.

Signature

Name Naresimhon G

Date 15/01/2018 03:28:56:PM

Printed On 15/01/2018 03:28:56:PM