You are on page 1of 4

FORM 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 Name and designation of the Employee Name and address of the Employer INDIAN OVERSEAS BANK A CHELLATHURAI 90 PETERS ROAD Roll No 25250 ROYAPETTAH CHENNAI 600014 PAN of the Deductor PAN of the Employee TAN of the Deductor AAACI1223J CHEI00209S CIT (TDS) Period Assessment Year Address: From To 2011-2012 01.04.2010 31.03.2011 City: Pincode: Summary of tax deducted at source Amount of tax Amount of tax Receipt Numbers of original statements of TDS deposited/remitt Quarter deducted in respect under sub-section (3) of section 200 ed in respect of of the employee the employee Quarter 1 10,800 10,800 Quarter 2 Quarter 3 Quarter 4 14,425 14,425 25,225 25,225 Total PART B (Refer Note 1) Details of Salary Paid and any other income and tax deducted Rs. Rs. Rs. 1. Gross Salary (a) Salary as per provisions contained in sec. 17(1) 523,031
(b) Value of perquisites u/s 17(2) (as per Form No. 12BB, wherever applicable) (c) Profits in lieu of salary under section 17(3)(as per Form No. 12BB, wherever applicable (d) Total

523,031

2. Less: Allowance to the extent exempt U/s 10 Allowance Rs. HRA 21549 Conveyance 0 21,549 3. Balance (1-2) 4. Deductions : (a) Entertainment allowance (b) Tax on employment 5. Aggregate of 4(a) and (b) 6. Income chargebale under the head 'Salaries' (3-5) 7. Add: Any other income reported by the employee Income Rs. Loss on house property -7612 8. Gross Total income (6+7) 7,612 491,674 ..2 501,482

2,196 2,196 499,286

www.taxguru.in

:: 2 :: 9. Deductions under Chapter VI A (A) sections 80C, 80CCC and 80CCD (a) Section 80 C (i) Providend Fund (ii) Housing Loan Repayment (iii) Life Insurance Premium (iv) Children Education (v) PPF (vi) NSC (vii) (viii) Infra Bonds (b) section 80 CCC (c) section 80 CCD
Note: 1. Aggregate amount deductible under section 80 C shall not exceed one lakh rupees. 2. Aggregate amount deductible under the three sections, i.e. 80C,80CCC,80CCD shall not exceed one lakh rupees.

Gross Amount Deductible Amount 46,208 46,208 10,000 10,000 6,564 6,564 24,000 24,000 86,772 86,772

(B) other sections (e.g. 80E,80G etc.) under Chapter VI-A Gross Amount

Qualifying AmountDeductible Amount -

(i) section (ii) section (iii) section (iv) section (v) section

80 D

10. Aggregate of deductible amount under Chapter VI A

86,772 404,902 24,490 735 25,225

11. Total Income (8-10) 12. Tax on total income


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

14. Tax Payable (12+13) 15. Less: Relief under section 89 (attach details) 16. Tax Payable (14-15)

25,225 Verification I, ------------------------, son / daughter of -------------------- working in the capacity of ---------------------(designation) do hereby certify that a sum of Rs.------------ [Rs. ----------------------------------- (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 31.05.2011 Designation: Signature of person responsible for deduction of tax Full Name: CHENNAI

www.taxguru.in

ANNEXURE - A
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)

S.No.

Tax Deposited in respect of the employee (Rs.)

Book identification number (BIN)


Receipt numbers of Form No.24 G

DDO Sequence Number in the Book Adjustment Mini Statement

Date on which tax deposited (dd/mm/yyyy)

Total

www.taxguru.in

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)

S.No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total

Tax Deposited in respect of the 7,800 3,000 14,425 25,225

Challan identification number (CIN)


BSR Code of tbe Bank Branch Date on which tax deposited (dd/mm/yyyy) Challan Serial Number

0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 2 2 2 2 2 2 2 2 2 2 2 2 2

7 7 7 7 7 7 7 7 7 7 7 7 7 7

0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 3 3 3 3 3 3 3 3 3 3 3 3 3

3 3 3 3 3 3 3 3 3 3 3 3 3 3

1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 3 2 2 2 2 2 2 2 0 2 2 2

8 9 1 7 4 7 9 2 8 6 2 8 6 9

0 0 0 0 0 1 1 1 0 0 0 0 0 0

6 6 7 9 9 0 1 2 1 2 4 6 2 4

2 2 2 2 2 2 2 2 2 2 2 2 2 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1

0 0 0 0 0 0 0 0 1 1 1 0 1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 1 0 0 0 0 0 0 0 0 0 0 0 1

4 2 6 1 2 1 1 1 2 2 1 2 5 5

www.taxguru.in