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FORM NO. 16

PAR'T B
inconre
tax deducted rtt source on salary
plid to an enrployce under section 192 or pension/ilrterest
(lcrtificntc undcr section 203 of the ACt. l96l lbr
of specilictl scnior c.1tiz:1Iclc1 :9qtio1 !li!
Last updrted on i7-MaY-2022
(lcrtilicxtcNo. FURI'ENA
scnior citizcn
N:unt and address ofthe Ernplol'ee/Specilicd
\anrc :tntl 2rddress of thc [mplove r/Spccitied Bank

INS I-I'ILJTI--
TI-IE (]L-i.]ARA'I CANCEI{ AND RESEAIICI]
NEW CiVII,- IIOSPITAL COMPOU. ASARWA' lvloNA CtllRAG DAR.ll
ASARWA. AI'IN4EDABAD - 38OOI6
q-OOU UOA'U'ATARAM CITY. OPP SHUKAN RESIDENCY'
doto cot, NEw s G ROAD. AI-IMEDABAD - 382481 cuiarat
Guiarirt

SA NI I PDAV Er:OItE D I FF MAI L CONI

citizen
'll.\N of thc De ductor PAN of the Ernplo"vee/Specificd senior
P,\\ of thc l)cductor
AFXPV0294I I

AAATG I O()EI-

.\ssessrnert Ycar Period with the EmPloYer

(TDS)-lar
The Cotntrisstoner of lttcotne 2022-23
Roonr No. 201. 2nd Floor, Naviivan'f rust
Building' B/h GLriarat
- 3800i'l
Vidhvaprth . Ashratn lioad' Ahmcdabad
Annexure - I

and tax deducted

Details of salarl Paid and any other income

Whether opting for taxation u/s 1 l5BAC

Cross Salary
974842.00
Salary as per provisions contailled in section
17(1 )

(as per Form No' 12BA'

iufl" Jfr.itfrl*,.t ,nat' section l7(2)
I (b)
rvherever aPPlicable
prof* i" f i* of salary ullcler sectioll l7(3) (as per Form No'
1 2BA, r.vherever aPPlicable

Reported total anloLlnt ofsalary received

from other ernployer(s)

Allorrances to the extent exelrpl tlnder sectioll

10
L-ess:

l0(5)
(a) Travel cottcession or assistance under section

0.00
1 0( I 0;
Death-currt-retirement gratuity under section

0.00
I 0( 1 0A
Comt'nuted valtre of pensioll under section
)

Cash equivalent of leave saiary encashnlent under section I0

(10AA )

[-louse t'ent allorvauce under section

l0t 13A)

Page 3 oi 6
 'l AN ol' llilrptoter: AllillT0 1560G Assessnlcilt Year: 2022-23
FT IIII]\A

Aurount of anY other exemPtion under section l0

(f) INote: Breali-up to be filled and signed by ernployer in the table
provide at the bottom of this forml

(g) Total anrount of ant' other exerlptiot-t unde r sectiorl l0 2400.00

Total arrount of exemption claimed under section l0 2400.00

(h)
[2( a)+2(b)+2(c)+2(d)+2(e)+2(
g)]

'fotal alroLlnt of salary received front current employer 972442.00

i3.
F
t4.
[1(d)-2(h)]
Less: Deductions uttder section 16

(a) Standald deduction under section l6(ia) 50000.0c

(b) Entertainrlent allor.vance under section l 6(ii) 0.0c

(c) Tax on employmerrt under section l6(iii) 2400.0c

I

I
52400.00
J'otal antount ofdeductions under section l6 [4(a)+4(b)+4(c)]

920042.00
6. Inconte chargeable uttder the head "salaries" [(3+l(e)-5]

7. Add: Anl,other inconre repolted by the enrployee under as per section 192 (28)
l

i lnconre (or aclmissible loss) h'om house property repofted by -9,i,195.00

(a)
employee oflered for TDS

(b) Income under the head Other Sources offered for TDS 0.00

Total arnount of other income repofted by the employee -94495.00

8.
[7(a)+7(b)]
r0 825547.00
Gross total inconre (6+8)
)"
i
I

r0. Deciuctions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life instlrance pretnia, contributiol.ts to 137821 .00 r37821.00

(a)
provident t'und etc. under section 80C

Deduction in respect of contribution to certain pension funds

0.00 0.00
(b) under sectiott 80CCC

l__
Deduction irt lespect of contribLrtion by taxpal'er to 1>ension
(c) scheme under section 80CCD ( 1) 0.00

37821 .00 r 3782 r .00

(d) Total clecluction under section 80C, 80CCC and 80CCD(1) r

Decluctions in lespect ofanlount paid/deposited to notilled

pension scher.tte trndcr sectior.t 80CCD ( 1B) 0.0c 0.00
(e)

Page 2 of 4

Page.1 ol6
 PAN of EnrDlolee: AF\PVo29{H Assessmeilt Year: 2022_23
( e r tilicrle N n mbcr: FLl RF[N]\ T'\N of limployer: AH ]l f0 I 560C

Dedr-rction in respect of contribution by Employer to

pellslon
0.00 0.00
(f) scheme under sectiot.t 8OCCD (2)

Deduction in respect of health insurance pretltia r.rnder sectiotr I 087i.00

(e) V/10873.00
80D

Deduction itr respect of interest otl loall taken for higher 0.00
0.00
(h) eductrtion under section 80E

C ross Qualifying Deductible

Anrout'tt Antount Amount

Total Deduction in respect ofdonations to certain funds, 0.00 0.00 0.00

(i)
eharirrhle instifrrtions. etc. under section 80G

Dedr-rction in respect of interest on deposits in savings accoullt 0.00 0.00 0.00

(j)
rrrrdcr scction 80TT A

Arrount Decluctible under atry other provision (s) of Chapter Vl-A

by employer in the table
(k) INote: Break-up to be filled and signed
provide at the bottom of this forml

Total ofautount deductible under atly otlier provision(s) of 0.00 0.00 0.00
(l)
Chapter Vl-A

Aggregate of dedLrctible anloullt under Chapter VI-A 14869'+.00

n l0(d)+10(e) r l0(fl+ l0(g)+ l0(h) F l0( i)+ I 0(j )+ l0(l)]
I

676853.00
12. Total taxable incorne (9-1 I)
47870.00
13. I ar .rtt totll ittcotlle

0.00
14. Rebate under sectiorl 87A, if applicable

0.00
15.
1,'1i"'rln::11"""':
19r5.00
16.
|:i"'11tlY1r::-- 49785.00
17.
]n"r:,r"1.,I*lj'1]1i
0.00
18. Less: Relief ltnder section 89 lattach details)

49785.00
19. Net tax ptyable (17-18)

Verificatiorr
pnriLnAShMix S.qNcueVt. \
son/daughter of RASIKLAL CHUNILAL i HOBA .\\'orking in the capacity
of FtNAr-CIAL
t,
([)eqionatiol) infbrmatioti
irlfbrrllatiorr givetl
gt above is tlue, contplete and correct and is based on the books
herebv certity
i.ctqTANT (Designation) do hereby
ASUSTAN]I certitV that the
of account. documents. TDS staterrents, ancl other available records.

P lxcc AIIMEDABAD (Signature of person responsible for aeOu1to19tt3!

Full
24-lVla1 -2022 PRITI I{ASI.IMIN SANGHAVI
l)ate Narne:

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