Petronet LNG Limited : Form12BB

PllForm12bb

FORM NO.12BB

Select Tax Regime:

FY -

FORM NO.12BB
(See rule 26C)
1. Name of the employee:
2. Permanent Account Number of the employee:
3. Financial year
Details of claims and evidence thereof
Sl No.	Nature of claim	Amount (Rs.)	Approved Amount	Remarks	Employee Remarks	Final Approved Amount	Final Remarks
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. 80EEA - 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:	14/04/2026	Full Name:
Designation:		Father name:

I hereby declare that I am claiming the interest on a housing loan for a property that is not under construction and is in possession.

I hereby declare that I am claiming the interest on the housing loan for the property, and it will not be claimed by any co-borrower, if applicable.

Note: Only PDF documents are accepted. The maximum file size is 1 MB each for all documents, except for LTA, Rent Agreement, and Telephone documents, which can be up to 2 MB each.

Rent Receipts

Notarised / Registered Rent Agreement

PAN Card of Landlord

Interest Loan Certificate

Home Loan Bank Statement

LTA Ticket and Bill

80C

80CCD (1B) - NPS Statement

80D

80DD

80DDB

80E

80 EE Home Loan Sanction Letter

80 EEA Home Loan Sanction Letter

80U

Telephone Bills

Block Year For LTC *

Claim *

leave Availed *

Origin *

Destination *

Mode Of Travel *

Period Of Journey *

SL. NO.	NAME	RELATIONSHIP	AGE	FARE		TOTAL	Action
SL. NO.	NAME	RELATIONSHIP	AGE	(A) Outward Journey	(B) Return Journey	TOTAL
TOTAL

I CERTIFY THAT THE ABOVE REFERRED PERSONS WHO TRAVELED WITH ME ARE DEPENDENT ON ME.

I CONFIRM THAT I HAVE UNDERTAKEN TO TRAVEL TO THE DESTINATION MENTIONED ABOVE DURING THE PERIOD MENTIONED ALONGWITH THE MEMBERS OF MY FAMILY.

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Form12BB

PllForm12bb

FORM NO.12BB