Form Compiled by www.finance.pushpi.com FORM NO.

16 [See rule 31(1)(a)] Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source on Salary Financial year Whether Original / Duplicate / Amended TAN of Deductor PAN of Deductee TDS Certificate number# If Amended give Previous TDS Certificate number Name of Deductor Name of Deductee Whether PAN uploaded Gross Amount was validated by Paid / Collected Income Tax Department? (Y/N)

TDS Unique Transaction Number (UTN) as provided by Income Tax Department

TDS/TCS Amount

Gross amount of TDS / TCS Total TDS amount where PAN was found valid by Income Tax Department* Details of Salary paid and any other income and tax deducted 1 Gross Salary (a) (b) (c) (d) 2 Salary as per provisions contained in sec.17(1) Rs

Value of perquisites u/s 17(2) (as per Form No.12BB, Rs wherever applicable) Profits in lieu of salary under section 17(3)(as per Rs Form No.12BB, wherever applicable) Total Rs Rs Rs Rs Rs Rs

Less: Allowance to the extent exempt u/s 10

3 4

Balance(1-2) Deductions :

(a) (b) (c) 5 6 7

Standard deduction Entertainment allowance Tax on employment

Rs. Rs. Rs. Rs

Aggregate of 4(a) to (c) Income chargeable under the head 'salaries' (3-5) Add: Any other income reported by the employee

Rs Rs Rs

8 9

Gross total income (6+7) Deductions under Chapter VIA Gross Amount (a) (b) (c) (d) Rs Rs Rs Rs Qualifying Amount Rs Rs Rs Rs Deductible Amount Rs Rs Rs Rs

10 11 12 13

Aggregate of deductible amount under Chapter VIA Total Income (8-10) Tax on total income Rebate and relief under Chapter VIII I. Under section 88 (please specify) Gross Amount (a) (b) (c) (d) (e) Rs Rs Rs Rs Rs Qualifying Amount Rs Rs Rs Rs Rs Rs Rs Rs Rs Tax rebate/ relief

(f) Total [(a) Rs to (e)] II (a) (b) III 14 Under section 88B Under section 88C

Under section 89 (attach details)

Aggregate of tax rebates and relief at 13 above [I(f) + II(a)+ II(b) + III]

15 16 17

Tax payable (12-14) and surcharge thereon Less: Tax deducted at source Tax payable/refundable (15-16)

I _____________________________________, son/daughter of _________________________________ working in the capacity of ________________________________________ (designation) do hereby certify that a sum of Rs. ____________________________ [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 accounts, documents and other available records. Place Date Designation Signature of person responsible for deduction of tax Full Name

source on Salary

S/TCS Amount

Rs

Rs Rs

Rs Rs Rs Rs

Rs

Rs Rs Rs

____________ working in the that a sum of Rs. ______ ____ (in words)] has been information given above is

tax