NMC- Faculty Declaration Form (2021-22)v .l.

'Faculty Declaration Form (For AY 2021 - 22)

Name of the College:NARAYANA MEDICAL COLLEGE' NELLORE' A.P.524003

Assessment date Remarks and Signature of Asscssor

Accepted Yes i No

Assessor's name

NotG: lt isthc rcsponsibility ofthe Dcan to ensurc lhat rhe s[bmitted Declamtion foIm is ONLY ofa Faculty memberwhois _'^'tr_' _' _ aJ ':-'
employee has notappcared for assessment rn anyother college for any discipline and in any capacity during the statcd acadcr

1 Name of Faculty: l\]t . F.

tr
aob^q I cri <.kn a
(Years) gg at a'
2. Age & Date of birth: / \.' /__f_o /__tg_A:*
3. Photo ID submitted: PAN ( lard,/Aadhar Card/Voter ID/Passport copy
A
Y
Number:
Issuing Authority: _-
Note:
(i) Decla atio[ li)flIs without r !i lid govemment issued Photo lD will NOT be u"""rfl.
(ii) It is mandatory 10 produce (,riginal certificates at the time ofverification.
NARAYANA ME0ICAL C0Utfff
(iii) Only ccrtillcates/documenl s'ccrtified tmnslations in the English language will be accqgFdNTHAFE DOypALEM,

4. present Designation: s=.*.<r.U C{"dgttfiA{q"$frtBEEa33fllfrorn

a. Appointment order: Certified copy of order at this institute attached: Yes / No

b. Department: ___
-Oftr.o &-e0io.
c. College/lnstitute: NAITA Y-\NA MEDICAL COLLEGE

d. City / District: CHIN IH AREDDYPALEM, NELLORE

/
e. Appointment: (i) ReeY la r/qontractuaVAd-hoc basis
(ii) Fulltiiie /Part tirne ,/
(iii) Wilh l'rivate practice / Without PrVate practice
f. Date of appearance-jr last MCI/NM C assessment:
i.
UG / PG / Any other: oa loe, I o,
ii. Nanre of College:
iii Whether appearerl and accepted at the same College: V6l N
iv Whcther appeare<l and accepted for the same designation: Yes / No
Whether retired fi om Govemment Medical College: Yes Afo
vi If yes, desigrration at the time of retirement:
5. Complete Residential Address o1'the employee:
a. Present: D -rt^.

b. Permanent:

!ftu --
6 Copy of Proof of Residence subrnitted and original verified: Yes / No
t/
(Only copies of PassporvAadhar card,,Voter lD/PassporvElectricity bilVlandline Phone bill will be considered)

7 Contact details:
a. Office telephone with STD code: OXC,I - I \ r?-q C.1 . AL
b. Residence telephone rvith STD code:

c. Mobile Phone Number:

d. Email address:
8. Date ofjoining the present institulion: / tc I
DEAN
I lLo+-t.,)ot4 LEGE
Signature of the Faculty SisnfidftlT& M,
" NELL ORE 52
ANDHRA PRADESH, INDIA
 NMC- Faculty Declaration Form (2021-22)V.l.l

9. Joining report verified / attached .Y6s./ No

10. Have you attended the 'Basic Course Workshop' Iirr training in MET: v".Ido.
If Yes, give details (strike out whichever is not applicable):
a. at MCVNMC Regional MET Centre: Yes AIo.
b. at your college under Regional Centre observership: Yes / No
i. Name of Observer:
I l. Educational Qualifications:
Rcgistration number with Name of State
Degree Year Name of College & University
date of re stratlon Medical council
I<qr e..od. 0 edrdl Cdtlq4
lvlBBS g saaqq
*1o"? t c,-.r "'d\ [0 rnc
O.r. N atLot\> r \r\ct$-.&dgt c o?
MDIK N-)m> D Rc- ,
9o\2- 51?U A 00mc
q6,^o$) 1 \<.r>.nfial-q
DM/MCh

PhD

a. MD/MS subject:
b. DM,MCh subject:
c. PhD subject:
Note: For PG & Post PG qualifications, particulars ofRegisrration of Adtlitional Qualificationcertificatcs
are to be fumished for them to be accepted. Strike out whichever section is not applicable.
12. Copies ofeducational qualifications: ,/
a. Copies of-YEBS-a P9DggIqq certificates verified and attached: vles / No
b. Copies of MBBS & P9 pgglg" Registration ve ritied and attached: vYes / No
13. Details ofTeaching experience till date:

