FORM NO.

16AA
[See rule 31(1)(a)]
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source from income
chargeable under the head 'Salaries'

Name and address of the employer Name and designation of the employee
.......... ..........
.......... ..........
PAN/GIR No. TAN PAN/GIR No.
.......... .......... ..........
TDS Circle where annual return/statement under Period Assessment year
section 206 is to be filed - .......... From .......... ..........
To ..........

Details of salary paid and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisions contained in section Rs. ..........
17(1)
(b) Value of perquisites under section 17(2) (as per Rs. ..........
Form No. 12BA, wherever applicable)
(c) Profits in lieu of salary under section 17(3) (as per Rs. ..........
Form No. 12BA, wherever applicable)
(d) Total Rs. ..........
2. Less: Allowance to the extent exempt under section Rs. ..........
10
3. Balance (1-2) Rs. ..........
4. Deductions:
(a) Standard deduction Rs. ..........
(b) Entertainment allowance Rs. ..........
(c) Tax on employment Rs. ..........
5. Aggregate of 4(a) to (c) Rs. ..........
6. Income chargeable under the head 'salaries' (3-5) Rs. ..........
7. Add: Any other income reported by the employee
(a) Rs. ..........
(b) Rs. .......... Rs. ..........
8. Gross total income (6 + 7) Rs. ..........
9. Deductions under Chapter VIA
Gross Amount Qualifying Deductible
Amount Amount
(a) Rs. .......... Rs. .......... Rs. ..........
(b) Rs. .......... Rs. .......... Rs. ..........
(c) Rs. .......... Rs. .......... Rs. ..........
(d) Rs. .......... Rs. .......... Rs. ..........
10. Aggregate of deductible amount under Chapter VIA Rs. ..........
11. Total income (8 - 10) Rs. ..........
12. Tax on total income Rs. ..........
13. Rebate under Chapter VIII-A
I. Under section 88 (please specify)
Gross Amount Qualifying Tax rebate
Amount
(a) Rs. .......... Rs. ..........
(b) Rs. .......... Rs. ..........
(c) Rs. .......... Rs. ..........
(d) Rs. .......... Rs. ..........
(e) Rs. .......... Rs. ..........
(f) Total [(a) to (e)] Rs. ..........
II. (a) Under section 88B Rs. ..........
(b) Under section 88C Rs. ..........
(c) Under section 88D Rs. ..........
14. Aggregate of tax rebates at 13 above [I(f) + II(a) + Rs. ..........
 II(b) + II(c)]
15. Tax payable (12 - 14) and surcharge thereon Rs. ..........
15A. Education Cess Rs. ..........
16. Relief under section 89 (attach details) Rs. ..........
17. Tax payable (15+15A-16) Rs. ..........
18. Less: (a) Tax deducted at source under section Rs. ..........
192(1)
(b) Tax paid by the employer on behalf of the Rs. .......... Rs. ..........
employee under section 192(1) on perquisites
under section 17(2)
19. Tax payable / refundable (17 - [18(a)+18(b)]) Rs. ..........

Details of tax deducted and deposited into Central Government Account

Sr. No. TDS Surcharge Education Cess Total Tax Cheque/DD No. BSR Date on which Transfer
Deposited Code of tax deposited voucher/Challan
Bank Identification
Branch No.

I .......... son of .......... working in the capacity of .......... (designation) do hereby certify that a sum of Rs. ..........
[Rupees .......... (in words)] has been deducted at source and paid to the credit of the Central Government. I
further certify that the information given above is true and correct based on the book of accounts, documents
and other available records.

Place : .......... Signature of the person responsible for deduction of

Date : .......... tax
Full Name ..........
Designation ..........

TO BE FILLED BY THE ASSESSEE

1. NAME OF THE ASSESSEE ..........

2. ADDRESS ..........
PIN .......... TELEPHONE ..........
3. DATE OF BIRTH .......... 4. SEX M/F: .......... 5. ASSESSMENT YEAR ..........
6. WARD/CIRCLE/SPECIAL RANGE: .......... 7. RETURN: ORIGINAL OR REVISED ..........
8. PARTICULARS OF BANK ACCOUNT (for payment of refund)
Name of the Bank MICR Code Address of Bank Branch Type of Account Account Number

VERIFICATION BY THE ASSESSEE

1. I, .........., son/daughter of Shri .......... solemnly declare that to the best of my knowledge and belief, the
information given in this return is correct, complete and truly stated and in accordance with the provisions of
the Income-tax Act, 1961, in respect of income chargeable to income-tax for the previous year relevant to the
assessment year ...........

Receipt No. ...........

Date ...........
Signature of the assessee
SEAL Date..........
Place: ..........
Signature of the receiving official