Form No.

16 [ 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 Designation of the Employee 1

Name and Address of the Employer

Form 24 Seq. No. : PAN / GIR No. TAN No Period From To PAN / GIR No. Assessment Year

TDS Circle where Annual Return/Statement under Sec.206 is to be filed.

Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDL web-site Quarter Acknowledgement No.

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

1 GROSS SALARY a) Salary as per provisions contained in sec.17(1) b) Value of perquisites u/s 17(2) (as per FormNo.12BA, wherever applicable) c) Profits in lieu of salary under section 17(3) (as per Form No.12BA, wherever applicable) d) Total 2 LESS : Allowances to the extent exempt under section 10 Allowance Conveyance Allowance 3 BALANCE (1-2)

Amount

4 DEDUCTION (a) Tax on employment (b) Entertainment Allowance 5 AGGREGATE OF 4 ( a to b ) 6 INCOME CHARGEABLE UNDER THE HEAD SALARIES ( 3 - 5) 7 ADD Any other income reported by the employee 8 GROSS TOTAL INCOME ( 6 + 7 ) 9 DEDUCTION UNDER CHAPTER VI - A (A) Sections 80C, 80CCC and 80CCD A. Section 80C (a) (b) (c) (d) B. Section 80 CCC C. Section 80 CCD (B) Other Sections (e.g. 80E, 80G etc.) under chapter VI A Gross Amt (a) (b) (c) (d) 10 Aggregate of Deductible amount under Chapter VI - A 11 TOTAL INCOME ( 8 - 10 ) 12 TAX ON TOTAL INCOME Qualify Amt Deductible Amt

Gross Amt

Deductible Amt

Page 2 : 13 SURCHARGE ( ON TAX COMPUTED AT SR.NO.12) 14 EDUCATION CESS @ 2% ON (TAX AT S. NO. 12 PLUS SURCHARGE AT S. NO.13) 15 TAX PAYABLE (12+13+14) 16 Relief under section 89 (attach details) 17 Tax payable (15-16) 18 Less : (a) Tax deducted at source u/s 192(1) (b) Tax paid by the employer on behalf of the employee u/s 192(1A) on perquisites u/s 17(2) 19 TAX PAYABLE / (REFUNDABLE) ( 17 - 18 ) DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT Sr.No. TDS Surcharges Education Cess Total Tax Deposited Chq No./ DD No. BSR Code of Bank Branch Date on which tax deposited (DD/MM/YY) Transfer voucher/Challan Identification No.

1 2 3 4 5 6 7 8 9 10

I , son/daughter of working in the capacity of (Designation) do hereby certify that a sum of Rs. #NAME? 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

Signature of the person responsible for the deduction of tax. Place : Date : Full Name : Designation :

Certificate No. FORM NO. 16A [See rule31(l)(b )] Certificate of deduction of tax at source under section 203 of the Income-tax Act, 1961 For interest on securities; dividends; interest other than interest on securities; winnings from lottery or crossword puzzle ; winnings from horse race; payments to contractors and sub-contractors; insurance commission; payments to non-resident sportsmen/sports associations; payments in respect of deposits under National Savings Scheme; payments on account of repurchase of units by Mutual Fund or Unit Trust of India; commission, remuneration or prize on sale of lottery tickets; commission or brokerage; rent; fees for professional or technical services; royalty and any sum under section 28(va); income in respect of units; payment of compensation on acquisition of certain immovable property; other sums under section 195; income in respect of units of non-residents referred to in section 196A; income from units referred to in section 196B; income from foreign currency bonds or shares of an Indian company referred to in section 196C; income of Foreign Institutional Investors from securities referred to in section 196D

Name and address of the person deducting tax

Acknowledgement Nos. of all Quarterly Statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDL web-site Quarter Acknoweldgement No

Name and address of the person to whom payment made or in whose account it is credited

Tax Deduction a/c no of the deductor

Nature of Payment

PAN/GIR No. of the Payee

PAN/GIR No. of the Deductor

For The Period

Details of payment, tax deduction and deposit of tax into central government account

Sr. No.

Amount paid /credit

Date of Payment/ Credit

TDS Rs.

Surcharge Rs.

Education Cess Rs.

Total Tax Deposited Rs.

Cheque/DD No (if any)

BSR Code of Bank Branch

Date on which tax was deposited

Transfer Voucher/Challan Identification No

1 2 3 4 5 6 7 8 9 10 11 18 12 13 Total -

Certified that a sum of Rs. (in words). #NAME? has been deducted at source and paid to the credit of the Central Government as per details given above.

Place Mumbai Date:

______________________________________________ Signature of person responsiblefor deduction of tax Full Name: Designation: