FORM NO.

12B

[See rule 26A]

Form for furnishing details of income under section 192(2) for the year ending 31st March, 2018

Name and address of the employee : Prabhakarappa Shashidhar

Permanent Account No. ____ BFSPS3333A

Residential status ______Resident

S. No Name and address of TAN of the Permanent Period of Particulars of salary as defined in section 17, paid or due to be paid Total of columns 6, 7, Amount deducted in Total amount of tax Remarks
employer(s) employer(s) as Account Number employment to the employee during the year and 8 respect of life deducted during the
allotted by the of the employer(s) insurance premium, year (enclose
ITO Total amount of Total amount of house Value of perquisites provident fund certificate issued
salary excluding rent allowance, and amount of contribution, etc., to under section 203)
amounts required conveyance allowance accretion to which sec. 80C †
to be shown in and other allowances to employee's provident applies (Give details)
columns 7 and 8 the extent chargeable to fund account (give
tax[See section 10(13A) details in the
read with rule 2A and Annexure)
section 10(14)]

1 2 3 4 5 6 7 8 9 10 11 12

1 Birlasoft India
Limited 01/04/2017 to
DELB06525B AAACB2769E 202366 100974 0 303340 12904 4488
H-9 Sector-63, 18/07/2017
Nodia, 201306

Verification

Prabhakarappa Shashidhar
do hereby declare that what is stated above is true to the best of my knowledge and belief.
I,______________________________________________________
Verified today, the_____________________day of______________________

Place Signature of the employee ____________________