Designation* Dep:rrtmcnt Institution Iirorn To 'fotal

Junior Resident
01S46A14 V
->r^SA Rc
, rXlaIA- lo.o>, 04 lO. oS.l 2- '>Ves^,

Senior Resident 9n :.[f qar' G0.,\. o\.b9.\> 30.o6'l) -5

CI(Sot\oadiq
{ rr^: } Rc O\.o?.13 r)1, oa,ls aYr-s
Tutor

Asst. Professor
pe? n\aUc"l
rlltrd6 5i's
o{ }S{k}d"rs to.o2.l6
c*ner , *ol'lao 3rn

Assoc.
Professor

Professor

* Write NA (Not Applicable) for the dcsignations not held

 \
NMC- Faculty Declaration Form (2021-22)v. t.l
To be filled in by personnel from lndian Defense Services ONLY:

I)csignation Institution* lrom To Total

Graded Specialist
Classified Specialist
Advisor
* Note: Docu,nents in supl)r)rt ofeach posting to be furnished for verification

14. Have you been considered in U(i/l'G, MCINMC inspection at any other medical college in
a teaching or administrative capacity during last 3 years. Ifyes, please give details:

Designation Subject College Dates

15. Details of employmentbefore joining the present institution:

a. Name of College/Institution
b. Designation:- <.. O a).\ dorf Date on which relieved: o2l _L{_
c. Reason for being relieved: Tendered resignation / Retired / Transferred / Terminated
-,.. No
d. Relieving order issued by previous institution verified and attached: {es /
16. PAN Card Number:

17. Aadhar card Number:

18. I have drawn total emoluments liom this college in the current financial year as under:

Month i\luount Ilcceived TI)S

l. April2020
2 Qooo 1 *oo
2. May2020
ooo o
&Qo
3. June 2020
9*os o -Qo o
4. Jlulv 2020
aoa *&o o
5. August 2020
Ooo t*o o
6. September 2020
2.* ooo 186,o
7. October 2020
Rqe,' BQo.
8. November 2020
R*o"o ')goo
9. December 2020
X4o oo RGaA
10. January 2021
?oooo 9looo
l. February 2021 000
I
9loao
12.March2021
loooo &-loo)
lcopy ofPAN card & Form l6(downloaded from TRACES) for FY 2019-20 (A$essment Yc8r 2020-21)to beattschedl
19. Number of Research articles in Indexed Joumals:
a. Intemational Joumals:
b. National Joumals:
c. State / lnstitutional Joumals: __--
20. Details of other publications:
a. Number ofBooks published:
b. Number ofChapters in books:
NMC- Faculty Declaration Form (2021-22)V.l.l

DECLARATION

l. I, Dr. p. O.u^a \ctir\nc,r am working in the :apacity,rf F\:g.(lvohsaa

U
lt') the Department of . erfl.t\e"-l;g at

h
.J paF\{F,..r Medical Collegc and do hereby give an undertaking
that I am employed as a full time teaching facultv, rvorking from ca_ A.M. to q_:ja
!f:
P.M. daily at this Institute.
2. I have not made myself available to any olher Medical College/Institution in any
discipline, in the capacity of a teaching faculty. a,lministrator or advisor in the currcnt
academic year for the purpose of NMC/Ir4CI assessrnents.
3. I do hereby solemnly declare that (tick the applica ble clause):
a. I state that I am not doing any Private Practice or working in any other hospital
during college hours.
b. I practice at __ _ Nursing Home / Clinic / Hospital
in the city of irr State and my hours of
private practice are from __: _AM/I'Mto__:_ _ AM/PM.
4. I am not working in any other medical/dental colleguin or outside the State in any capaciry,:
Regular/Contractual/Ad-hoc or Full time/Part time/tlonorary.
5. I declare that I have provided all details with regarJ to my rvork and teaching experiencc
and no information has been concealed by me.
6. Ido solemnly declare that all the details/informatit,n fumished by me in this declaration
form is absolutely true and correct, and all tl,e documerrts/certificates that weremade
available by me for verification or have been sutrnrrtted by nre along with this declaration
form are authentic. In the event of any infonnatioo fumished or statement made in this
declaration subsequently tuming out to be falsei inci,rrect or any document/s or certificate/s
is/are found to be out of order, or it comes to lighr that there has been suppression ofany
material information, I understand and accept that it shall be considered as gross
misconduct thereby rendering me liable to disciplurary and/or legal proceedings. It nright
also lead to suspension/cancellation of my Registralion raith the qtate Medical Council
and/or removal of my name from the Indian Medrc.rl Register.

Date:
Place: N dls"-
-? Tb^-^-
(Signature of the Faculty)

ENDORSEMI'NT
This endorsement is the certification that the uldersigned has satisfied herself/l.rinrscll'
about the correctness, authenticity and veracity ()f'rhe content ol this declaratiotr lorm itt its
entirety and endorsed the above declaration as true and correct. I have personally verificd
all the certificates/documents submitted by the teaching faculty rvith thc origitrrtl
certificates and documents that were subntilted by her/him to the Institutc llrtl
confirmed the same rvith the concerned Institute and have found them to bc corrcct
and authentic.

2. I also confirm that Dr. 2. Rrn, n log\no.. is ttot indulging in private practice
of any kind or carrying oirt any other prolessrooal or other commercial activity duritlg
college working hours, from AMto-:-,1'M, - since she/he hasjoined the Instittrtc'
3. -:- tuming out to bc t'alse or incorrect or any part of lltis
In the event of this declaration
declaration subsequently tuming out to be falsc or incorreot or it comes to light that thelc
has been suppression of any material informalrorr, it is undcrstood and accepted that rhc
undersigned shall also be equally responsible bcsrJes lhe declarant hersellThirnselt, lbr thc
misdeclaration or misstatement.

Date;

Place: Frdif'e- GE

NEtl 0RE-524 P. lA) DIA

 NMC- Faculty Declaration Form 12021-22)V.1 I

CHECKLIST

SI Documents Subnritted
I Recent Passport size photo of Emplol'ec, Signed by Dear/Principal ofcollege {es/t,to
2 Photo lD proof(Cou. issrr:di: PassporUPAN Card/Voter lD/Aadhar Card p)f6s / No
^.ulhority
Cetified copy of Appointment order ,rf the present lnstitute f6slNo
4 Proof of Residence: Passport/Voter t--ard/Electricity/Landline phone bill/ Aadhar Card / No
'21es
5 Joinilg report at the prerient institute tx6lNo
6. Copies ofMBBS, PG, PhD degrees tas applicable). 1-les / No
,7
Copies ofMBBS, PG, PhD degree Rcgistration Certificates (as applicable)
.-)eS / No
Copy of experience certrLficates of I terching appointments before joining present post. rNo
8 al
,y,6
Relieving order from the previous institutior/posting.
9
.Y2rl No
10. Copy ofPAN Card .,1es / No
1l Form l6A. (dorvnloaded liom TRAC ilS 1 for FY 2019-20 (Assessment Year 2020-21) r}ds / No
t2. Letter head (in case ofteachers who are practicing) Yes i Nt'd-

13. Copy ofletter iiom affiliating University' recognizing as UG teacher Yes / ltle.--

l4 Copy of letter flom affiliating Univer';ity recognizing as PG teacher (for PG assessment) Yes/lG/
l5 Copy ofAadhar Card \/ies / i,lo

t
a,^^\r- L
Signature of Faculty
NABA
Date: E

NELLORE.
tA)

Signature Head of Institute Signed & Verified (Assessor)

Date: DEAN Date:
NARAYANA MEDICAL COLLEGE
CH.INTHAFF OOYP,iI. EIV] NOTE
NELLORE 52.r^r!.
ANDHqA pFiinr-.\ Lr I !nil
I1 This Declaration Form vrill not be accepted and the Faculty member will not be considered as a
Teaching Faculty in case any of lhc documents listed above are not enclosed./attached with the
Declaration Fonn.
n) The Faculty member will not be considered as a Teaching Faculty ifthe original Appointment letter,
Relieving order, Experience certificates, Govemment Photo ID,Degrees, Registration Certificates,
PAN Card, Aadhar Card, State Medical Council ID (ifissued) are not produced for verification at the
time of assessment.

lll) Faculty members must submit the revised Declaration form in this format only, Submissions in the
old fonnat lvill be rejected and Facultr members will not be considered as Teaching Faculty.
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t,lELLoRE - 524003.
ANDHRA PRADESH' INOIA.
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i$t' Serlal No : 64865 Oater 22 Jflrt 20L5

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t;t' cortncll urrder
ir, Reglstratlon llo | 57 748 Date! Og Aug 2007
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l,lanre r P,RAI,IAKRISI|NA

Father., NanTE I PABOLU RAMA SUBBA RAO

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"iti) Date of ttlrth | 23 oct 1982 Sex: t4 k
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Address I 16-I-3OO, M V AGRAHARAI4,

.(*I oPP:CO-oPEnATMi BANK, TRUNl( nOAD,
'!D ELLONE,ANDHNA. I'RADESH-524O0 1.
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I M.B'g.S Doter JUL 2oo7

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Unlvorsity: NTn UN1VEnSIlY of llEALT|l sCIEI{CES,AP"'
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RESEARCII CNHTRE, RANGAI.ORE.

nAJrv GANDHT uNtvERsrrY oF tIEALTH scrrltcts'rcnhruarll<a'IN DrA'

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NABAYANA MEDICAL COLLEGE

CHINTHABEDDYPALEM,
NELLORE - 524003.
ANDHRA PBADESH, INDIA.
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ANDIIRA PRADESI.I MEDICAL COUI.ICIL

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Cortlllcnto of Ronowril ol Roglotrntlon
(Socllort - 15C ol A.P. Mo<llcnl Prnctltlonoro Roglnlrallorr {Anrondmontt Acl.'l$1Xl
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SNo 27083 -
Nomo ol tho Ooctor P.RAMAKRI9I'INA

Father's Nsmo PABOLU RAMA SUBBA RAO

Reglstrotlon Numbor 57748

Oate ol reglstratlon 08 Aug 2007

Dato of Blrth 23 Oct 1982

Data ol Rsnew.l of Reglstratlon 15 Jul 202'l

Valid upto 14 Jul 2026

Pressnl Addross 16-I.300, M V AGRAHARAM

OPP:CO-OPERATIVE BANK
NELLORE Andhra Pradcsh 524001

Reqislered

Qualificallon Date of Reglstratlon

M.B.B.S 08 Aug 2007

MS-Orthopaedics 22 Jan 2015

This is to certify that ths above menlioned doctor having complied with lhe requlrements of
Section-15C of Andhra Pradesh Medlcai Practitioners Registration Acl. 1968 (as amended Ac1 No.
10/2013) and the rules made thereunder, hlslhsr tegistrallon has been renewed for the period
tlqo 1s_&Leggl!o14 Jul 2026

Vijayawada
Acorih
REGISTE(R
Dated:15 Jul 2021 ANDHRA PRADESH MED]CAL COUNCIL
tll (,t\ (4rr
Andhrd p;,:idc\tr t.ltL,15r
o rlrR 6gua6,,
-.
UrrS 0"rrc,r,Si-
o
q
.._Dr
v l: avlwron. s I o do<.

+
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t

Sri SathYa Sai

General HosPital
TRUST
I UUTT OI' SATHYA SAI MEDICAL

3otr' Jurre 201 3

sssghwld/ SA't2013'14

R Et-l i:VlN o RD["R

Ref: Acceptanced,l"ot;%lTf,. 1 6,,, April 2.01 j

Letter No: s33g

llill]';"1iil
;".#Jit*dfr i;il"i[1l:x;H';:i;l'"ft
H,}l:$iffi
,L( .[tJ--tf
-Dr.UPerrla G'Acharya
Meclicat SuPerintendettt

I?.p.namu xrishna

l'; t',','ri"J !:? t::L ra r H osP*a t

Whitefield
Bangalore

_ 560 066
Bon(lalu^t
Main Aosd, Whltell6ltl sttsg
I ogo zoas
lol oB0 2845 2330 le tetar

L
slhm6 olg lrl'
li-rrrnll fir6'ghv/ld(933

DEAN
NARAYA}IA IilEDICAL GOLLEGE
CHINTHAREDDYFALEM,
NELLORE - 524003.
ANOHRA PRADESH, INDIA.
 'fifefri Institute of gvteficafsciences {,Wsearcfr Centre

vtMS & ItC/liSl-- I I 14/201 5- I (\ Date: ()2.0'l .20l,5

IIXPDIIIDNCIi CIJltlllr.l(lA'I'I,.t lUil,l ltvtN(; ORDILlt

Dr.P.llnrn.t l(rishua has. rvorkcd ns Senior ltesiderrt in thc Deputnrent of'Orthopredics

Iionr 01.07.2013 to 02.07.2015 at Vydehi Institutc of Mt'tlical Soiences & l{esearclt Centle,

l:3algalore-560 0fi6 and he is relieved olhis dtr(ies rvith cll'ect lionl 02.07.2015 AN, vide his

rcsigtation notice letter d0ted l)3.04-201 5.

I(indly acknorvledge the receipt.

. PITINCIPAI.
t/tltNCltrAt-
Vydehi ln1;lil,rle ol Dledical .c.'cil;tc, ,

S llescirrcll C(r,ilrc
Copy to: tl 82.l:Pl? Aroa. Whilclrcl(1.
Serrg tlt17,P - 5lio 066
l. 'l'he Direotor, vlMs R(l fior killd infotmation
2. Thc Medical Superintendent, vlMs & ltc
-1. 'l-he I)rof. & I'IOD, Dept. of Orthopaodiss vlMs
& R('

4. Dr.P,Rnrno Krishna, t)ept. of Olthoptredlcs, vltvls & Itc

5. 'fhe C.F.O. vlMs & R(:
ri. 'l he llR DePartment' vlMs & RC
7. Office CoPv

()Ii(i, f,ll:otj()"2t]ltlJSl]l/t'2/a3ltJ4/45
tl l|2, r.,y).r. Al.ta, Whltl,.leld, lJAl.l(]ALoRl] 56(,
-

I'ax : '2Bt! l2g5O, ')tl4l6lg'c)' F-lnall : ill [o'4)vlrlls'a(] lll' We'l) : www vlttls att:'llr

'ffit#frfrflh,":li*',
NELLoRE - szacn.-i""
ANDHRA pnlorsi, jj,rcra.
 llAfi[Yfilfi MI0lCAt
-
G0lrttG[
CHINTHAREDDYPATEM, NELLORE 524 OO3. A.P, INDIA
6' : 0861-23'l7963, 64, 68 Fox : 0861-2it17962
;
E- rnoil : noroyononredicol@yohoo.corn

Office of tho Prlncipnl

Ref. No. NMC/A/ J322 t2o1 B Date: 25.01.2016

ROC EDINGS O T INCIP L: ATTAYANA MEDICAL CO LEGE

NELLORE

Prssont: Dr. G. Veera Nagi Reddy, M.D.,

Prlnclpal.
APPOINTM T ORDER
Sub :- Narayana Medical College, Nellore - Establlshment - Mddlcal
Faculty - Appointinent of Dr. P. llama Krishna, Assl. Professor in
Orthopaodics - Orders lssued - lleg.

The Prlncipal is pleased to appoint Dr. P. Rama Krlshna, M'S', as

Asst. Profesaor itr the dopertment of Orthopaedlcs, Narayana Medlcal
College, Nellore.

He is requested to report to the Professor & l'lOD of Ortllopaedics

immediately and the HoD of orthopaedics lo send the cotnpliance of ioining
report of Dr. P. Rama Krlshna, wlten he reporled to tho department'
.,L,lo-t-:,_,
",.,-'' - Lsl , lt,
fntNctpal
PIIINCIPAI.
Na rayana ;Medicn I Collelle
Terms & Conditlons: t'3i1',-!',)t'dof/a+le?hlAhrro16'-'l
-ts l-le should glve at loast 3 rnonth'6 rlotice to n*
lnstitution
prn crr" ho wante to gel relievecl irnnrediately he has to
pay three months
salary to the institution in lieu of three nronths notice'

)p He is govenred by the rulss & regulationE of Nsrayana Merlical college,

Nellore.
To,
Dr. P. Rama Krlehna, M.S',
Nellore.

Copy to :
The D|roclor. NMl, Nelloro
The Medical Superlnlendent, NMCI{, Nollore
The Coordinator, NMC, Nollore
il; F;.fr;;;;e'xoo, oept of orthopaedics' NMCrI' Nellore
The Finance Section, NMCH, Nellore
The HRD
The MRD

:ffip.ir,4;f,l;'
 JOINING REPORT

oate: ..1.9.\1.-) :t.9,1I ,

To,
'fhe Principal / Medlcal Superinlenclent,
Narayana Medical ColleEJo & Hospital,
Chinthareddypalem,
Nellore.

Sir,

Sub: Joinlng Report - Subrnlttecl - Reg.

Ref

As per tho reforence oited above, l or. ..ll Ilflm.ft.. tr-I?.)Jl+A{.'4,.. . ....

Joining as .R.+s(4J.ft1"'-{.'...f.n.f (.t'tsr,IL,..in the d€partment of ....!/1J,1..l].S)4/! \,1?t.("\

from the forenoon / afternoon or ......... .19.},A) 2,91.(...... .. ...

'Ihankittg yoLt,

Yours faithfttlly,

F. i 2- an-..,-,[:,iiL.o.

pr. .1. : *tt.tt *,..is{t-l \ttxr.r- )

f)F"\N
NARAYANA fulEolCAL CiU: rit;
CHINTHAREDDYFT.L.Livi,
NELLORE - 52.1CO3.
ANDHRA PRADESII, INSI^.
(2TDS
lf Cc,lrJidl I'lrrY$ins Cdn
I

I
TRACES
TDs Recoi.iliation AnalFis and clrection Enabting system
ffi
Q
FORM NO. 16
lsee rulc 3l(1Xa)l

PART A

Certificrte under Scction 203 ofthe Income-t.r Act, 196l for lrt dcduc(ed rl source or srlary

CertilicateNo. ACWSTAA Lasa updrted otr l4Jul-2021

Nrm€ rrd iddre$ ofthc Employer Nrme rnd rddress ofthe Employe€

NARAYANA EDUCATIONAL SOCIETY

I4l72,IIARNATHPURAM,
RAMA KRISHNA PABOLU
NELLORE. 524003
16l-300, M.v. ACRAIIARAM, TRITNK ROAD - 524001 AndhE
Andhra Pradesh
Prad.sh
+(9 r )861-2304624
VENKATAANILKUMARK@NARAYANACROUP.COM

EEploy€€ Refcrcm€ No.

PAli of lhe Employee
PAN ofthe Deduclor TAN of lhc Deductor provided by the Employer
(!f rvsileble)

AAATNI6T2R HYDNO3OOSF ANMPPO545h-

crT (TDS) Perlod with lhe Employer

To
rhc comnissioncr oflncomc Tax (TDS)
Room No. 1l I, lncome T.'x Towen, I G2-3 A.C. Guard, 2021-22 0l-Ap.-2020 ll-Dec-2020
Hyderabad - 5000t)4

SummNry ofrmount paid/credited rtral tsr deducled .t source thereon in respect ofthe €mployee

Receipt Numbers of original

AlrouDt of tsr deposited / remitted
querlerly stet€m€tr13 of TDS Amoult of t.r deducted
Ourrter(s) Amount paid/credited (Rr')
undcr sub-.s€ction (3) of (R!.)
Scction 200

Ql QUFMUGTA 85355.04 24400.00 24400.00

Q2 QUHCZDNC 86710.00 25400.00 25400.00

Q3 QULQGAHC 86709.90 25400.00 25400.00

Q4 QULPIA}IA 210000.00 61000.00 61000.00

Total (Rs.) 46a714.94 138200.00 138200.00

I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN TIIE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
(Thc deductor to provide paymenl wise details oftsx deducted attd deposited with respect to lhc deductee)

Book ldentificrtloo Number (BlN)

Trr Deposited lo respectofthe
Sl. No, deducaee Drle of transfer voucher St.tus of matchinq
(Rr.)
Rcceipt Numb€r. ofFor6 DDO serhl rumber io Form no.
(d'VDm/yyyy) rri(h Form no.24C
No,2,lG 24G

Tokl (Rs.)

II. DETAIIJ OF TAX I}EDUCTED AN'D DEPOSITED IN THE CENIRAL GOI'ERNMENT ACCOIJNI TEROUGH CEALLAITI
(The deductor to provide payment wisc details oftax deductod and deposited with respect to the deductee)

Chrllan IdeDtilic.tion Numb€r (Cf N)

T.t Dcpo.ited in rerpect of th.
Sl. No. deductar
(Rs) BSR Code ofthe Bank Drte on whlch Tat deposited Chrllen Scrial Numbrr Strtus of matching nith
Brrnch (dd/m m/yyly) OLTAST

I 8800.00 6390340 21-t0-2020 01441 F

2 8800.00 6390340 2t-tu2020 03441 F

3 7800.00 6190140 04- t l-2020 02291 F
8800.00 6390140 04-11-2020 02291 F

Pagc I of2
 Cenifi 0i. )iunb.r; ,{C$ STA,{ T N ol f, mploy.r: ltYDNl}]m3F PAN ot Eoplore: A\M Pm5asN A!.Brn..l Y...r 2021-22

Chrllin [dentilicition Numb€r (CIN)

Trr DepGlted in rBpe.t of th€
Sl. No. deductee
(Rc.) BSR Code ofthe B.trk Drt€ on which TlI deposlt€d Chdhtr Serirl Number Strt$ of oatching with
Brarch (dd/mnt/yy!'l) OLTAST

5 7800.00 6190340 0+t l-2020 02289 F

6 7800.00 6390340 t'7-tt-2020 02473 F

7 81r00.00 6390340 l7-l r-2020 0372t F

8 7800.00 6390140 07-0t-2021 113324 F

9 8800.00 6190340 0t-01-2.021 18124 F

t0 21000.00 5390340 I l-01-2021 05249 F

21000.00 6390340 2G02-202t 00562 F

t2 21000.00 6390340 22-03-202t 03715 F

Total (Rs.) 138200.00

I, I.OIISIyAIA_.8AO_BAIII8L .otr / d.r8hl.] ot RAPIIev worling in th. c.pacity of srCRrTARv (dctlanrtlon) do h.r.by certify lhrl ! rrm of
^lrDIsEsHAlA[I
R3.l18200.il0IR3.@(ln$o.d3)|t.'b.end.du..ed.nd..umotR3.|i8200.00IR..0&-Ir.L.h_u1B}-.Ei8hr
Ttous.r{t Two Ilundrcd Onr'l nr3 bcco dcporit.d to th..r.dit of lle Ccnt..l Coverrment, I fu]ther certify tt.a tbe ilforEilion given .bovc i3 true,.omplere ..d
correct ud h b.s.d or tbe boot. of.ccou!r, documerrs, TDS 3rrt.m.Dr3, TDS deporir.d xd ori.r .[lhbl. records.

Phce NELLORE

Date l9Jul-2021 (Signrture of for deduction ofTar)

Desigtrrtlon: SECRETARY Full Nrne: KOTESWARA RAO RAPURY

Notes:
I Part B (Ann.xurc) offie cediiic,re in Fonn No.l6 sh.ll b€ issu.d by lh€ enployer.

of ta\ deducrcd and deposned for all tle quan.s offtc financid ycar.
3- Ile essc. is cmploy.d udc. moE thu on..mploy.r duiry th. yd, @h of lhc cnlPlolB shall isu. Pet A of tbc c.nificdc in Fom No.l6 p€rtlining to th. Friod for ehich such

4. To updarc nAN details in Inco,nc Tax Depanmcnt drlabase, apply for'PAN cb.nge rcqu$t' lhroud NSDL or UTITSL.

I eg€nd lrsed in Form t6

* Statu3 ofmatchirg with OLTAS

Muclors hav. not d€posiEd hx6 or have fmist d i&o.rEl p.ltLula5 ofirr p.IDc t Fin t credtu uill b. rcflected otny who p6yn.nt
U
derailsi! boll mtch with &rtils of dcpGit i! TDS / TCS stcrao.rn
Provisionnl l,( credil is ell..rcd o y fo. mS / TCS Sr.iem€trts filcd by Gov€mln€nt d.d@tors.'P' sraru! will b€ cheg.d ro Fi@l (E) on
P
vdification ofpq,rDert d.taib submirt d by Pay lnd Ac@unls Of|icer (PAO)
tn cas.ofnon€overnne deduclm, paymdl dltrils oflDs / TCS deposited in bank by dcductor bavc Datchcd r{ith t}o Fymcnt details
t' DolioDcd iD $e TDS / TCS 3tddnent fil€d by drc dedwl6. ttr ce of govemmmt doducloB, detsils of TDS / TCS boot.d iD Govclmor
a..ount hrvc beer v.rifid by Pry & Ac.outrls Officlr (PAO)
P.ynml &bils of mS / TCS d.posited in babl by dcduclor h.!e mtched with der.ils mmtioned ir lhc mS / TCS siltemcd bqr rh€
o amount i! ovq claiDed h thc sllremcnt. Fin l (F) crcdn vil bo rcflected only when dc{uclor rcduces claihcn moul itr thc srrtemmt or
males n.w paymc for .xc.s Mounl claim.d in lh. statement

