FORM NO.

16
[ See rule 31(1) (a) ]

"NON-ORIGINAL"

Certificate under section 203 of the Income-tax Act, 1961,

for tax deducted at source from income chargeable under the head "Salaries"
Name and address of the Employer

Name and designation of the Employee

Mr/Ms: yadav ramseh
Desig.: HR EXECUTIVE II
Emp #:00000029

PAN/GIR NO.
KA001/27277

PAN/GIR NO.
AAAAA9999A

TAN
S-0002-AS(1234)

TDS Circle where Annual Return / Statement

under Section 206 is to be filed

Period
From
09.04.2008

Assessment
year
To
31.03.2009

2009-2010

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
Particulars

Rs.

1. Gross salary
a) Salary as per provisions contained in section 17(1)
b) Value of perquisites under section 17(2)
( as per Form No.12BA wherever applicable )
c) Profits in lieu of salary under section 17(3)
( as per Form No.12BA wherever applicable )
d) Total

Rs.

135733.33
0.00
0.00
135733.33

2. Less: Allowance to the extent exempt under section 10

3. Balance(1-2)
4. DEDUCTIONS:
(a) Entertainment allowance
(b) Tax on Employment

Rs.

11733.33
124000.00
0.00
0.00

5. Aggregate of 4 (a) to (b)

0.00

6. INCOME CHARGEABLE UNDER THE HEAD "SALARIES"(3-5)

124000.00

7. Add: Any other Income reported by the employee

0.00

8. GROSS TOTAL INCOME (6+7)

9. DEDUCTIONS UNDER CHAPTER VIA
(A) sections 80C, 80CCC and 80CCD
(a) section 80C
i) Employeee Provident Fund
8448.00
(b) section 80CCC
(c) section 80CCD
Note : 1. aggregate amount deductible under section 80C shall not
exceed one lakh rupees
2. aggregate amount deductible under the three sections, i.e, 80C,
80CCC and 80CCD, shall not exceed one lakh rupees
(B) other sections (for e.g., 80E, 80G etc.) under Chapter VIA
(a) 80C(01)
8448.00
10. Aggregate of deductible amount under Chapter VI-A
11. Total income (8-10)
12. Tax on total income
13. Surcharge (on tax computed at S.No.12 )
14. Education cess (on tax at S.No.12 and surcharge at S.No.13)

124000.00
Gross amount

Deductible amount

0.00
0.00

0.00
0.00

8448.00

8448.00
8448.00
115550.00
555.00
0.00
11.00

15. Tax payable (12+13+14)

16. Relief under section 89 (attach details)

572.00
0.00

17. Tax payable (15-16)

18. Less:

a) Tax deducted at source u/s 192(1)

b) Tax paid by the employer on behalf of the employee
u/s 192(1A) on perquisites u/s 17(2)
19. Tax payable / refundable (17-18)

572.00
52.00
0.00

52.00
520.00

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

Sl.
No.

TDS
Rs.

Surcharge
Rs.

Education
Cess
Rs.

Total Tax
deposited
Rs.

Cheque /DD No. BSR Code of

(if any)
Bank Branch

Date on which Transfer

Tax deposited voucher/Challan
(dd/mm/yy)
Identification No.

_______________________________________________________________________________________________________________________________________________________________

I, SINGAL, son/daughter of working in the capacity of do hereby certify that

a sum of Rs 52.00 [ Rupees FIFTY TWO ONLY ]
has been deducted at source and paid to the credit of the Central Government. I further certify that the information given
above is true and correct based on the books of account, documents and other available records.

Place: GHAZIABAD (U.P)

Date: 30.04.2008

______________________________________________
Signature of the person responsible for deduction of tax
for
Full name: SINGAL
Designation:

Annexure to Form No.16

Name: yadav ramseh

Emp No.: 00000029

Particulars

Amount(Rs.)

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Emoluments paid
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Basic Salary
Conveyance Allowance
House Rent Allowance
Uniform Allowance

10400.00
2253.33
6000.00
1200.00

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Perks
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Gross emoluments

135733.33

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Income from other sources

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Total income from other sources

0.00

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Exemptions u/s 10
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

HRA Exemption

11733.33

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Total Exemption

Date: 30.04.2008
Place: GHAZIABAD (U.P)

11733.33

Full Name: SINGAL

Designation:

