NMC- Faculty Declaration Fonn (2021-22)\/ I I

Faculty Declaration Form (For AY 2021 - 22)

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

Assessment date Remarks and Signature of Assessor

Accepted Yes r No

Assessor's name

ofth. Dean to ensure that rhe lubmitted Declaration form is ONLY ofa Faculty member$hois -tim€
Notc: It islhc r€sponsibility
cmployre has notlppeared for as!,essment rn anyother.ollege for any discipline and in any capacity during the stated ocadem

1. Name of Faculty: F=.,

*6
2. Age & Date of birth: G[ -rYcars) o? t_OL t _]s_LL rE
3. Photo ID submifted: PAN ('ard/Aadhar Card/Voter ID/Passport copy 1
I
Number: Ae,f PRsBe tK \
Issuing Authority GuL af Jr^cl,r.*
5
Note:
(D Declaration forms without a valid govcmment issued Photo lD willNOT bc
(ii) It is mandatory lo produce ( rriainal certificales at the time ofverification ut rl'N
(iii) Only certifi cateVdocuments 'cerlified translations in the English languagc wi L COLLEGE
PALEM.
4 Present Designation: 6l 4003

a. Appointment order: Certifie d copy oforder at this insti tute attached: :lCs / Nci "-
ANDHEA PtrNNE SH, INDIA.

b. Department: fqr',-t*.ar',.uh.,,r
T
c. College/lnstitut E: NARAYANAMEDICALCOLLEGE
d. City / District: ar*r-
e. Appointment: (i) Rqsdi4r/ContractuaUAd-hoc basis
(ii) Fuly'tirne /Part time
(ii9 Wirt Private practice / With# Private practice
t Date of appearance i4 last MCI/NM C assessment:
i. UG , 96 / Any rrther:
ii. Name of College:
iii. Whetlrer appeared and accepted at the same College: yA t tlo ,
iv. Whether appeared and accepted for the same designation: Y/s / No
v. Whether retired fi om Government Medical College: Yes ,DiZo
vi. Ifyes. designation at the time ofretirement:
5. Complete Residential Address ollthe employee:
a. Present: . ,ur t tla )zrL
P.r.^'lln Nol-lfir-
b. Permanent: :q 1t t^r'
-Nq\-r
rse}l5]<--
6. Copy of Proof of Residence suhrnitted and original verified: Yes/No
(Only copies of Pas sportl Aadhar &'voter lD/PassporL/Electricity bilVlandline Phone bill will be considered)

7. Contact details:
a. Oftice telephone with STD code: o86l- .l3l +q a3,Gt1
b. Residence telephone with STD code:

c. Mobile Phone Number: >L I

d. Email address:
8. Date ofjoining the present lnstltutlon: leto / aoll
R. D
NA
Signature of the Faculty c
NELLORE 524003.
ANOHRA PRADESH, iNDIA
 NMC- Faculty Declaration Form (2021-22)V.1. I

9. Joining report verified / attachea vt'l

No
10. Have you attended the 'Basic Course Workshop' lbr training in MET: v"r r Jo
If Yes, give details (strike out whichever is not applicable):
a. at MCI/NMC Regional MET Centre: Yes A.{o.
b. at your college under Regional Centre observership: Yes / No
i. Name of Observer:
I L Educational Qualifications:
Re gistration number with Name ol State
Degree Year Name of College & University
date ofre rstrallon Medical council
MBBS K,,s.,no( Me,Iica! Cdlegit, l+9t+
(q85 Xrrrwtdot Atuc
SV U'..ivit*,lih l&- os.8+
MD^tr
tqq0
f."di^^b" i.ae&r-J. r"q^{} APMC
"^.l*fi#?fr#^,r lB- ou-o'l
DMIM€h
(181 k".t*..L MeJn-J coilo,,f, \;1,{ F Ptrrc
D'O,tho Mttfr*^m u,m.r,^c,art^,
.
"
rg.ol'o1
U
PhD

a. MDQ$aubject:
b. DM/lvICh subject:
c. PhD subject:
Note: For PG & Post PG qualifications, particulars ofRegistration of Atlditional Qualificationcertificates
are to be fumished for them to be accepted. Strike out whichcver section is not applicable.
qualifications:
^f
12. Copies ofeducational
a. Copies of MEBS & PG Degree certificates venfied and attached: YEI-No
b. Copies oJ-MBd& ffd-ffie
Registration veritied and attached: y#l No
13. Details ofTeaching experiEfrEE till date:

Designation* Depnrtment Institution From To Total

t4
Junior Resident Ozttryoi;'4
,M *"{*J llsq 11?o 3Y^
Senior Resident LGlbr*l.A Medi@,i
Ont^{^!d;"} lf-ol-q I t6 -ot-15 Q Y'u
CoJ,bZt, M".o*fir'[
Tutor

lta,rt"nb^ McdiJ S"[\%e, r). ol.q3 o8 .lo. 9+ I Vqr9,y

Asst. Professor ,\{p\{uf5t
Cn*fiq,a!,&.,
Nc.na5o^rw Veaic^l O
lp.oJ. ol tr.\l .o\ :% \q
Ndldl{
5% Iq

Assoc. Naru-jarl* HeAnJ

Professor oiHrcf,6a& lQ.tt.o\ l+.\\' AB ,.{%
&tl,rr , N€Ud\'L

Professor
l3Se
laiou2ryo- Me.U.J
0dicg^'Ai,.\
Coll-a?f , Nttlorr te'\t'oB 'Tiu(>h G11

* Writc NA (Not Applicable) for the dcsignations not hcld

 NMC- Paculty Declaration Form (2021-22)v. I .l

To be filled in by personnel frorn Indian Defense Services ONLY:

Designation Instilution* From To Total

Graded Specialist
Classified Specialist
Advisor
* Note: Docurnelts irl sul port ofeach postiug to b€ furnished for verification

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

Designation Subje* College Dates

15. Details of employmentbefore joining the present institution:

a. Name of College/lnstitution _

b. Designation Date on which relieved: o fr/ _l Q / _1134

c. Reason for being lelieved: Te SI gnation / Retired / Transferred / Terminated
d. Relieving order issued by previous institution verified and attached: y,4 I No
16. PANCardNumber: AB KpA Bga5 K
lT.AadharcardNumber: $63; 5151 la6l{
18. I have drawn total emoluments iiom this college in the current financial year as under:

Month z\lnount Reccivcd TDS

l. April 2020
;boc a ls*aa
2. Mav 2020
fi1oo l)J) o
3. June 2020
(-A oo O ls-to o
4. ldy2020 e, -lo a l.)>lo
5. August 2020
Snloo llsto
6. September 2020
{L ooo I YeOo
7. October2020
o,: llsD o
-9-.))
8. Novernber 2020
\-'6 oo o /rt@
9. December 2020
-S-?l o o lrsoa
10. January 2021
l2o ao o 3Loo o
l. February
I 2021
l2a ssa 3l,eo
12- March 2021
/l@o 3@d
[Copy ofPAN card & Form l6(downloaded from I'RACES) for FY 2019-20 (Assessmcnt Ycar 2020-21)to berttach€dl

19. Number of Research articles in Indcxed Joumals:

a. International Joumals:
b. National Jounrals:
c. State / lnstitutional Joumals:
20. Details of other publications:
a. Number of Books pr.rblished:
b. Number of Chapters in brroks:
NMC- Faculty Declaration Form (2021-22)V.l.l

DECLARATION

l. I, Dr. am working in the capacity of ?,ncp-^ta

in the Department of O:,$r...no" J;T at

Medical College and do hereby give an undertaking

that I am employed as a full time teaching faculty, working from _ _:_ _ A.M. to _ _:_ _
P.M. daily at this Institute. -_T
2. I have not made myself available to any other Medical College/lnstitution in any
discipline, in the capacity of a teaching faculty, administrator or advisor in the current
academic year for the purpose of NMCA4CI assessments.
3. I do hereby solemnly declare that (tick the applicable 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 lIr State and my hours of
private practice are from _ _:_ _ AM/I)M to _ _:_ _ AM/PM.
4. I am not working in any other medical/dental collegcin or outside the State in any capacity:
Regular/Contractual/Ad-hoc or Full time/Part time/Flonorary.
5. I declare that I have provided all details with regard to my work and teaching experience
and no information has been concealed by me.
6. Ido solemnly declare that all the details/information fumished by me in this declaration
form is absolutely true and correct, and all the documents/certificates that weremade
available by me for verification or have been subnritted by me along with this declaration
form are authentic. In the event of any information fumished or statement made in this
declaration subsequently tuming out to be false/incc,nect or any documenVs or certificate/s
is/are found to be out of order, or it comes to lighr that there has been suppression of any
I
material information, understand and accept that it shall be considered as gross
misconduct thereby rendering me liable lo disciplinary and/or legal proceedings. It might
also lead to suspension/cancellation of my Registration with the State Medical Council
and/or removal of my name from the Indian Medical Register.

