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COLLABERA SOLUTIONS PRIVATE LIMITED

Digitally Signed

Form 16
Form16 Details:
Employee Name:

GURUVULU AVULA

Employee PAN:

ATMPA0825C

Employee Serial Number:

3657

Employee Designation:

Engineer

Form16 Control Number:

3657/ATMPA0825C

Assessment Year:

2011 - 2012

Signature Details:
This form has been signed and certified using a Digital Signature Certificate as specified under section 119 of the Income-Tax
Act, 1961. (Please refer Circular No.2/2007,dated 21-5-2007).
The Digital Signature of the signatory has been affixed in the box provided below. To see the details and validate the signature,
you should click on the box
Digitally Signed by

:Mr .LAKSHMI NARAYANAN N

Digitally Signature Certificate issued by

Serial Number of DSC


Number of Pages

: 5 (including this page)

Signed by: NATARAJAN LAKSHMI


NARAYANAN
Date: 2011.05.31 19:01:36 +0530

GURUVULU AVULA-3657

FORM NO.16
[See rule 31(1)(a)]
PART-A
Certificate under section 203 of the Income-Tax Act, 1961 for tax deducted at Source on Salaries
Name and address of the Employer
COLLABERA SOLUTIONS PRIVATE LIMITED
31,Grape Garden, 17th H Main, Koramangala 6th Block,
Bangalore - 560095

PAN of the Deductor


AABCP2354A

TAN of the Deductor


BLRP01490G

CIT(TDS)

Address:Room No. 59, H.M.T. Bhawan, 4th Floor,


Bellary Road, Ganganagar
City:Bangalore
Pincode:560032
Quarter

Name and Designation of the Employee


GURUVULU AVULA/3657
Engineer

PAN of the Employee


ATMPA0825C

Assessment Year
2011 - 2012

Period
From

To

29/10/2010

31/03/2011

Summary of tax deducted at source


Receipt Numbers of original statements of TDS
Amount of tax deducted in respect of the
under sub-section (3) of section 200
employee

Quarter1
Quarter2
Quarter3
Quarter4
Total

JPDSCNSB
GPZXXHFG
GPZXCAOB
GPZXERWA

0.00
0.00
590.00
1768.00
2358.00

Amount of tax
deposited/remitted in
respect of the
employee
0.00
0.00
590.00
1768.00
2358.00

PART B (Refer Note 1)


Details of Salary paid and any other income and tax deducted
Particulars
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)

Rs.

Rs.

Rs.

198086.00
0.00
0.00

Total
2. Less : Allowance to the extent exempt u/s 10
Sl No. Allowance

198086.00
Rs.

House Rent Allowance Exemption

0.00

Transport Exemption

Gratuity Exemption

0.00

Children Education Allowance

0.00

Leave Encashment

0.00

LTA exemption

0.00

4000.00

Total
3. Balance (1-2)
4. DEDUCTIONS :
(a) Entertainment Allowance
(b) Tax on Employment
5. Aggregate of 4 (a) and (b)
6. Income chargeable under the head 'salaries'( 3-5 )
7. Add : Any other income reported by the employee
Income

4000.00
194086.00
0.00
1000.00
1000.00
193086.00
Rs

Income / Loss from House Property

0.00

Income from Other Sources

0.00

Other_Source_Income2

0.00

Other_Source_Income3

0.00

8. Gross total income( 6+7 )

0.00
193086.00

GURUVULU AVULA-3657

9. DEDUCTIONS UNDER CHAPTER VI-A


(A) Sections 80C, 80CCC & 80CCD
(a) Section 80C

Gross Amount

Deductible Amount

(i) Life Insurance Premium

0.00

0.00

(ii) Public Provident Fund

0.00

0.00

(iii) National Saving Certificates

0.00

0.00

(iv) Children Tuition Fees

0.00

0.00

(v) Mutual Funds / ULIP

0.00

0.00

(vi) Housing Loan Principal Repayment

0.00

0.00

10194.00

10194.00

(viii) Infrastructure Bonds

0.00

0.00

(ix) Others / (Fixed Deposit (5 Years) , NSS, SCSC,etc )

0.00

0.00

(x) NSC Interest / Approved Superannuation

0.00

0.00

(xi) Voluntary Provident Fund

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

(vii) Employee Provident Fund

(b) Section 80CCC


(c) Section 80CCD
(d) section 80CCF ( Long Term Infrastructure Bonds )
Total of (a)+(b)+(c)+(d)
Note:

10194.00

1. Aggregate amount deductible under section 80C shall not exceed one lakh rupees.
2. Aggregate amount deductible under the these sections, i.e., 80C,80CCC,80CCD and 80CCF shall not exceed Rs. one lakh twenty thousand.

