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 salary

Certificate No. RWRHARL Last updated on 28-May-2018

Name and address of the Employer Name and address of the Employee

GREENLAM INDUSTRIES LIMITED

1501-1505, NARAIN MANZIL, 23,BARAKHAMBHA ROAD - 110001 YOGENDRA KUMAR UPADHYAY
Delhi W/O SURESH KAPOOR, 95 CIVIL LINES, P/123 CIVIL LINES,
+(91)11-42791399 BUTLER PLAZA, BAREILLY - 243001 Uttar Pradesh
SATYASIVA.ROUTRAY@GREENLAM.COM

Employee Reference No.

PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

AAFCG2966D DELG16365G ACBPU7758C

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2018-19 01-Apr-2017 31-Mar-2018
4 , Luxmi Nagar, Delhi - 110092

Summary of amount paid/credited and tax deducted at source thereon in respect of the employee

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q1 FXFCLZDC 167324.00 3132.00 3132.00

Q2 FXFFYZVB 162324.00 2871.00 2871.00
Q3 FXFIXMCP 162324.00 2871.00 2871.00
Q4 FXGOWOMS 192324.00 1729.00 1729.00
Total (Rs.) 684296.00 10603.00 10603.00
I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Book Identification Number (BIN)

Tax Deposited in respect of the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

Total (Rs.)
II. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Challan Identification Number (CIN)

Tax Deposited in respect of the
Sl. No. deductee
(Rs.) BSR Code of the Bank Date on which Tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

1 963.00 6910333 06-05-2017 52042 F

2 1212.00 6910333 07-06-2017 55025 F
3 957.00 6910333 07-07-2017 65671 F
4 957.00 0013283 05-08-2017 15265 F

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 Certificate Number: RWRHARL TAN of Employer: DELG16365G PAN of Employee: ACBPU7758C Assessment Year: 2018-19

Challan Identification Number (CIN)

Tax Deposited in respect of the
Sl. No. deductee
(Rs.) BSR Code of the Bank Date on which Tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

5 957.00 0004329 07-09-2017 36999 F

6 957.00 0011352 07-10-2017 06963 F
7 957.00 0011352 07-11-2017 16765 F
8 957.00 0011352 07-12-2017 28880 F
9 957.00 6910333 06-01-2018 55438 F
10 1729.00 6390340 07-02-2018 23978 F
11 0.00 - 07-03-2018 - F
12 0.00 - 27-04-2018 - F
Total (Rs.) 10603.00

Verification

I, SATYASIVA SUNDAR ROUTRAY, son / daughter of NIRAKAR ROUT working in the capacity of GM COMMERCIAL (designation) do hereby certify that a sum of
Rs. 10603.00 [Rs. Ten Thousand Six Hundred and Three Only (in words)] has been deducted and a sum of Rs. 10603.00 [Rs. Ten Thousand Six Hundred and Three
Only] has been 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.

Place NEW DELHI

Date 02-Jun-2018 (Signature of person responsible for deduction of Tax)

Designation: GM COMMERCIAL Full Name:SATYASIVA SUNDAR ROUTRAY

Notes:
1. Part B (Annexure) of the certificate in Form No.16 shall be issued by the employer.
2. If an assessee is employed under one employer during the year, Part 'A' of the certificate in Form No.16 issued for the quarter ending on 31st March of the financial year shall contain the details
of tax deducted and deposited for all the quarters of the financial year.
3. 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 (Annexure) of the certificate in Form No. 16 may be issued by each of the employers or the last employer at the option of the assessee.
4. To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Legend used in Form 16

* Status of matching with OLTAS

Legend Description Definition
Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
U Unmatched
details in bank match with details of deposit in TDS / TCS statement
Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
P Provisional
verification of payment details submitted by Pay and Accounts Officer (PAO)
In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
F Final mentioned in the TDS / TCS statement filed by the deductors. In case of government deductors, details of TDS / TCS booked in Government
account have been verified by Pay & Accounts Officer (PAO)
Payment details of TDS / TCS deposited in bank by deductor have matched with details mentioned in the TDS / TCS statement but the
O Overbooked amount is over claimed in the statement. Final (F) credit will be reflected only when deductor reduces claimed amount in the statement or
makes new payment for excess amount claimed in the statement

