FORM NO.

16 Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source

[See rule 31(1)(a)]

PART - A
Name and address of the Employer Name and designation of the Employe

PAN No. of the Deductor TAN No. of the Deductor PAN No. of the Employee

Assessment Year Period

Address: From To

SUMMARY OF TAX DEDUCTED AT SOURCE

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

PART - B (REFER NOTE 1)DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1 Gross Salary
(a) Salary as per provisions contained in insection 17(1)
(b) Value of perquisites u/s 17(2) (as per Form No 12BA,
wherever applicable
(c) Profits in lieu of salary under section 17(3) (as per Form
No.12BA
(d) Total
2 Less: Allowance to the extent exempt under Section 10
Allownce Rs.
HRA

3 Balance (1 – 2)
4 Deductions: (a) entertainment allowance
(b) Tax on employment
5 Aggregate of 4(a) and (b) Rs.
6 Income chargeable under the head Salaries (3-5)
7 Add : Any other income reported by the Employee
Income Rs.
House loan interest

8 Gross total income (6 + 7) Rs.

9 Deductions under Chapter VI-A Rs.(A) sections 80C, 80CCC and 80CCD
Deductabl
(a) section 80C e amount
Gross Amount
(i) GPF
(ii) APGLIC
(iii) GIS
(iv) LIC
(v) Housing loan repayment
(vi)
(vii)
(b) section 80CCC Rs. Rs.
(c) section 80CCD Rs. Rs.
Note: Aggregate amount deductible under the three sections, i.e., 80C, 80CCC and 80CCD, shall not exceed
one lakh rupees
(B) other sections (e.g., 80E, 80G etc.) under Chapter VI-A
 Gross Qualifying Deductable
Amount Amount in Amount In
(a) Section 80c in Rs. Rs. Rs.
(i) Section 80 D
(ii) Section 80 G
(iii) Section
(iv) Section
(v) Section
10 Aggregate of deductible amount under Chapter VI-A
11 Total income (8-10)
12 Tax on total income
13 Education Cess @ 3% (on tax at S. No. 12)
14 Tax payable (12+13)
15 Relief under section 89 (attach details) Rs. Rs.
16 Tax payable (14-15)
ANNEXURE
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT
THROUGH BOOK ENTRY
(The employee to provide payment wise details of tax deucted an deposited with respect to the employee)
Book Identification Number (BIN)
DDO Sequence Number in
Tax deposited in respect of the book Adjestment Mini
Sl. No the Employee (rS.) Reciept numbers of Form No.24G statement

Total
Note:1. In the column for TDS give total amount for TDS, surcharge (if applicable) and Education Cess
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT
(The employee is to provide tranction - wise details of tax deducted an deposited)
Date on which Tax
BSR code of deposited Transfer voucher/ Challan
S.No. Total tax deposited Rs. Cheque/ DD No (if any) Bank Branch (dd/mm/yyyy) Identification No.

VERIFICATION
I ___________________________ Son/daughter of ______________________________ workig in the capacity
of _____________________ (designation) do hereby certify that a sum of Rs.____________(Rupess____________
________________________________________________________________________________(in words)
been deducted and deposited to the Central Government. I further certify that the information given above is true,
has complete and correct and is based on the books of account, documents , TDS statement, TDS deposited and
other available records.

Place: Signature of the person responsible for deduction of tax

date: Full name:
Designation
in the capacity
ess____________
__(in words)