Sionature Not Verified

o"L,r ".={ioJ
KdTESWARA 9Ao RAPURY
Date:2021.0d9 17 10:05
IsT J
Page 2 of 2
 NARAYANA EDUCATIONAL SOCIETY
PAN ofthe Deductor: AAATN1672R TAN ofthe Deductor: HYDN03008F
PAN of the Financial Assessement
Name ofthe Employe€
EmDloyee Year Year
DR RAMA KRISHNA.P ANMPPO545N 2020-27 2021-22
FORM 16-PART B (Annexure)
Detalls ofSalary paid and any other income artd tax deducted
1. Gross Salary
(a) Salary as per provisions contained in sec- 17(1) 4,68,775
(b) Value ofperquisites u/s 17(2) (as per Form No.12BA, wherever
applicable)
(c) Profits in lieu of salary under sedion 17(3)(as per Form No.12BA,
wherever applicable)
(d) Total Salary 4,64,775
2. Less: Allowances to the extent exempt under section 10
3. Total amourt of salary received from current employer [1(e)-2(d)] 4,6A,775
4- Deductions under section 16
(a) Standard deduction under section 16(ia) 50,000
(b) Entertainment allowances under section 16(ii)
(c) Tax on employment under section 15(iii) 0
5. Total amount of deductions undersection 16 [4(a)+4(b)+4(c)] 52 0
5. lncome chargeable under the head 'salaries' (3-5) 4,16,375
7. Addr Any other income reported by employee under sec 192 (2b)
(a) Income (or admissible loss) from house property
reported by employee offered forTDS - u/s 24@)
(b) lncome underthe head other sources offered forTDS
8. Total amount ofother income reported by the employee [7(a)+7(b)]
9. Gross total income (6+8) 4,16,375
Gross Deductible
Amount Amount
10. Deductions under chapter VIA
(a) Deduction in respect oflife insurance premi4 contributions to
provident fund etc under section 80C
(b) Deduction in respect ofcontribution to certain pension funds under
section 80CCC
(c) Deduction in respect ofcontribution by taxpayer to pension scheme
under section 80CCD (1)
(d) Total deduction under section 80C,80CCC and 80CCD(1)
(e) Deductions in respect ofamouDt paid/deposited to notified pension
scheme under section 80CCD [18)
[0 Deduction in respedofhealth insurance premia under section 80D
(Self/family & Parentsl
(g) Deduction in respect ofinterest on loan taken forhigher education
under section 808
O) Total Deduction in respect ofdonations to certain funds, charitable
institutions, etc under section 80G
(i) Deduction in respect ofint€rest on deposits in savings account under
0) Amount deductible underany other provision(sJ ofChapterVl-A
11, Aggregate ofdeductible amount u[der chapterr/l-A
12. Total Income (9-11) 4,16,375
13. Tax on Total lncome
14. Health & Cess @ 4% (on tax at S. No. 13)
15. Tax liability (13+14)
16. Less: TDS 1,38,200
17. Tax payable/(Retund)(1S-16) (1,38,200)
VERIFICATION
l,KOTESWARA RAo RAPURy. son/daughter of B/IEIIBI AUDISESHATAH working in t}le capacity of AIIIIOBIZED
SIGNAIOBI(designation) do hereby certify that the information given above is true.
Place: Hyderabad
Date, 31 /07 /2021 [simatur€ of person responsible for deduclion of tax)
Desisnation: AUTHORIZED SIGNATORY Full Namer K0TESWARA RAo RAPURY
Doqr*{ oird|a },

Dato:
rsT

Y
r$

DEAN-
NARAYANA MEDICAL COLLEGE
CHINTHAREDDYi,ALEM.
NELLOBE 52'" '93
ANDHRA PFlADF-Sti, .i: -]].A.
 NARAYANA EDUCATIONAL SOCIETY

Pay Slip for the Uonth of April - 2022

( Amouots in Il{R )

Name DR RAMA KRISHNA. PABOLU Emp No 648-00562

Department ORTHOPAEDICS
ESI NO 1111111111
Des ignation ASSISTANT PROFESSOR
PAN NO ANMPPO 54 5N
Gross Safary ?0,000.00

Total Number of Days : 30 Paid Number of Days: 30

Earnings Deductions

Basic Salary 24,500.00 PF Contribution 0.00

House Rent Allowance 9,800.00 Professional Tax 200.00
TransporL AIIouance 2,100.00 Income lax 21,000.00
0. 00
LTA 10, 500 .00

Medical Allowance 3,500.00 Salary Advance 0.00

Eood Allowance 5,600.00 Phone 0 .00

Personal Al Iowance 3,500.00 GMC 0.00

Education Allowance 1,400.00 Food Coupons 0 .00

Monthly performance 9, r-00.00 Misc . Amount 0.00

70,000.00 2t ,200 -00

Net Pay Rs. Forty-Eight Thousand Eight Hundred only 48,800.00

Generated an I OglOOl2022
 NARAYANA EDUCATIONAL SOCIETY

Pay slip for the uonth of May - 2022

( Alnoultts in INR )

Name DR RAMA KRISHNA. PABOLU Emp No 648-00562

Department ORTHOPAEDlCS
ESI NO 1111111 111
Des ignation ASSISTANT PROFESSOR
PAN NO ANMPPO545N
Gross Salarv 70,000.00

Total Number of Days:31 Paid Number of Days: 31

Earnings Deductions

Basic salary 24, 500 . 00 PE Contri-bution 0.00

House Rent AI lo!,rance 9, 800 .00 Professional- Tax 200.00
fransport Allowance 2, 100 .00 Income Tax 21,000.00
0.00
LTA 10,500.00
Medical Allowance 3,500.00 Salary Advance 0 .00

Food Al lowance 5, 600 - 00 Phone 0.00

Personal AIlowance 3,500.00 GMC 0.00

EducaLion AIIowance 1,400.00 Food Coupons 0 .00

Monthly performance 9,100 - 00 Misc. Amount 0.00

70,000.00 21 ,2O0 -O0

Net Pay Rs. Forty-Eight Thousand Eight Hundr€d ody 48.800.00

)

Generated on 't 0910612022