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FORM 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 address of the Employer Name and designation of the Employee

PAN. No. of the TAN. No. of the Deductor PAN. No. of the employee
Deductor

Acknowledgement No’s of all quarterle Period Assessment Year


statements of TDS under subsection (3) of section
200 as provided by TIN Faciltation Centre or NSDL
web-site

Quarter Acknowledgement No. From To

Details of salary paid and any other income and tax deducted
Sl. Particulars Amount(Rs) Amount(Rs) Amount(Rs)

1. Gross Salary

(a)Salary as per provisions contained


in sec. 17(1)

(b) Value of the prerequisite u/s


17(2) ( as per Form No. 12BB,
wherever applicable)

(c) Value of the prerequisite u/s


17(2) ( as per Form No. 12BB,
wherever applicable)

Total

2. Less allowance to the extent exempt


u/s 10

3. Balance (1-2)

4. Deductions

(a) Standard Deduction

(b) Entertainment Allowance

(c)Tax on employment

5. Aggregate 4(a) to 4(c)

6. Income chargeable under the head


“Salaries” (3-5)

7. Any Other Income reported by the


Employee

8. Less: Less from SOP

9. Gross Total Income (6+7-8)

10. Deducted Under Chapter VI-A

Particulars Gross Amount Qualifying Deductible


Amount Amount

(a) Section 80 C

(b) Section 80 D

(c) Section 80 DD

(d) Section 80 G

(e)Section 80 U
(c)

(d) Total ( a to c)

II. (a) Under section 88B

(b) Under section 88C

III. Under section 89 (Attach


Details)

Aggregate of Tax Rebates

18 Tax Payable (16-17)


.

19 Less: (a) Tax deducted at source


.

(b)Tax paid by the employer


on behalf of the employee u/s
192(1A) on the perquisites u/s
17(2)

20 Tax Payable/Refundable (18-19)


.

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT


ACCOUNT

(The employer is to provide transaction- wise details of tax deducted and


deposited)

Sl. TDS Surchar Educati Total Cheque BSR Date on Transfe


(Rs) ge on Cess Tax /DD No. Code of which r
# (Rs) deposit (if any) Bank tax Vouche
(Rs) ed Branch deposit r
ed Challan
(Rs) Identifi
(dd/mm cation
/yy) No.

I , son/daughter of
working in capacity of

(Designation) hereby certify that a sum of Rs. (Rupees

(in words) has been deducted at source and paid to credit of the Central
Government. I further certify that the information given above is true and correct
based on the books of account,documents and other available records.
Place

Date

Signature of the person responsible for


deduction of tax.

Full Name:

Designation:

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