Gopal G. Trivedi - (108-108) - (2011 - 2012) - Form24

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FORM 16 [See Rule 31(1)(a)] PART 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: Acrysil Limited. 704 , Center Point J. B. Nagar Andheri Kurla Road Andheri (East) - 400059 MAHARASHTRA PAN of the Deductor TAN of the Deductor AABCA0583C MUMA20070B CIT(TDS) Address Name and Designation of the Employee: Gopal G. Trivedi DY. MNGR. - IT & ERP

PAN of the Employee AENPT0272Q Assessment Year 2011-2012 From 04/10/2010

Period To 31/03/2011

City Quarter

Pin code Summary of tax deducted at source Receipt Numbers of original Amount of tax deducted in respect Amount of tax deposited/remitted in respect of the employee statements of TDS under sub-section of the employee (3) of section 200. JPDBHBJD FDPXXRFA EUHXBRUB FSWXIJUA PART B ( Refer Note 1 ) DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED 1 Gross Salary * (a) Salary as per provisions contained in section 17(1) (b) Value of perquisites under section 17(2) (as per Form No.12BA, wherever applicable) (c) Profits in lieu of salary under section 17(3) (as per Form No. 12BA, wherever applicable) (d) Total 2 Less :Allowance to the extent exempt under Section 10 Conveyance Exemption Other Exemptions 3 Balance (1-2) 4 Deductions : a) Entertainment Allowance b) Tax on Employment 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 Deductions under chapter VIA Rs Rs Rs Rs Rs Rs 4800 Rs Rs 4800 111494 116294 116294

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total

Rs Rs

1200 Rs 1200 Rs Rs. 110294 110294

Gross Amount Qualifying Amount (in Deductible Amount Rs.) (in Rs.) (in Rs.) (A) Sections 80C,80CCC AND 80CCD (a) section 80C (i) Statutory Provident Fund (b) section 80CCC (c) section 80CCD Note: 1.Aggregate amount deductible under section 80C shall not exceed one lakh rupees. 3560 3560

2. Aggregate amount deductible under three sections, i.e., 80C,80CCC and 80CCD shall not exceed one lakh rupees. (B) Other Sections(80E,80G etc.) under Chapter VI-A. 10 Aggregate of deductible amounts under chapter VI-A 11 Total income (8-10) 12 Tax on total income 13 Education Cess @ 3% (on tax computed at S.No.12) 14 Tax Payable (12 + 13) 15 Relief under section 89 (attach details) 16 Tax Payable (14 - 15) Verification I Mr. Chetan N. Shah S/o Narottamdas Shah working in the Capacity of Costituted Attorney (designation) do hereby certify that a sum of Rs. 0 [ Rupees Zero Only (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,complete and correct based on the book of accounts, documents,TDS statements,TDS deposited and other available records. Rs Rs Rs Rs Rs Rs Rs 3560 106734

Place :

MUMBAI

Date :

11/04/2011

Signature of the person responsible for deduction of tax Full Name: Mr. Chetan N. Shah

Designation: Costituted Attorney

Notes : 1. If an assessee is employed under more than one employer during the year, each of the employers shall issue Part A of the certificate in Form no. 16 pertaining to the period for which such assessee was employed with each of the employers. Part B may be issued by each of the employers or the last employer at the option of the assessee. 2. Government deductors to enclose Annexure-A if tax is paid without production of an income-tax challan and Annexure-B if tax is paid accompanied by an income-tax challan. 3. Non-Government deductors to enclose Annexure-B. 4. The deductor shall furnish the address of the Commissioner of Income-tax (TDS) having jurisdiction as regards TDS statements of the assessee. st day 5. This Form shall be applicable only in respect of tax deducted on or after 1 of April,2010.

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