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FORM NO.12BA |
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| See Rule 26A(2) | ||
| as inserted by | ||
| the Income-tax (22nd Amendment) Rules, 2001, 25th September, 2001 | ||
Statement showing particulars of
perquisites, other fringe
benefits or amenities and profits in lieu of salary
with value thereof
1) Name and address of employer : ___________________________________________________________________________
2) Name and designation of employee : ________________________________________________________________________
3) Assessment Year: ______________
| S.No | Nature of
perquisite (see rule 3) |
Value
of perquisite as per rules (Rs.) |
Amount, if
any paid by employee (Rs.) |
Amount
of taxable perquisite (Rs.) |
| 1 | Accommodation | |||
| 2 | Cars | |||
| 3 | Sweeper, gardener, watchman or personal attendant | |||
| 4 | Gas, electricity, water | |||
| 5 | Interest free or concessional loans | |||
| 6 | Holiday expenses | |||
| 7 | Free or concessional travel | |||
| 8 | Free meals | |||
| 9 | Education | |||
| 10 | Gifts, vouchers etc. | |||
| 11 | Credit card expenses | |||
| 12 | Club expenses | |||
| 13 | Use of movable assets by employees | |||
| 14 | Transfer of assets to employees | |||
| 15 | Stock options (non-qualified options) | |||
| 16 | Other benefits or amenities | |||
| 17 | Profits in lieu of salary as per 17(3) | |||
|
Total value of perquisites |
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| Total value of profits in lieu of salary |
DECLARATION BY EMPLOYER
I . S/o . working as (designation) do hereby declare on behalf of .. .. (name of the employer) that the information given above is based on the books of account, documents and other relevant records or information available with us and the details of value of each such perquisite are in accordance with section 17 and rules framed thereunder and that such information is true and correct.
Signature of the person responsible
for deduction of tax
Place
Date
Full Name
Designation .