Signature Not Verified

SATYASIVA SUNDAR ROUTRAY
Date: 11.06.2018 19:47:42 +05:30
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Employee Code Employee Name PAN of the Employee TAN of the Deductor PAN of the Deductor Assessment Year
110773 Mr. Yogendra Kumar Upadhyay ACBPU7758C DELG16365G AAFCG2966D 2018-2019

PART B (Annexure)

Details of Salary Paid and any other income and tax deducted
Rs. Rs. Rs.
1. Gross Salary

(a) Salary as per provisions contained in section 17(1) 684296.00

(b) Value of Perquisites under Section 17(2)

0.00
(as per form No. 12BA , wherever applicable )
(c) Profits in lieu of salary under Section 17(3)
0.00
(as per form No. 12BA , wherever applicable )
(d) Total 684296.00

2. Less: Allowance to the extent exempt u/s 10

Allowance Rs. 93228.00

Sec 10(10)-Children Education Exemption 2400.00

Sec 10(14)-Conveyance Exemption 19200.00

Sec 10(13A)-House Rent Allowance 71628.00

3. Balance (1-2) 591068.00

4. Deductions :

(a) Entertainment allowance 0.00

(b) Tax on Employment 0.00
5. Aggregate of 4 (a) and (b) 0.00

6. Income Chargeable Under The Head 'Salaries' (3-5) 591068.00

7. Add: Any other income reported by the employee (123741.00)

Income Rs.

Loss from House Property-Self Occupied 123741.00

8. Gross Total Income (6+7) 467327.00

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Employee Code Employee Name PAN of the Employee TAN of the Deductor PAN of the Deductor Assessment Year
110773 Mr. Yogendra Kumar Upadhyay ACBPU7758C DELG16365G AAFCG2966D 2018-2019

9. Deduction under Chapter VI-A

(A) sections 80C,80CCC and 80CCD Gross Amount Deductible Amount

(a)Section 80 C
1. 80C Life Insurance 27713.00 27713.00
2. 80C Provident Fund through Company 33564.00 33564.00
3. 80C Life Insurance Premium 10190.00 10190.00
4. 80C Principal Payment-Housing Loan 66627.00 66627.00
5. 80C Term Deposit / Post Office -5 years 100000.00 11906.00
6. 80C Tuition Fees 36000.00 0.00
(b)Section 80 CCC
80CCC Pension Policy 0.00 0.00
(c)Section 80 CCD
80CCD(1) National Pension Scheme 0.00 0.00

Note: 1. Aggregate amount deductible under sections 80C, 80CCC and 80CCD(1) shall
not exceed one lakh fifty thousand rupees.

(B) other sections (e.g.80E,80G,80TTA, etc.) under Chapter VI-A

Gross Amount Qualifying Amount Deductible Amount
1. 80D Parents 5700.00 5700.00 5700.00

10. Aggregate of Deductible Amounts under Chapter VI-A 155700.00

11. Total Income (8-10) 311627.00

12. Tax on Total Income 581.35

13. Education cess @3% (on tax computed at S.No.12) 17.44

14. Tax Payable (12 + 13 ) 599.00

15. Less:Relief Under Section 89 (attach details) 0.00

16. Total Tax Payable (14-15) 599.00

Verification
I, SATYASIVA SUNDAR ROUTRAY son / daughter of NIRAKAR ROUT, working in the capacity of GM COMMERCIAL (designation)
do hereby certify that the information given above is true, complete and correct and is based on the books of account, documents,TDS
statements and other available records.

