Form No.

16
Certificate under section 203 of the Income Tax Act. 1961 for deducted at
source from the income Chargeable under the Head Salaries.
Name and Address of the Employer
Dr. O.P. Sharma
Director, Higher Education , H.P.

Name and Designation of the

Employee

PAN No.
TAN NO. PTLR. 11993C
Period: 2011-12
TDS circle where annual
Assessment year: 2012-13
return/statement under section 206
is to be filed:- Shimla
Detail of the salary paid and any other income and tax deducted:1. Gross salary (including taxable allowances and arrears if any)
Rs.
2. Less Allowance to the extent under section 10
i.

HCA
Rs..

ii.

HRA
Rs..

3. Under section 24(a) HBA interest

Rs..
4. Balance (1-3)
Rs..

Total

5. Other Income reported by the Employee

Rs
6. Gross Total Income (4+5)
Rs..
7. Less deduction under section 80G
Rs..
(Contribution to PM/CM relief fund) 100%)
8. Net Income (6-7)
Rs
9. Rebate and relief (section 80C)

Rs
a. GPF contribution Rs.
b. GIS deduction

Rs.

c. LIC/PLI deduction Rs.

d. PPF deduction
e. HBA

Rs
Rs..

f. LIC Mutual Fund Rs..

g. Other invest. /Pension Scheme, specify Rs..

Total (a to g)

Rs

Qualifying amount

Rs.1, 00,000/-

10.

Taxable Income
Rs.

11.

Income Tax up to Rs.1,80,000/-(for womenRs.1,90,000/-)

NIL

12.
Rs.1, 80,000/-(for womenRs.1, 90,000/-) to Rs.5,00,000/-@10%=
Rs
13.
Rs.5, 00,001/- to 8, 00,000/- @ 20%
=Rs..
14.
Rs. 8, 00,001/- and above @ 30%
=Rs..
15.
Income Tax
=Rs..
16.
Education cess @ 3%
=Rs..
17.
Total Income Tax
=Rs.
18.
Less Tax deducted at source
=Rs
19.
Tax Payable/Refundable
=Rs..

Certified that a sum of Rs. (Rs..

only )has been deducted from the individual for the months of
March/2011 to Feb./2012 as Income Tax payable to the Govt. Certified that the
above information is true and correct as per record.

Signature of officer/official
responsible

Signature of the person

for deduction of the tax

Station: Shimla
Dated: