FORM NO. 10BA

[See rule 11B]

Declaration to be filed by the assessee claiming deduction

under section 80GG

I/We ………………………………………………………………………………………………………………………………………….

(Name of the assessee with permanent account number)

do hereby certify that during the previous year …………………… I/we had occupied the premise

……………………………………………. (full address of the premise) for the purpose of my/our own residence for

a period of ………………… months and have paid Rs…………………… in cash/through crossed cheque, bank

draft towards payment of rent to Shri/Ms/M/s ……………………………………………………………………..

…………………………………………………………….. (Name and complete address of the landlord).

It is further certified that no other residential accommodation is owned by

(a) me/my spouse/my minor child/our family (in case the assessee is HUF), at ………………. where I/

we ordinarily reside/perform duties of office or employment or carry on business or profession,

or

(b) me/us at any other place, being accommodation in my occupation, the value of which is to be

determined u/s 23(2)(a)(i) or u/s 23(2)(b).