Serial No. of Signature: 171810100172 This Certificate is signed using Digital Signature

Place : NEW DELHI For Greenlam Industries Limited

Date : 02-06-2018
Designation : GM COMMERCIAL Full Name: SATYASIVA SUNDAR ROUTRAY

Signature Not Verified

SATYASIVA SUNDAR ROUTRAY
Date: 11.06.2018 19:47:43 +05:30

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 Employee Code Employee Name PAN of the Employee TAN of the Deductor PAN of the Deductor Assessment Year
110773 Mr. Yogendra Kumar Upadhyay ACBPU7758C DELG16365G AAFCG2966D 2018-2019

Annexure for filing Individual Tax Returns (ITR)

(i) Salary (excluding all allowance, perquisites and profit in lieu of salary) 279720.00

(ii) Allowances not exempt 311348.00

(iii) Value of prequisites 0.00

(iv) Profits in lieu of salary 0

(v) Deductions u/s 16 0.00

All other details are available in Form 16

House Property Details

Address Type Location Ownership Percent Date of Date of Rental Municipal Pre EMI Authorized
status Loan Completion Income Tax (1/5) Interest

108,Keshar Vatika Bareilly Self Same City Single 100 01/04/2017 31/03/2018 - - 0 123741

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Employee Code Employee Name PAN of the Employee TAN of the Deductor PAN of the Deductor Assessment Year
110773 Mr. Yogendra Kumar Upadhyay ACBPU7758C DELG16365G AAFCG2966D 2018-2019

Employee Code:- 110773

FORM NO.12 BA
{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 employer : Greenlam Industries Limited

1501 - 1505,Narain Manzil,23 Barakhamba Road,New

Delhi - 110001
2) TAN DELG16365G

3) TDS Assessment Range of the employer : ITO (TDS) (LTU), DELHI

4) Name, designation and PAN of employee : Mr. Yogendra Kumar Upadhyay

Deputy Manager
ACBPU7758C

5) Is the employee a director or a person with substantial NO

interest in the company :
(where the employer is a company)
6) Income under the head "Salaries" of the employee : 591068.00
(other than from perquisites)

7) Financial Year : 2017-2018

8) Valuation of Perquisites

S. Nature of perquisites Value of perquisite Amount, if any, recovered Amount of perquisite

No (see rule 3) as per rules (Rs.) from the employee (Rs.) chargeable to tax (Rs.)

1 Accommodation 0.00 0.00 0.00

2 Cars /Other Automotive 0.00 0.00 0.00

3 Sweeper, gardener, watchman or personal attendant 0.00 0.00 0.00

4 Gas, electricity, water 0.00 0.00 0.00

5 Interest free or concessional loans 0.00 0.00 0.00

6 Holiday Expenses 0.00 0.00 0.00

7 Free or concessional travel 0.00 0.00 0.00

8 Free Meals 0.00 0.00 0.00

9 Free Education 0.00 0.00 0.00

10 Gifts, vouchers etc 0.00 0.00 0.00

11 Credit card expenses 0.00 0.00 0.00

12 Club Expenses 0.00 0.00 0.00

13 Use of movable assets by employees 0.00 0.00 0.00

14 Transfer of assets to employees 0.00 0.00 0.00

15 Value of any other benefit/amenity/service/privilege 0.00 0.00 0.00

16 Stock options (non-qualified options) 0.00 0.00 0.00

17 Other benefits or amenities 0.00 0.00 0.00

18 Total value of perquisites 0.00 0.00 0.00

19 Total value of profits in lieu of salary as per 17(3) 0.00 0.00 0.00

9) Details of tax -

(a) Tax deducted from salary of the employee u/s 192(1) As per FORM NO 16 attached

(b) Tax paid by employer on behalf of the employee u/s 192(1A) As per FORM NO 16 attached

(c) Total tax paid As per FORM NO 16 attached

(d) Date of the payment into Government treasury As per FORM NO 16 attached

DECLARATION BY EMPLOYER

I SATYASIVA SUNDAR ROUTRAY son / daughter of NIRAKAR ROUT working as GM COMMERCIAL do hereby declare on behalf of
Greenlam Industries 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 the value of each such perquisite are in accordance with section 17 and rules framed
thereunder and that such information is true and correct.

This Certificate is signed using Digital Signature Serial No. of Signature: 171810100172
For Greenlam Industries Limited

This document has been digitally signed

Full Name SATYASIVA SUNDAR ROUTRAY

Designation GM COMMERCIAL

Place :- NEW DELHI Signature Not Verified

Date :- 02-06-2018
SATYASIVA SUNDAR ROUTRAY
Date: 11.06.2018 19:47:45 +05:30

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