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 and Address of the employer Name and Designation of the employee

PAN / GIR No. TAN PAN / GIR No.

TDS Circle where the Annual Return / Period Assessment

Statement under section 206 is to be filed From To Year

DETAILS OF SALARY PAID, AND OTHER INCOME AND TAX DEDUCTED

1 Gross Salary Rs.
2 Less: Allowance to the extent exempt under section 10 Rs.
3 Balance (1 – 2) Rs.
4 Deductions
(a) Entertainment allowance Rs.
(b) Tax on Employment Rs.
5 Aggregate of 4 (a & b) Rs.
6 Income charged under the head Salaries (3 – 5) Rs.
7 Any other income reported by the employee Rs.
Interest on HBA Rs.
8 Gross Total Income (6 + 7) Rs.
9 Deductions under chapter VI - A
A. Sections 80C, 80 CCC and 80CCD
Section 80 C Gross Amount Qualifying Amount
1. Provident Fund Rs Rs
2. LIC Premiums Rs Rs
3. GIS Contribution Rs Rs
4. SLI Premiums Rs Rs
5. Repayment of Principal of HBA Rs Rs
6. ICICI Bonds etc Rs Rs
7. Tuition Fee Rs Rs
8. PLI Premiums Rs Rs
9. GPAIS Rs Rs
Rs Rs
Rs Rs
 (a). Total Section 80 C Rs Rs
(b). Section 80CCC Rs Rs
(c). Section 80CCD Rs Rs
Total of 9 (a to c) Rs Rs
B. Other Sections Gross Amount Qualifying Amount
Section 80 D Rs Rs
Section 80 E Rs Rs
Section 80 G Rs Rs
Section 80 U Rs Rs
10 Aggregate of deductible amount under chapter VI - A Rs.
11 Total Income (Taxable) Rs
12 Tax on total Income Rs
13 Surcharge Rs
14 Education Cess Rs
15 Tax on total Income Rs
16 Aggregate of Tax Rebates and relief at 13 above (1+2+3) Rs
17 Tax payable and surcharge thereon Rs
18 Less tax deducted at source Rs
19 Tax payable / Refundable Rs

DETAILS OF TAX DEDUCTED AND DEPOSITED IN CENTRAL GOVERNMENT ACCOUNT

Amount Date of payment Name of Bank and Branch where Tax is deposited
Rs.

I, ………….…………………… son/daughter of Sri ……………………...………………..

working in the capacity of Principal 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 book of accounts,
documents and other available records

Signature of the person responsible for deduction of Tax

Full Name
Designation
Place
Date