FORM No.12BA
{See Rule 26A(2)(b)}
Statement showing particulars of perquisites , other fringe
benefits or amenities and profits in lieu of salary with value thereof
1) Name and address of employer :
, - ,
2) TAN: S-0002-AS(1234)
3) TDS Assesment Range of the employer :
,,,,
4) Name, designation and PAN of employee :
Mr/Ms: yadav ramseh , Desig.: HR EXECUTIVE II , Emp #: 00000029 , PAN: AAAAA9999A
5) Is the employee a director or a person with substantial interest in
the company (where the employer is a company):
6) Income under the head "Salaries" of the employee :
124000.00
(other than from perquisites)
7) Financial year :
2008-2009
8) Valuation of Perquisites
S.No
(1)

Nature of perquisite
(see rule 3)
(2)

Value of perquisite
as per rules (Rs.)
(3)

Amount, if any, recovered

from the employee (Rs.)
(4)

Amount of perquisite
chargeable to tax(Rs.)
(5) Col(3)-Col(4)

Accommodation

0.00

0.00

0.00

Cars/Other automotive

0.00

0.00

0.00

Sweeper, gardener, watchman or

personal attendant

0.00

0.00

0.00

Gas, electricity, water

Interest free or concessional loans

0.00

0.00

0.00

Holiday expenses

Free or concessional travel

Free meals

Free Education

10

Gifts, vouchers, etc.

11

Credit card expenses

12

Club expenses

13

Use of movable assets by employees

0.00

0.00

0.00

14

Transfer of assets to employees

15

Value of any other benefit

/amenity/service/privilege

16

Stock options ( non-qualified options )

17

Other benefits or amenities

18

Total value of perquisites

0.00

0.00

0.00

19

Total value of profits in lieu of salary

as per section 17 (3)

9. Details of tax, (a) Tax deducted from salary of the employee u/s 192(1)
52.00
(b) Tax paid by employer on behalf of the employee u/s 192(1A)
0.00
(c) Total tax paid
52.00
(d) Date of payment into Government treasury
*
* Refer to page 3 of form 16 under Details of tax deducted and deposited into Central Government Account.

DECLARATION BY EMPLOYER
I, SINGAL son/daughter of working as (designation ) do hereby declare on behalf of ( name of the employer ) that the information given
above is based on the books of account, documents and other relevant records or information available with us and the details of value of each
such perquisite are in accordance with section 17 and rules framed there under and that such information is true and correct.

Place: GHAZIABAD (U.P)

Date : 30.04.2008

Signature of the person responsible

for deduction of tax
Full Name : SINGAL
Designation :

FORM No.12BA
{See Rule 26A(2)(b)}
Statement showing particulars of perquisites , other fringe
benefits or amenities and profits in lieu of salary with value thereof
1) Name and address of employer :
, - ,
2) TAN: S-0002-AS(1234)
3) TDS Assesment Range of the employer :
,,,,
4) Name, designation and PAN of employee :
Mr/Ms: yadav ramseh , Desig.: HR EXECUTIVE II , Emp #: 00000029 , PAN: AAAAA9999A
5) Is the employee a director or a person with substantial interest in
the company (where the employer is a company):
6) Income under the head "Salaries" of the employee :
124000.00
(other than from perquisites)
7) Financial year :
2008-2009
8) Valuation of Perquisites
S.No
(1)

Nature of perquisite
(see rule 3)
(2)

Accommodation

Cars/Other automotive

Sweeper, gardener, watchman or

personal attendant

Gas, electricity, water

Interest free or concessional loans

Holiday expenses

Free or concessional travel

Free meals

Free Education

10

Gifts, vouchers, etc.

11

Credit card expenses

12

Club expenses

13

Use of movable assets by employees

14

Transfer of assets to employees

15

Value of any other benefit

/amenity/service/privilege

16

Stock options ( non-qualified options )

17

Other benefits or amenities

18

Total value of perquisites

19

Total value of profits in lieu of salary

as per section 17 (3)

Value of perquisite
as per rules (Rs.)
(3)

Amount, if any, recovered

from the employee (Rs.)
(4)

Amount of perquisite
chargeable to tax(Rs.)
(5) Col(3)-Col(4)

9. Details of tax, (a) Tax deducted from salary of the employee u/s 192(1)
52.00
(b) Tax paid by employer on behalf of the employee u/s 192(1A)
0.00
(c) Total tax paid
52.00
(d) Date of payment into Government treasury
*
* Refer to page 3 of form 16 under Details of tax deducted and deposited into Central Government Account.

DECLARATION BY EMPLOYER
I, SINGAL son/daughter of working as (designation ) do hereby declare on behalf of ( name of the employer ) that the information given
above is based on the books of account, documents and other relevant records or information available with us and the details of value of each
such perquisite are in accordance with section 17 and rules framed there under and that such information is true and correct.

Place: GHAZIABAD (U.P)

Date : 30.04.2008

Signature of the person responsible

for deduction of tax
Full Name : SINGAL
Designation :