PARTICULARS ONLY FOR MALE EMPLOYEE FOR FILLING F

FIRST NAME IN CAPITAL LETTERS

FORM 16 MIDDLE NAME IN CAPITAL LETTERS

FOR GENERAL LAST NAME IN CAPITAL LETTERS

DESIGNATION IN CAPITAL LETTERS

PAN NO OF EMPLOYEE
PARRICULARS REGARDING EMPLOYEE'S SALARY

Total Income from Salary Rs :(col.no 3 )of Salary Gross salary( includ
0
Statement submitted by the Employee INT.From Bank/N.S.

Income by interest from N.S.C./BANK 0

P.TAX(Proffessional Tax) 0
H.B. LOAN INTEREST(U/S 24(B)(Max-1,50,000/-) 0
DETUCTION OF THE EMPLOYEE U/S 80C,80CC,80CCC,80D,80DD,8
80 C G.P.F. 0
Deduction U/S 80c G.I.S. 0
80C,80D,80DD,80E,80G Prepared by
L.I.C./Tuition
(Max.limit 100000/-) 80c 0 Pranab Ban
Fees/NSC
Jiaganj,Murshidaba
80C HB Loan (Principal 0 Contract No.
Pension Fund (Max.1,00,000/-) 80CCC 0 E.mail. pranabLr@
For Handicapped(Max.1,00,000/-) 80 U 0 G.mail;-pranabban
Prem. Health Insur(Max.15000/-) 80 D 0 Web
Educational Loan(Max.100,000/-) 80E 0 htpp://pranabbandy
Donation (Max 100% of donation) 80G 0
Total Deduction 0
ARREAR RELIEF OF U/S 89(1) 0
ADVANCE TAX PAID 0
NAME & ADDRESS OF THE EMPLOYER

PAN NO OF OF THE DEDUCTOR

TAN NO OF THE DEDUCTOR CALS15817E

EE FOR FILLING FORM 16
IN CAPITAL LETTERS

IN CAPITAL LETTERS
FORM 16 FOR
IN CAPITAL LETTERS
GENERAL
IN CAPITAL LETTERS

OYEE'S SALARY

Gross salary( including HRA,BONUS,ANY

INT.From Bank/N.S.C./House property etc.

C,80CCC,80D,80DD,80E,80G

Prepared by
Pranab Bandyopadhyay,
Jiaganj,Murshidabad,
Contract No.
E.mail. pranabLr@yahoo.com,
G.mail;-pranabbanerjee83@g.mail.com.
Website :-
htpp://pranabbandyopadhyay/hpage.com

NOTE:-Please Double Click for

mentioned three(3) Cells and put a
Pass word " pranab " and Edit the
Cell.
 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 chargable under the head on Salary
Name and address of the Employer Name and designation of the employee
- - - - -
PAN NO.of
Deductor
TAN No.of the Deductor PAN NO. of the Employee
- CALS15817E 0
Acknowledgement Nos. of all quarterly Period Assessment Year
statements of TDS under sub-section (3) of
section 200 as provided by TIN Facilitation
Centre or NSDLWebsite. 2009-2010 2010-2011
Quarter Acknowledgement No From To
Mar-09 Feb-10
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT

1 Gross Salary IN RUPEES IN RUPEES IN RUPEES

Salary as per provisions contained in
(a) section 17(1) 0
Value of perquisites under section 17(2)
(b) (as per Form No. 12BA,wherever 0
applicable)
Profits in lieu of salary under section
(c) 17(3)(as per Form No. 12BA, wherever 0
applicable)
(d) TOTAL 0
2 Less: Allowance to the extent exempt u/s 10
Allowance Rs.
0 0
3 Balance(1-2) 0
4 Deductions : Rs.
H.B.Loan Int.(Max-1,50,000/-)
(a)
u/s 24(B) 0 0
(b) Tax on employment 0
5 Aggregate of 4(a) to (b) 0
Income chargeable under the head 'salaries'
6
(3-5)
0
Add: Any other income reported by the
7
employee
a)Income form N.S.C./Bank int.etc. 0
8 Gross total income (6+7a) 0
9 Deductions under Chapter VIA
U/s 80C,80CCC& 80CCD,80DD,80E,80G
Gross
A (Aggregate amount Maximum Rs.1,60,000/-) Deductible Amount Rs.
Amount
(a)(i)Sec.80C-G.P.F. Rs. 0
(ii) G.I.S. Rs. 0
(iii) L.I.C./P,L.I./U.LIP/Tuition
Fees/NSC
Rs. 0
(iv) H.B.LOAN(PRINCIPAL) Rs. 0
(v) Deduction U/S 80 U Rs. 0
(b) Section U/S 80CCC Rs. 0
(c) Section 80 D Rs. 0 0 0
Qulfy
B Other sections e.g.,80E,80G,etc under chapter VI Gross Amount Deductible Amount Rs.
amount
(a) Section 80 E Rs. 0
(b) Section 80 G Rs. 0
© Section Rs. 0
(d) Section Rs. 0

3/7
 (e) Section Rs. 0
Aggregate of deductible amount under
10
Chapter VIA
0 0
11 Total Income (8-10) 0
12 Tax on total income 0
13 Surcharge on col.12 0
14 Education & cess @3% on col.no.12 0
15 Tax payable (12+13+14) 0
16 Relief U/s 89(1) 0
17 Tax payable/refundable (15-16) 0
18 Less (a) Tax deducted at source 0
19 Net Tax payable /Refundable(col.17-18) 0
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT
(The employer is to provide transaction-wise details of tax deducted and
deposited)
Transfer
voucher
Total Tax Dt.of which tax
Sl. Surchar Education Cess Cheque No/DD BSR Code of No/Challa
No
TDS Rs.
ge Rs. Rs.
Deposited
No (if any) Bank Branch
deposited
Rs.
n
(dd/mm/yy
Identificati
on No.
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0

I, 0 son/daughter of 0
working in the capacity of 0 (designation)do hereby certify that a sum of Rs 0

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 books of account, documents and other available records.

0
Place
Signature of the person responsible
12/30/1899 for deduction of tax
Date

Full Name with desitgnation

4/7
5/7
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CERTRAL GOVERNMENT ACCOUNT
(The employer is to provide transaction-wise details of tax deducted and deposited)

BSR
Total Tax
Sl. TDS Surcharge Education
Deposited
Cheque No/DD Code of Dt.on which tax
No Rs. Rs. Cess Rs. No (if any) Bank deposited
Rs.
Branch (dd/mm/yy

9
(Rupees
10

I, son/daughter of
working in the capacity of (designation) do hereby certify that a sum of Rs
) Two Thousand only
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 books of account, documents and other available records.

0
Place
Signature of the person responsible
for deduction of tax
Date

Full Name with desitgnation

T
and deposited)

Transfer voucher
No/Challan
Identification No.

(In words)
he information
rds.

responsible

ation