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 & Address of the Employer

Name & Designation of the Employee

PAN/GIR NO.

TAN

PAN/GIR NO. Period From To Assessment Year

Acknowledgement Nos. of all quarterly statements of TDS under sub- section(3) or section 200 as provided by TIN Facilitation Centre or NSDL website

Quarter

Acknowledgement No.

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED 1. GROSS SALARY (a) Salary as per provisions contained in section 17(1) Value of perquisites under section 17 (2) (b) (as per Form No. 12BA, where applicable) (c) Profits in lieu of salary under section 17(3) (as per Form No. 12BA, where applicable) (d) Total 0 2. Less: Allowance to the extent exempt under Section 10 Allowance Rs. 0 3. Balance(1-2) 0 4. Deductions : (a) Entertainment Allowance Rs. Nil (b) Tax on Employment Rs. Nil 5. Aggregate of 4(a) and (b) 6. Income Chargeable under the head 'Salaries' (3-5) 0 7. Add: any other income reported by the employee Rs. 8. Gross Total Income (6+7) 0 9. Deductions under Chapter VI-A 0 (A) Section 80C, 80CCC and 80CCD Deductible Gross Amount Amount (a) Section 80C (i) G.P.F./CPF (ii) G.I.S. (iii) L.I.C. (iv) PPF (v) NSC (vi)
Rs. Rs. Rs. Rs. Rs. Rs.

(b) Section 80 CCC (c) Section 80 CCD

Note:1. Aggregate amount deductible under section 80 C shall not exceed one lakh rupees 2. Aggregate amount deductible under the three sections i.e. 80 C,80 CCC and 80 CCD shall not exceed one lakh rupees

(B)Other sections (for e.g. 80 E, 80 G etc.) under Chapter VI-A Gross Amount (a) Section Rs. (b) Section Rs. (c) Section Rs. (d) Section Rs. (e) Section Rs. Total Rs.
10. Aggregate of deductible amount under Chapter VI-A

Qualifying Amount Rs. Rs. Rs. Rs. Rs. Rs.

11. 12. 13. 14.

Total Income (8-10) Tax on Total Income Surcharge (on tax computed at sr. no. 12) Education Cess (on tax computed at S. No.12 and 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 prequisites u/s17(2) 19. Tax Payable/Refundable (17-18)

Deductible Amount Rs. Rs. Rs. Rs. Rs. Rs. Rs. 0 Rs. 0 Rs. Rs. Nil Rs. Rs. Rs. Rs. Rs. Rs. Rs.
0 0 0

Rs. Rs.

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT (The Employer is to provide transaction wise details of tax deducted and deposited) S. No. TDS Rs. Surcharge Rs. Education Cess Total tax Cheque/D BSR Code Date of Transfer Rs. deposited D No.(if of Bank depositin voucher/ any) branch g tax Challan Identification No.
1 2 3 4 5 6 7 8 9 10 11 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Govt. Treasury Fatehgarh Sahib

I, _____________________working in the capacity of Principal (Designation) do hereby certify that a sum of Rs. _______ [Rupees _________________________ Only (in words) has been deducted at source and paid to the credit of the Center

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

Date ;

Desgination