Date:
Place: !el-[dlo R.
(Signature of the Facultl,)

ENDORSEMENT
This endorsement is the certification that the undersigned has satisfied herselflhimsell
about the correctness, authenticity and veracity of the content of this declaration lomr in its
entirety and endorsed the above declaration as true and correct. I have personally verificd
all the certificates/documcnts submitted by the teaching faculty with the original
certificates and documents that were submilted by her/him to the Institute and
confirmed the same with the concerned Institule and have found them to be corrcct
and authentic.

2. I also confirm that Dr. is not indulging in private practice

of any kind or carrying out any other professional or other commercial activity during
college working hours, from _:_ AM to _:_- I'M, since she/he has joined the Institute.
3. In the event of this declaration tuming out to be false or incorrect or any part of this
declaration subsequently tuming out to be false or incorrect or it comes to light that there
has been suppression of any material information, it is understood and accepted that the
undersigned shall also be equally responsible besides the declarant herself/himself, for the
misdeclaration or misstatement.

Date:

Place: A,at\di"
Signature ( Instit
witJtarfrftfiUl fEolcA LCO Slbr
?ALEM.
A,P. { lA) CHINTH AREOOV
NELLORE.524 NELL oFE 52.1003
ANDHRA PRaOt SH, iH
 NMC- Faculty Declaration Form t2021-22)V.1. I

CHECKLIST

SI Documents Submitted
I Recent Passpon size photo of Empltrvcc. Signed by Dean/Principal ofcollege YYslNo
2 Photo tD proof (Go!.1. Authority issucdt: PassporVPAN Card/Voter ID/Aadhar Card rVr I No
Certified copy ofAppoinlnent ordet ,rf the present Institute. r",/l No
4 Proof of Residence: Passport/Voter (lard/Electricity/Landline phone bilU Aadhar Card rdtNo
5 JoiDing report at the preselt institute t/ru No
6 Copies of MBBS, PG, Fhlxegrees rxs applicable) ydrNo
'7
Copies ofMBBS, PG, RbAdegree Rt gistration Certificates (as applicable) y#tuo
8. Copy ofexperience certificates ofall teirching appointments before joining present post. tdl no
9 Relieving order from the previous institutiorl/posting. 'r4 t No

10. Copy ofPAN Card Yuy'No

ll Form l64. (dolvnloaded fiom TRAC liS ) for FY 2019-20 (Assessment Year 2020-21) (J//No
t2 Letter head (in case ofteachers who are practicing) Yes / No

l3 Copyof letter from affiliating Univer;it1 recognizing as UG leacher Yes / No

l4 Copy of letter from affiliating University recognizing as PG teacher (for PG assessment) Yes / No

l5 Copy ofAadhar Card YrtNo

{_.
Signature of Faculty D
NARA
Date:
524 AP,

Si mtftECd Signed & Verified (Assessor)

neoov FrrtEu. Date:
HINTHA 4co3
NELLO RE 52 H,INDIA-
ANDHRA P FiAOES NOTE
I) This Declaration Form will not bc accepted and the Faculty member will not be considered as a
Teaching Faculty in case any of thc documents listed above are not enclosed/attached with the
Declaration Form.
il) The Faculty member rvill not be considered as a Teaching Faculty if the original Appointment letter,
Relieving order, Experience certillcales, Govemment Photo ID,Degrees, Registration Certificates,
PAN Card, Aadhar Card, State Med ical Council ID (if issued) are not produced for verification at the
time ofassessment.

III) Faculty members must submit tlre levised Declaration form in this format only, Submissions in the
old fonnat will be rejected and Facu lty' rnembers will not be considered as Teaching Faculty.
 Gr-TrrT }il-ira Tfiffrq
PARruNNT OF INDI,A
RAPARLA VENKATESWARLU

CHALAMAIAH CHOWDARY RAPARLA

1
ii ,1.,

ABKPR3825K

Il,ARA

G€
DEAN
NABAYAIIA MEDICAL COTIEGE
, INDIA.
CHINTHAREDDYPALEM,
NELLOFE . 524003.
ANOHRA PRADESH, INDIA.
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I!,5i:5oc:/ Enrollment No. : 102? l10197lOO?23

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o.!6&rASJ INFORMATION
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. Aldhsar l5 prool ol ki6ntity, not ol clti2enshlp.
! 6A'{OHIMOAR
NEAF SUNOAT MAEIGI
I To ostablish identity, aulhenticala onlino.

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7037 5157 1264 a Aedhsar will bo llolpfut ln svailing Govommant

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9*, ,,n/, * .%t "/tt %,,ir*g

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ccrtificare No.. .. )../ 9.*.7,.
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It is hereby cer tifled thrt this lg tho €ltry of thc rbove epeclfled nrue ln
I the ltlcdical Regisler.

