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: Last updated on
Name and address of the employer Name and address of the employee
Employee Reference No.
PAN of the Deductor TAN of the Deductor PAN of the employee provided by the Employer
(if available)
CIT (TDS) Assessment Year Period with the Employer
Address From To
City Pin Code
Summary of amount paid/credited and tax deducted at source thereon in respect of the employee
Quarter(s) Receipt Numbers of original Amount Amount of tax deducted Amount of tax
quaterly statements of TDS paid / credited ` deposited/remitted
under sub-section (3) of `
section 200
I
II
III
IV
Total - - -
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)
Tax deposited in respect Book Identification Number (BIN)
of the deductee
` Receipt numbers DDO serial number in Date of transfer Status of matching
Sl. No. of Form 24G Form No. 24G voucher with Form No. 24G
(dd/mm/yyyy)
Total -
II. DETAILS OF TAX DEDUCTED AND DEPOSITED IN CENTRAL GOVERNMENT ACCOUNT THROUGH
CHALLAN
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)
Tax deposited in respect Challan Identification Number (CIN)
of the deductee BSR Code of the Date on which tax Challan Serial Status of Matching
Sl. No. ` Bank Branch deposited Number with OLTAS
(dd/mm/yyyy)
1
2
3
4
5
6
7
8
9
10
11
12
Total -
Verification
I son/daughter of working in capacity of
do hereby certify that a sum of ` in words
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.
Place
Date (Signature of person responsible for deduction of tax)
Designation: Full Name:
PART B (Annexure)
Details of salary paid and any other tax deducted
1. Gross Salary ` ` `
(a) Salary as per provision contained in Section 17(1)
(b) Value of perquisites u/s 17(2) (As per Form No. 2BB wherever
applicable)
(c) Profits in lieu of salary u/s 17(3) (As per Form No. 12BA
wherever applicable)
(d) Total -
2. Less: Allowances to the extent exempt under section 10
Allowance `
Total - -
3. Balance (1 - 2) -
4. Deductions under Section 16
(a) Entertainment Allowance u/s 16(ii)
(b) Tax on Employment u/s 16(iii)
5. Aggregate of 4(a) and 4(b) -
6. Salary/Pension received from any other employer
7. Income under the head "Salaries" (3 - 5 + 6) -
8. Add: Any other income reported by the employee
Nature of Income `
Total - -
9. Gross Total Income (7 + 8) -
10. Deductions under Chapter VI-A Gross Amount Deductible Amount
(a) Sections 80C, 80CCC & 80CCD
(i) Life insurance premium
(ii) Provident fund
(iii) Public provident fund
(iv) Principal of housing loan repayment
(v) Educational expenses
(vi) Mutual fund investment
(vii) Time deposits
(viii)Others
(ix) Enter here
(x)
I Contribution to pension fund - 80CCC
Sam Contribution to pension fund - 80CCD
(xi)
eer
Sure Total - -
sh
Reg
e Note: Please check the ceiling on amount deductible under the
aforementioned sections as amended by latest Finance Act.
son/
dau
(b)
ghte Other sections Gross Amount Deductible Amount
r of Section 80D
(i)
(ii)
Sure Section …………..
sh
(iii)
Reg Section …………..
e
(iv) Section …………..
Total - -
wor Aggregate of amount deductible under Chapter VI-A
11. -
king
in Total Income (9 - 11)
12. -
the
13.
capa Tax on total income -
city
14. Rebate under section 87A
of
Dire Education cess @3% on tax computed at (13 - 14)
15. -
ctor
16. Total tax (13 - 14 + 15) -
17. Relief under section 89
do
here Tax payable
18. -
by
19. Less: Tax deducted at source
certi
fy Balance tax payable / (Refund)
20. 0
that
the Verification
info
rmat
ion 0 son/daughter of 0 working in the capacity of (desgn) 0
give
do hereby certify that the information given above is true, complete and correct and is based on the books of account, documents,
TDSn statements, and other available records.
abo
ve
is Place 0
true,
com Date 30-Dec-1899
plet (Signature of person responsible for deduction of tax)
e
Designation:
and 0 Full Name: 0
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ect
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