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"
FORM NO.12BA
{ See Rule 26A(2) }Statement
showing particulars of perquisites, other fringe benefits
or amenities and profits in lieu of salary with value
thereof
- Name
and address of employer :
- Name
and designation of employee :
- Assessment
Year:
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S.No
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Nature
of perquisite (see rule 3)
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Value
of perquisite as per rules (Rs.)
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Amount,
if any paid by employee (Rs.)
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Amount
of taxable perquisite (Rs.)
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| 1 |
Accommodation |
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| 2 |
Cars |
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| 3 |
Sweeper,
gardener, watchman or personal attendant |
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| 4 |
Gas,
electricity, water |
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| 5 |
Interest
free or concessional loans |
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| 6 |
Holiday
expenses |
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| 7 |
Free
or concessional travel |
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| 8 |
Free
meals |
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| 9 |
Education |
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| 10 |
Gifts,
vouchers etc. |
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| 11 |
Credit
card expenses |
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| 12 |
Club
expenses |
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| 13 |
Use
of movable assets by employees |
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| 14 |
Transfer
of assets to employees |
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| 15 |
Stock
options (non-qualified options) |
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| 16 |
Other
benefits or amenities |
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| 17 |
Profits
in lieu of salary as per 17(3) |
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Total
value of perquisites |
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Total
value of profits in lieu of salary |
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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
.
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