Andhrs Medlcrl Council Officc.

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uyoeranad...../.* .:....6..,-.,...t9 8,? .

I
Registorod Medical Ptacllllon?lr should Fcarrrrrr,r'.0,.," no,ffil---:-,^
lheir resirtored oddress end slso to snswsl all I nqu be ae nt to th.m by tha Scglstrlr ln rogard thcrc to
in order lhat thoir correct addrear may b. duly intsrrod ln ths Medlcrl Rcglrtrt.

No Charge is made rot oltoration ol rddre88'

Alrsr tho publlGation ol lho namo ln lhc p,lntrd Mcdlcll Rcglsta, th! l!3r rdlllon of lhal .tona h th. lsgal
ovidenco ol roghtration.
II
Atl polsons registered under whatovot Diploms ot Diplomm lro loorlly qualilicd fot the pnctlcr ot
Modicino, Su.gory ond Midwifery.

L DEAN
NARAYANA MEDICAL COLI.TGE
CHINTHAREDDYPALEM,
NELLOHE.524OO3.
:,ff{+fiEHffffl" ANDHRA PHADESH, INOIA.
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POST - GRADUATE MEDICAL DIPLOMA

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ffi{mil'H:r DEAN
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NELLORE.524OO3.
ANDHRA PFIADESH, INDIA,
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MASTER OE SURGERY
(M.S.)

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ANDHRA PRADESH MEDICAL COUNCTL

REGISTRATON OF ADDITIONAL QUALIFICATION
d;*u,ln lt. 3423 @o/"n.or.roo,

ril,* i k, -.,ty'i tl"ttlof//ou";ry Qart . la *,ftd /a / b rra "il da Voun,l

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17U7tAMC 12.05.'r987
an/ar .equt'r<rlrbnt\lb. Qob
VENKATESWARLU. R
o.,lt.nc
R. CHALAMAIAH CHOWDARY
&o//,or't n llrrn
07.01.1961 M
?:rrt" rf')A;ril EA
16'2-318 GANDHI NAGAR
' '
^1,/r/r/rrtt.
NEAR SUNDAY MARKET , POGATHOTA, NELLOIT:. 524 OOI

MBBS JAN - 1987

Prirr,rrry 2"a./y'ica/kru . ?,b
J1/r,ri*xr/,1 SRI VENKATESWARA UNIVERSTTY
.

M.S. ORTHOPAEDICS 1990

!2,,t/ &ru,/o,,/a, 1o/"

KASTURBA MED.COLLEGE, MANIPAL

r-,4ii,," n/"n1/",1n o,/,no 9P S. Goor,tu u &rrld.
Jllrri,*r,tr/y. MANGALORE UNIVERSITY

tl ME
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DEAN
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0ounoil, ,\\
uoUl MSBEA red mtt
* Hy d.
ELLOIiE 5 t003.
I
I I

MED ICAL COLLE

NARAY ANA DYP ALEM'
CHI NTH ARED
52 4003
N ELL OBE.
..,^!raA PBAD ES H. IN DIA
 E a
E]

ANDHRA PRADESH MEDICAL COUNCIL

E
Certificate of Renewal of Registration
(Section - 15C of A,P. Medlcal Practitaoners Reglstratlon (Amendment) Act, 20'13)
(See Rule - 6(13) of the Rutes)

SNo 00978

Name of the Doctor VENKATESWA,RLU. R

Fathe/s Name R. CHALAMAIAH CHOWDARY

Registration Number AMC17947

Date of registratlon 12 May 1987

Date of Blrth 07 Jan '1961

Date of Renewal of Reglstration l9 Jul 2019

Valid upto 18 Jul 202'l

Present Address H.NO: l6/4/316, GANOHI NAGAR,

NEAR SUNDAY MARKET, POGATHOTA
NELLORE Andhra Pradesh 52,f001

Reoistered Qualifi cation(s)

Qualiflcatlon Date of Reglstratlon

M,B.B.S 12 May 1987

DIPLOMA IN ORTHOPAED]CS 18 Feb 2009
M.S . ORTHOPAEDICS 18 Feb 2009

This is to certi! that the above mentioned doctor having complied with the requirements of
Section-l5C of Andhra Pradesh Medical Practitioners Registration Act, 1968 (as amended Act No.
I 0/2013) and the rules made thereun der his/her registration has been renewed for the period
1 1 1

Vljayawada
Dated: 19 Jul 20'19
6
KAH
ANoHRA pRADEf;itH0Ffi[FAL CO. UNCrL

* -{ififii;F'fiiffi-
t)Flw
N ABAA N A MEDICA L C 0 LLE
CH NTH F EDc P
uE
L ti
N t L L o t,' E rl0 3
AN D H E"AN

EDDYP ALE
C HINT HAB E-52 4003
NEL LOR D IA
n r'tOHflA irR
AOES H. IN
 f,UTNOOL MEDICAL COLLEGE,
XURNoOL - 5t8oo2 a. P. INDIA

STUDY & CONDUCT CERTIFICATB

rhir ir to cc'rify rhar p,.i:-I9EJIIiltr!----

-
thi! insrilution ia thc MBBS coursc from---
hss sturlied in
0CIoBERT 1980
ovBrt3ER, 85 lod passcd llOVISIBEA, 1985
thc Finrl MBBS Erominotlon hcld in

Hc/jllr h83 eomplctcd onc ycsr Intcrnsbip in thc arocirlcd

Covcrnm€nt Gcncral Hospital, Kurnool.

HislBr conduct during he pcriod of strldy wt.&tp{

Drtc :.21 .1 .1997 -l*1,

PzuNCIPAf
KURNOOL MEDICAL COLLEGE.

L
:"m'*k+s*" -N*iffi;*H:'
rerog.jrr, -KE,EHSEE' Tctophonc: 20060 udugi (pABX t0llncrl
THE KASTURBA MEDTCAL COLLEGE
(A UNIY OF T. M. A PAI FOUNOATION'
OR.
POST 8OX No.8

MANIPAL-5761'I9 KARNATAKA, INOIA

Ref; *.2!:!.:!ltt I
pr,SF ,Otr8lp|L0.ltll

thle ls to oartlfy that

Dr.Yentatesrarlu.S, rEB a boaaf,lds
Post-Saduute studoat ol tbls oollege
aad BaeseA the l{.S. (Orthopacitlos)
Eraalnatlon ooaduotcd by the tiangnlore
Ualverelty la Deoeraberr 199O.

ED

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Kasturba Medical College, Manipal
Acon dtl.ot co[.g. o, Laa.lpal Unm.llty

May 06,2010

CERTIFICATE

This rs lo certify that Dr R Venkateswarlu worked rn the Department of

Orthopaedics, Kasturba Medical College, Manipal in the following
capacrties:

Registrar '17/ 01, / lDt / 1997

to 3.1. / 03
Lrctu rer 0l / M / 7W1 to t 6 /
/ 7c)93
01
Assistant Professor 17 /01/1983toG3/10/1994

Duri the above perio4 his work, conduct and character were good.

*el$+'ffrmLfp..,To,
o',, o i,?i'i illo'o 3 tfl io,.,

Manf pal - 576 10,r, f\amstatr, hdia. Pbo.rc: 9i 620 Bn32S, nZZl4
? a\i 91 820 2571927 E-mall; olfic.. km@mai ip.t.cdu Wcb3it : wrtr msntpal.odu

NA$IAMr?B|UL coLucE
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ANDHBA PRADESH, INDIA.
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CHINIIIAREDDYPATEM, NELI.ORE - 524 OO3. A.P, INDIA
0 : 086'l -2317963,64, 68; Fox : 0861 -2317962
E-moil : noroyonomedicol@yohoo'com

Ref.No.NMCT/67312048 Date: "18.11.2008

PROGEEDINGS OF THE PRINCIPAL :: NI\RAYANA MEDICAL COLLEGE.

NELLORE

Present: Dr. P. Narasinrha Redey, M.D.,

Principal.

ORDER:

The Principal is pleased to promote Dr. R. Venkateswarlu, M.S., presently

working as Associate Professor of Orthopaedics, Narayana Medical College &
Hospital, Nellore as Professor in the depa{ment of Orthopaedics, Narayana
Medical College & Hospital, Nellore w.e.f., 18.1n.2008.

He is requested to report to the Profes:;or & HOD of Orthopaedics and the

HOD of Orthopaedics is requested to send the compliance of joining report of
Dr. R. Venkateswarlu, when he reported to the dr:partment.

PRINCIPAL
TXlNL',trAl
Noroyano Medrcol Lotteg.
ITELLoBE . 624 002

To,
Dr. R.Ven kateswarlu, M.S.,
Associate Professor of Orthopaedics,
Narayana Medical College & Hospital,
Nellore

Copy to:
The Medical Superintendent, NMCH, Nellore
The Coordinator, NMCH, Nellore
The Prof. & HOD, Dept. of Orthopaedics, NMCH, Nellore
The Finance Section, NMCH, Nellore DEAN
NARAYANA MEOICAL COI.LEGF
()tilNTHABEDDypALEttl.
NELLOHE.524OO3.
ANDHRA PRADESH, INDIA,
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TRACES
TDS R€ronciliation Analysis ard Correctjor Eoabling system
&
db

FORM NO. 16

tsce nile 3l(lXa)l

PART A
Certlflcate under Section 203 of the lDcome-tr! Act, 196l for tar deducted rt source on s.lrry

Certificrre No. AcwsQLA Lrst updrted on l4-Jul-2021

Nrm. rnd rdalress oflhe Employcr Nrme rnd rddress ofth€ Employec

NARAYANA EDUCATIONAL SOCIETY

I
I4l?2, HARNATHPURAM,
VENKATESWARLU RAPARLA
NELLOR.E - 524003
162.3I8, GANDHI NAGAR. NEAR SIJNDAY MARKET,
Andhra Pradesh
POCATHOTA, NELLORE - 524001 Andhra Pndcsh
+(91)86 l-2304624
vENKATAANILKUMARX@NARAYANACROUP.COM

Employe€ Rercretrc€ No.

PAN ofth€ Employe€
PAN ofthe Deductor TAN ofthe Deduclor provided by lh. f,mploy€r
(If rvdhble)

AAATN I672R HYDNO3OO8F ABKPR3825K

CIT (TDS) AssessmentYerr. Period ldith the Employ€r

From To
Tlc Connnissioner oflncomc Tax (TDS)
Roon No. 4l l, lncome Tax Towe$, lG2-3 A.C. Cuard, 2021-22 0l -Apr-2020 3l -Dec-2020
Hyderabad - 5000M

Summrry ofamount prid/credi(ed rod t3x deductcd rt source thercon ln resp€ca ofthe employec

Receipt Numberu of orlgtr.l

qurrterly st.teEetrts of TDS Amount of lrt deducted
AEoutrt of tu dcpo.ll.d / remltted
Qurrte(,
. (Rs)
under ruEsectlon (3) of (RsJ
Sectloo 200

Q1 QUFMUCTA 170064.48 49100.00 49100.00

Q2 QUHCZDNC t72t28.00 50800.00 50800.00

Q3 QULQGAHG t72t28.96 50u00.00 50800.00

Q4 QULPIA}IA 360000.00 108000.00 108000.00

Torrl (Rs.) 871321,44 25E700.00 258700.00

I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENIRAL GO}'ERNMf,,NT ACCOUNT THROUGH BOOX ADJUSTMENT
(The deductor to provide payment wise details oftax deductcd and deposited with resp€ct to the deduct€e)

Book Id€ntificrtion Number (BlN)

Td Deposited in respect ofthe
Sl, No. deducte€ Dale of transfer Youcher Strtus of malching
Receipt Number' ofForm DDO serirl number itr Form no,
(Rr.) (dd/mm/yyly) rrith Form Do. 24G
No. 24G 24G

Total (Rs.)
II. DETAILS OF TAX DEDUCTEDAND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT TIIROUGH CIIALLAN
CIt€ deductor to provide payment wise details oflax deducted and deposiled wit}I respect to the deducte€)

Challrn ldcntincition Number (CrN)

TrI Deposit.d in rerpect ofthe
Sl. No. deductee
(Rs.) BSR Cod. oflhe B.nk Dr(€ on rYhich Trr dcposited Chllrn Serial Numb€r Strtus ofm.tchitrg nith
Brrnch (d'Ynm/yyyy) OLTAS'

I 17500.00 6190340 23-tU2020 03441 F

2 17500.00 6190340 23-tG2020 0t44t F

3 r5800.00 6390340 04-t l-2020 0229t F

4 17500.00 6190340 04-11-2020 02291 F

PaSe I of2
 c.nili..r. Nrot r: ac1lSQL IA\ of f,oplo!..: Ill'DNlr.rl|o8F PAN oI Ef,plo!6: ABKPn3825X atE!m.!r Y.r4 2021-!2

Challar ldentificalion Number (ClN)

Tax Deposited h resp€ct ofthe
Sl. No. d€duclee
(Rs.) BSR Code ofthe Bank D.te or which Trx d€posited ChaUrn Scrirl Number Statui of m.tching rYilh
Brrnch (d'vmn/yyyy) OLTAST

