ANNEXURE - I

NAME : CH DILLESWARA RAO

DESIG. : LECTURER IN MECHANICAL Financial Year : 2022 - 2023
P.A.N : ASWPC8912B Assessment Year : 2023 - 2024

Ot EWF/
C.C A.P.G.L
Month Basic Pay P.P/S.P D.A H.R.A her Gross Pay C.P.S E.H.F G.I P.T I.T Flag Total Net Pay
.A .I
s fund

Mar-22 49790 110 9968 4979 64,847 5976 4000 30 200 20 10,226 54,621
Apr-22 49790 110 9968 4979 64,847 5976 4000 30 200 10,206 54,641
May-22 49790 110 9968 4979 64,847 5976 4000 30 200 10,206 54,641
Jun-22 49790 110 9968 4979 64,847 5976 4000 30 200 10,206 54,641
Jul-22 49790 110 9968 4979 64,847 5976 4000 30 200 10,206 54,641
Aug-22 49790 110 9968 4979 64,847 5976 4000 30 200 10,206 54,641
Sep-22 49790 9968 4979 64,737 5976 4000 30 200 10,206 54,531
Oct-22 49790 9968 4979 64,737 5976 4000 30 200 10,206 54,531
Nov-22 51140 10238 5114 66,492 6138 4000 30 200 10,368 56,124
Dec-22 51140 10238 5114 66,492 6138 4000 30 200 50 10,418 56,074
Jan-23 52600 10531 5260 68,391 6313 4000 30 200 10,543 57,848
Feb-23 52600 10531 5260 68,391 6313 4000 30 200 10,543 57,848
EAMCET 0 0 0
AAS Arrears
1119 225 112 1456 134 134 1322
PAY

PRC ARREARS

PRC ARREARS

TOTAL 606,919 660 121,507 60,692 0 0 789,778 72,844 0 48,000 360 2,400 0 70 123,674 666,104

Signature of the Officer

 152,489.00

70007.7 207640
70008
66,478.00
3,530.00
42360
Net Govt
Recoverie
Final Net salary
s

54,621
54,641
54,641
54,641 26520 39250
54,641
54,641
54,531
54,531
56,124
56,074 22279
57,848 32777
57,848 55056
0

54252 54227
25
 STATEMENT OF INCOME FOR THE PURPOSE OF TAX DEDUCTION AT SOURCE
Financial Year : 2022 - 2023
Assessment Year : 2023 - 2024
1 Name of the Government Servant :
Designation :
P.A.N :
2 Whether living in own or rented house : Rented
If living in rented house, rent paid per month : 8,000.00
Residential Address of the employee : NAIDU RESIDENCY

SRIKAKULAM

3 Details of gross amount received during

financial year including remuneration &
honororium
i) Basic Pay + D.P. + P.P + S.P : 607,579
ii) Dearness Allowance : 121,507
iii) H.R.A : 60,692
iv) C.C.A : 0
v) Other income stated above :
TOTAL : 789,778 789,778
4 Exemption in respect of H.R.A u/s 10(13-A)
a) Actual H.R.A. Received : 60,692
b) i) Rent paid Annually 96,000
ii) 10 % of Salary (Pay + D.A) 72,909
iii) Excess of rent paid over 10 % of salary : 23,091
c) 40 % of salary received during the year : 291,634
d) Least of a, b(iii), c : 23,091
Deduct Exemption u/s 10(13-A) : 23,091 23,091

5 Balance : 766,687 766,687

6 a) Deduction u/s 16(iii) Professional tax : 2,400

b) P.M.R.F / E.W.F/Flag FUND : 70
c) Medical Insurance U/S 80(d) :
d)Standard Deduction 50,000
Deduct Total : 52,470 714,217

7 Net Income under the head Salary : 714,217 714,217

8 Income from House property
a) Annual value 0 0
b) Less Municipal Tax 0 0
c) Adjusted annual Value 0 0
d) Less 30% of (c ) for repairs u/s 24 0 0
e) Total ( c - d) 0 0
f) Less interest on Borrowed capital u/s 24(1)VI 0
Total : ( e - f ) 0 0
0
8 Other income not being a loss on which
T.D.S has to be made u/s 192(2b) : 0
(EAMCET / EXAMS)
9 Gross Total Income : 714,217 714,217
10 Deduction under Sec 80C / 80CCC / 80CCD
a)C.P.S 72,844
 U/S 80 CCD (1) 22,844
U/S 80 CCD (1b) 50,000
b) A.P.G.L.I 48,000
c) Group Insurance 360
d)LIC 0
e) SUKANYA SUVIDHA 0
f) N.S.C / N.S.S 0
g) Units of U.T.I 0
h) I.C.I.C.I.Bonds 0
i) Bank 5 year fixed deposits 0
j) Repayment of housing loan (principle) 0
l) Children Tuition fee 0
m) L.I.C Jeevan Suraksha ( Sec 80CCC) 0
n)Other specified savings (sec 80 CCF) 0
TOTAL SAVINGS 121,204 121,204

11 Total Taxable Income 593,013 593,020

12 Gross Income Tax on Income at Sl.No.11 31,104

Tax rebate 0
Education Cess 4% 1,244
13 Total Income Tax payable 32,348 32,348
14 Income Tax already recovered during the
year so far 0 0

15 BALANCE Tax to be deducted 32,348

Tax to be deducted for the month

of FEBRUARY 2023 32,348

Station : SRIKAKULAM Signature :

Date : Name :
Designation :
17469
11219
11219
25000
64907

11322
25000
18213
11219
65754
46946
 0

165420 33084
33000 12500

52555 12500

0
 FORM NO. 16
[See rule 31(1)(a)]
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 sec.17(1) Rs. 789,778
Value of perquisites u/s 17(2) (as per Form No.12BA,
(b) Rs.
wherever applicable)

Profits in lieu of salary under section 17(3) (as per Form

(c) Rs.
No.12BB, wherever applicable)

(d) Total Rs. 789,778

2 Less: Allowance to the extent exempt u/s 10
Allowance Rs.
House rent Allowance Rs. 23,091 Rs. 23091.4
3 Balance (1-2) Rs. 766,687
4 Deductions :
(a) Entertainment allowance/EWF Rs. 70
(b) Tax on employment Rs. 2,400
5 Aggregate of 4(a) and (b) Rs. 2,470
6 Income chargeable under the head 'salaries' (3-5) Rs. 764,217

7 Add: Any other income reported by the employee

Income
Income from house Rs. 0
Others if any Rs. Rs. 0
8 Gross total income (6+7) Rs. 764,217
9 Deductions under Chapter VIA
(A) Sections 80C, 80CCC and 80CCD
(a) Section 80C Gross Amount Deductible Amount
(i) GPF Rs. 72,844
(ii) APGLI Rs. 48,000
(iii) GI Rs. 360
(iv) LIC Rs. #NAME?
(v) PLI Rs. 0
(vi) TUITION FEES Rs. 0
(vii) PPF Rs. 0
(viii) Reyapment of HL Rs. 0
(b) Section 80CCC Rs. 0
(c) Section 80CCD Rs. 0
TOTAL Rs. #NAME? Rs. #NAME?
Note: 1. Aggregate amount deductible under section 80C shall not exceed one lakh fifty thousand rupees.

Aggregate amount deductible under the three sections, i.e., 80C, 80CCC and 80CCD shall not exceed one lakh fifty
2
thousand rupees

(B) Other sections (e.g. 80E, 80G etc.) under Chapter VI-A Gross amount Qualifying amount Deductible amount

(i) Section 80D Rs. 0 Rs. 0 Rs. 0

(ii) Section 80E Rs. Rs. Rs.
(iii) Section 80G Rs. Rs. Rs.
(iv) Section 80U Rs. Rs. Rs.
 (v) Section 80CCF Rs. Rs. Rs.
10 Aggregate of deductible amount under Chapter VIA Rs. #NAME?
11 Total Income (8-10) Rs. #NAME?
12 Tax on total income Rs. #NAME?

13 Education cess @ 3% (on tax computed at S. No. 12) Rs. #NAME?

14 Tax Payable (12+13) Rs. #NAME?

15 Less: Relief under section 89 (attach details) Rs.
16 Tax payable (14-15) Rs. #NAME?
17 Tax deducted at source (all four quarters) Rs. 0
18 Balance tax payable / refundable Rs. #NAME?
Verification

I,T.R.S.LAKSHMI, son/daughter of SURYANARAYANA TADALA working in the capacity of PRINCIPAL (designation) do

hereby certify that a sum of Rs. 200500 [Rs. Two lakh five hundred (in words)] has been deducted and deposited to the credit of
the Central Government. I further certify that the information given about is true, complete and correct and is based on the books
of account, documents, TDS statement, TDS deposited and other available records.

Place VIZIANAGARAM
Date Signature of person responsible for deduction of tax
Designation :PRINCIPAL Full Name: Smt. T.R.S.LAKSHMI
 Notes:
1. 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 may
be issued by each of the employers or the last employer at the option of the assessee.
2. Government deductors to enclose Annexure-A if tax is paid without production of an income-tax challan and Annexure-B if tax
is paid accompanied by an income-tax challan.
3. Non-Government deductors to enclose Annexure-B.
4. The deductor shall furnish the address of the Commissioner of Income-tax (TDS) having jurisdiction as regards TDS
statements of the assessee.
5. This Form shall be applicable only in respect of tax deducted on or after 1st day of April, 2010.
ANNEXURE-A
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK
ENTRY

(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)

Book identification number (BIN)

Tax Deposited in
S. No. respect of the Date on which tax
DDO Sequence Number in the Book
employee (Rs.) Receipt numbers of form No. 24G deposited
Adjustment Mini Statement
(dd/mm/yyyy)

Total

Note: 1. In the column for TDS, give total amount for TDS, Surcharge (if applicable) and education cess.

ANNEXURE-B
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN

(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)

Challan identification number (CIN)

Tax Deposited in
S. No. respect of the Date on which tax
employee (Rs.) BSR Code of the Bank Branch Challan Serial Number
deposited (dd/mm/yyyy)

Total
Note: 1. In the column for TDS, give total amount for TDS, Surcharge (if applicable) and education cess.
31824
 125000
1411512 1250000 161512 40378
165378

Net Taxable Income (Rs) 

0-2.5 lakhs 
2,50,001 to 5 lakhs 
5,00,001 to 7.5 lakhs 
7,50,001 to 10 lakhs 
10,00,001 to 12.5 lakhs 

12,50,001 to 15 lakhs 
15 lakhs+ 
Old Tax Regime  New Tax Regime 

Exempt  Exempt 
5% over 2.5 lakhs  5% over 2.5 lakhs 
Rs. 12,500 + 20% over Rs. 5 lakh  Rs. 12,500 + 10% over Rs. 5 lakh 
Rs. 12,500 + 20% over Rs. 5 lakh  Rs. 37,500 + 15% over Rs. 7.5 lakh 
Rs. 1,12,500 + 30% over Rs. 10 lakh  Rs. 75,000 + 20% over Rs. 10 lakh 

Rs. 1,12,500 + 30% over Rs. 10 lakh  Rs. 1.25 lakh + 25% over Rs. 12.5 lakh 
Rs. 1,12,500 + 30% over Rs. 10 lakh  Rs. 1,87,500 + 30% over Rs. 15 lakh