Form no 12BBA Income Tax Forms
Form no. 12BBA
(see rule 26D)
Declaration to be furnished by Specified Senior Citizen under sub-clause (iii) of clause (b) of Explanation to
section 194P
(1) Name and address of the person :
(2) PAN or Aadhaar :
(3) Previous Year :
(4) Date of Birth :
(5) Name of the Specified Bank :
(6) Name of Employer from which pension is drawn :
(7) Pension Payment Order (PPO) Number :
Verification
I, ………….. son/daughter of …………………. do hereby certify that the information given above is complete and correct
and that I do not have any income other than the income of the nature of pension and/or interest which is received or
receivable only in the account(s) of the specified bank stated above
Date …………….……………
Place …………..
(Signature of person)
Full Name: …………………. .”;