5 15800.00 6390140 04-11-2020 02289 F

15800.00 63903.{0 17-tt-2020 02473 F

'7 I7500.00 6390340 07-12-2020 91324 F

8 15800.00 6390340 o7-0)-2021 78324 F

9 17500.00 6390340 07-0t-2021 78324 F

l0 36000.00 6390340 06-02-2021 19589 F

ll 16000.00 6390340 06-03-2021 43967 F

t2 36000.00 6390140 3r-03-2021 39999 F

'I ot!l (Rs.) 258700.00

V€rlflcalion

r, KOI&IIIABA-BA0-BAEIIBL ion / d.r8ir.r of R^Plrev AIltrlsFsF^lAH *orll.g l! ti. .rprcity of SECBEI-ABI (d..i8D.aior) do h.reby ccrttfy tbrl r .rD ol
R'.2$20!.00tR!.@(ln?o]d.)lh..b..nded!ct.di!d.!uEo'Rr.25u0!JoIR..TwoIrkhFllryrl8hr

correct rld tu bried on tlc book of...ounl, docuE.rtr, TDS sa.t![l.rlt, TDS d.porli.d trd ot[.. .vdhbl. r.cord..

Place NELLORE

Dstc l9-Jul-2021 (Signrture.of person r€sponsible for deduction of Tax)

Dcsign,rtion: SECRETARY Full Nsme:KOTESW

I. Pan a (Anrexurc) of the c..tificrte in Form No.l6 shrll b. isued by lhe employer.

of l&r deduclcd ed dep6itld for all the qu.ne6 of thc finmci.l yc.r.

csgs *4.mploy.d wilh €.cb of the.mploye6. P.n B (Amenli.) of&€ crniricar. i! Fom No. 16 may b. isud by €acb oflh..mplry.6 or rh. l$t .nployer a. th€ optim of th. scac-
4. To up&tc PAN &tails in lncoEe Tu D.psrttncrt .lar.b.s., .pply for ?AN .iangc llqu.st' 6rou8h NSDL or UTITSL.

Legend used In Form 16

I Strtu8 ofmstching with OLTAS

Etil
Dcduclors hrvc nor dcposired las or hav. tumish.d inconlcl paniculur ofbx payrffr Firat crcdir will bc rcflcc.ien o y whd palbdt
U
.lclails i! bant Erch wirh.l€raih of&posit in TDS / TCS dlcmcnr

P
Provirion l lar credn is .fidt d otrly fo. TDS / TCS Snrmcors ,ilod by Cov.rDD€ d.dutoB..p. sratu! will b€ cheged to FiEt (F) otr

ln ca of non-gov.lme d.ducrds, p3lmenl &bils ofTDS / TCS deposit€d in b6DL by d.dudor h.v. mnched wilh th. payoent det ih
f mcndoncd i, lhc TDS / TCS strtemetrt filcd by tbc dcduclo$. ID qs. ofSovemment dedu.lors, d.bils ofTDS / TCS t'ootcd iD covl:|mot
...ou.t havc becn vsifi€d by Pay & Accounb Officcr (PAO)
Paymml ddaih of TDS / TCS deposited in bank by dcducto. h3vc m.arched wil} det ils mentioned in th. TDS / TCS st rement but the
o smount is ovcr chimcd in lhc st{muL Final (F) €redi! eill bc rcflccr€d only whcn d.ductor rcduccs claimcd mounr i. the srabmerr or
malc. ncw psym.nt for cxces! amount claim.d in rhc 6brcmcnr