(B) Other Sections(e.g. 80E,80G etc.) Under Chapter VI-A


Gross Amount

Qualifying Amount

Deductible Amount

(a) 80 D

Medical Insurance Premium

0.00

0.00

0.00

(b) 80 DD

Handicapped Dependents

0.00

0.00

0.00

(c) 80 DDB Medical Expenses, Chronic Diseases

0.00

0.00

0.00

(d) 80 E

Interest on Loan taken for Higher Education

0.00

0.00

0.00

(e) 80 U

Permanent Physical disability

0.00

0.00

0.00

(f) 80 G

Donation

0.00

0.00

0.00

Total
10. Aggregate of deductible amounts under chapter VIA

0.00
10194.00

11. Total Income (8-10 )

182890.00

12. Tax on total income

2289.00

13. Education Cess @ 3% on (on tax computed at S.No.12)

69.00

14. Tax Payable (12+13)

2358.00

15. Less:Relief under section 89(attach details)

0.00

16. Tax Payable (14-15 )

2358.00

17. (a) Tax Deducted at source u/s 192 (1)

2358.00

(b) Tax paid by the employer on behalf of the employee u/s 192 (1A)

0.00

On perquisites u/s 17(2)


18. Tax payable / refundable (16-17 )

0.00
Verification

I, Mr .LAKSHMI NARAYANAN N son / daughter of NATARAJAN S V working in the capacity of ASSOCIATE VICE PRESIDENT - FINANCE do hereby certify that a
sum of Rs.2358.00 [Rs Two thousand three hundred and fifty-eight only] has been deducted and deposited to the credit of the Central Government.I further certify that
the information given above is true,complete and correct and is based on the books of account,documents,TDS statements,TDS deposited and other available records.

Signature of the person responsible for deduction of tax

Place : Bangalore
Date : 31/05/2011

Full Name : Mr .LAKSHMI NARAYANAN N


Designation : ASSOCIATE VICE PRESIDENT - FINANCE

This Form 16 is signed using Digital Signature. Please see Page1.

GURUVULU AVULA-3657

FORM NO. 12BA


[See rule 26A(2)(b)]
Statement showing particulars of perquisites, other fringe benefits or
amenities and profits in lieu of salary with value thereof
1. Name and Address of the Employer

COLLABERA SOLUTIONS PRIVATE LIMITED


31,Grape Garden, 17th H Main
Koramangala 6th Block
Bangalore-560095

2. TAN
3. TDS Assessment Range of the Employer

BLRP01490G
Room No. 59, H.M.T. Bhawan, 4th Floor,, Bellary Road, Ganganagar,
Bangalore-560032

4.Name,Designation and PAN of the employee


a). Name
b). Designation
c). PAN
5. Is the Employee a Director or a person with substantial
interest in the company (Where the employer is a company)
6. Income under the Head 'Salaries' of the Employee
(Other than from perquisites)
7. Financial Year
8. Valuation of Perquisites
Sl No.

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)

193086.00
2010 - 2011

Nature of perquisite (See Rule 3)

(1)
(1)

GURUVULU AVULA-3657
Engineer
ATMPA0825C
No

(2)

Accommodation
Cars/Other automotive
Sweeper,gardener,watchman or personal attendant
Gas,electricity,water
Interest free or concessional loans
Holiday expenses
Free or concessional travel
Free Meals (Food Coupons Taxable )
Free Education
Gifts,vouchers,etc.
Credit card expenses
Club expenses
Use of movable assets by employees
Transfer of assets to employees
Value of any other benefit/amenity/service/privilege
ESOP /ESPP/RSU Perquisites
Other Benefits or amenities
Total Value of Perquisites
Value of profits in lieu of salary as per section 17(3)

Amount,if any,
recovered from
employee(Rs.)

Amount of
perquisite
chargeable to tax
Col(3)-Col(4)

(3)

(4)

(5)

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

(19)
* Other benefits or amenities includes medical reimbursement exceeding Rs. 15,000/-.

9. Details of Tax
a) Tax Deducted from Salary of Employee u/s 192(1)
b) Tax Paid by Employer on behalf of Employee u/s 192(1A)
c) Total Tax Paid
d) Date of Payment into Government Treasury

Value of perquisite
as per rules(Rs.)

:
:
:
:

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

2358.00
0.00
2358.00
AS PER FORM 16 ATTACHED

DECLARATION BY EMPLOYER
I,Mr .LAKSHMI NARAYANAN N son / daughter of NATARAJAN S V working in the capacity of ASSOCIATE VICE PRESIDENT - FINANCE do hereby declare on
behalf of COLLABERA SOLUTIONS PRIVATE LIMITED that the information given above is based on the books of account ,documents and other relevant records or
information available with us and the details of value of each such perquisite are in accordance with section 17 and rules framed thereunder and that such information
is true and correct.

Signature of the person responsible for deduction of tax

Place : Bangalore
Date : 31/05/2011

Full Name : Mr .LAKSHMI NARAYANAN N


Designation : ASSOCIATE VICE PRESIDENT - FINANCE

This Form 16 is signed using Digital Signature. Please see Page1.

GURUVULU AVULA-3657

Income Tax deduction details for the Financial year 2010-11


ANNEXURE-B
1. Name and Address of the Employer

COLLABERA SOLUTIONS PRIVATE LIMITED


31,Grape Garden, 17th H Main
Koramangala 6th Block
Bangalore-560095

2. TAN of the employer


3. Name of the employee with employee No

BLRP01490G
GURUVULU AVULA
3657
ATMPA0825C

4. PAN of the employee

DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
Sl.

Tax Deposited in respect

No

of the employee (Rs.)

Challan identification number (CIN)


BSR Code of the Bank Branch

Date on which tax deposited


(dd/mm/yyyy)

Challan Serial Number

590.00

6360218

07/01/2011

03789

589.00

6360218

07/02/2011

03773

590.00

6360218

04/03/2011

01682

589.00

6360218

30/04/2011

04492

Total

2358.00

GURUVULU AVULA-3657