Sionature Not Verified

o.ir" *."d]'nJ
KdTESWARA 960 RAPURY
Dare: 2o21.orls 17:05:02
IST J
P^se 2. ot2
 NARAYANA EDUCATIONAL SOCIETY
PAN ofthe Deductor: AAATN1672R TAN ofthe Deductor: HYDN03008F
PAN ofthe Financial Assessement
Name ofthe Employee
Employee Year Year
DR VENKATESWARLU.R ABKPR3825K 2020-21 2027-22
FORM 16-PART B (AnnGxure)
Details ofSalarv pald and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisionscortained in sec- 17(1) 8,7 4,322
[b] value ofperquisites u/s 17(2) (as per Form No.12BA, wherever
applicable)
(c) Profits in lieu ofsalary under section 17[3xas per Form No.12BA,
wherever applicable)
(d) Total Salary 4,7 4,322
2. Lessi Allowances to the extent exempt under sedion 10
3. Total amount ofsalary received ftom current employer [1(e)-z(d)] 4,74,322
4. Deductions under section 16
(a) Standard deducuon under section 16(ia) s0.000
(b) Entertainment allowances urder section 16(ii)
(c) Tax on employment undersection 16(iii) 2,400
5. Total amount ofdeductions under section 15 [4(a)+4O)+4(c)] 400
6, lncome chargeable under the head 'salaries' [3-5) 4,2L,922
7. Add: Any other income reported by employee under sec 192 (2b)
(a) Income (or admissible loss) from house property
reported by employee offered for TDS - u/s 24[b)
(b) lncome under the head other sources offered for TDS
B. Total amount ofother income reported by the employee [7(a)+7(b)]
9. Gross total income (6+8) 8,27,922
Gross Deductible
Amount Amount
10. Deductions under chapterVlA
(a) Deduction in respect oflife insurance premia, contributions to
provident fund etc. under section 80C
O) Deduction in respect ofcontribution to certaio pension funds under
section 80CCC
(c) Deduction in resped ofconEibution by taxpayer to pension scheme
under section 80CCD (1)
(d) Total deduction under section 80C,80CCC and 80CCD(1)
(e) Deductions in respect ofamoult paid/deposited to notined pension
scheme under section 80CCD [18)
(0 Deduction in respect ofhealti insurance premia under section 80D
(Self/family & ParensJ
(g) Deduction in respect ofinterest on loan taken for higher education
under section 80E
(h) Total Deduction in respect ofdonations to certain funds, charitable
institutions, etc under sectiol 80G
(i) Deduction ln respect ofinterest on deposits in savings account under
0) Amount deductible under any other provision(s) of Chapter VI-A
11. Aggregate ofdeductible amount under Chapter VI-A
12. Total Income (9-11) 4,21,922
13. Tax on Total lncome 7 6,A84
14. Health & Cess @ 4016 (on tax at S. No. 13) 3,075
15. Tax liability (13+14) 79,960
16. Less : TDS 2,5A.700
17. Tax payable/fRetund)[15-16) (L7A,740)
VERIFICATION
I, KoTESWARA RAO RAPURY- son/daughter of B/IEIJBI AUDISESHAIAH working in the capacity of AIIIIQBIZED
slcNAToRY(desiqnationl do hereby certify that the information given above is true.
Place: Hyderabad
Datet 3l /07 /2021 [Sisnature ofperson responsible for deduction of tax)
Desisnation: AUTHoRIzED SIGNAToRY Futl Name: KOTESWARA RAO RAPURY
Oe.rrEr c..ri!al b,

RAPURY
Date: 202 l7:04:16
IST

W
DEAN
NARAYANA MEDICAL COLIEGE
CHINTHAFEDDVPALEM,
NELLOiTE t2 ''1',.-1:i

ANDHRA pRnr_r F- :t i. :, i I I DlA.

 NARAYANA EDUCATIONAL SOCIETY

Pay Slip for th6 Month of Aptil - 2022

( turount! ir INR )

Name DR VENKATESI,IARLU. R Emp No 648-00043

Department ORTITOPAEDICS
ESI NO 0
Designat ion PROFESSOR
PAN NO ABKPR382 5K
Gross salary 120,000.00

Tota1 Nunrlcer of Days : 30 Paid Number of Days: 30

Earni.ngs Deductions

Basic Salary 42.000.00 PF Contribution 0 .00

House Rent Al lowance 16,800.00 Professional Tax 200.00
Transport Allowance 3, 600.00 Income Tax 36,000.00
0.00
LTA 18, 000 . 00

Medical All-owance 6,000.00 salary Advance 0-00

Food Al lowance 9, 600 .00 Phone 0.00

Personal Allowance 5,000.00 GMC 0 .00

EducaLion Allowance 2,400.00 Food Coupons 0.00

Monthly performance 15. 600.00 Misc.Amount 0 .00

120,000.00 36,200.00

t Net Pay Rs. Eighty-Three Thousand Eight Hundred only 83,800.00 I

cenerated on .: 0910612022
 NARAYANA EOUCATIONAL SOCIETY

Pay Slip foa Cbe ltoneh of May - 2022

( Amounta in INR )

Name DR VENKATESWARLU. R Emp No 648-00043

Department ORTTIOPAEDICS
ESI NO 0

Designatj.on PROFESSOR
PAN NO ABKPR3825K
Gxoss Salarv 120,000.00

Total Nurdcer of Days:31 Paid Nurnber of Days: 31

Earnings Deduct,ions

Basic salary 42,000.00 PF Contribution 0.00

House Rent AIlowance 16, 800 . 00 Professional Tax 200.00
Transport AlIowance 3,600.00 Income Tax 35,000.00
0.00
LTA 18,000.00 ESI
Medical Aflowance 6,000.00 Salary Advance 0 .00

Food AI lowance 9, 600.00 Phone 0.00

Personal- Allowance 6,000.00 GMC 0.00

Education AILolrance 2 t 400 .00 Food Coupons 0-00

Monlhly performance 15.600.00 Mi sc . Amount 0.00

120.000.00 36,200.00
Net Pay Rs. Eighty-Three Thousand Eight Hundred only 83,800.00
)

Generated on | 0910612022