Amit Kumar Verma

FORM NO. 16
[ See rule 31(1) (a) ] "TEST COPY"

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 State Bank of India Name and designation of the Employee Mr/Ms: Amit Kumar Verma Desig.: Branch Manager Emp #:00298040

PAN No. of the Deductor AAACS8577K

TAN No. of the Deductor MUMS63193E

PAN No. of the Employee ADEPV4880G Period Assessment year

Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDL web-site Quarter 1 (April - June) 2 (July - September) 3 (October - December) 4 (January - March) Acknowledgement No. 060640400262245 060640400285010 060640200652393 From 01.04.2011

To 31.03.2012 2012-2013

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
Particulars 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 2. Less: Allowance to the extent exempt under section 10 3. Balance(1-2) 4. DEDUCTIONS: (a) Entertainment allowance (b) Tax on Employment 5. Aggregate of 4 (a) and (b) 6. INCOME CHARGEABLE UNDER THE HEAD "SALARIES"(3-5) 7. Add: Any other Income reported by the employee Deductions u/s 24 - Interest 8. GROSS TOTAL INCOME (6+7) 9. DEDUCTIONS UNDER CHAPTER VIA (A) sections 80C, 80CCC and 80CCD (a) section 80C i) Employeee Provident Fund 31555.00 ii) Payment towards Life Insurance Policy 4752.00 iii) Contribution to Public Provident Fund 70000.00 iv) Repayment of Housing loan 127900.00 v) Tuition fee - child 1 12000.00 (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, Gross amount Deductible amount -100000.00 474466.62 INR INR INR

574466.62 0.00 0.00 574466.62 0.00 574466.62 0.00 0.00 0.00 574466.62 -100000.00

246207.00 0.00 0.00

100000.00 0.00 0.00

Amit Kumar Verma

80CCC and 80CCD, shall not exceed one lakh rupees (B) other sections (for e.g., 80E, 80G etc.) under Chapter VIA (a) 80C(01) 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) 15. Tax payable (12+13+14) 16. Relief under section 89 (attach details) 17. Tax payable (15-16) 18. Less:

246207.00

100000.00

100000.00 100000.00 374470.00 19447.00 0.00 583.00 20030.00 0.00 20030.00 20030.00 0.00 0.00 20030.00 0.00

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) c) Tax deposited under different TAN 19. Tax payable / refundable (17-18)

Amit Kumar Verma

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

AMOUNT RS. DATE&CHALLAN NO. NAME OF THE BANK & BRANCH WHERE TAX DEPOSITED SBI FOCAL POINT BRANCH BANGALORE BSR CODE

20030.00 0.00

06/05/2011(04542) 06/06/2011(12256) 06/07/2011(27003) 03/08/2011(07013) 06/09/2011(13968) 02/11/2011(07522) 03/12/2011(13003) 04/01/2012(02671)

4329

I son/daughter of working in the capacity do hereby certify that, a sum of INR 20030.00 [TWENTY THOUSAND THIRTY Rupees] has been deducted at source and paid to the credit of the Central Government. A sum of 0.00 [NIL] has been paid by the Bank behalf of the employee u/s 192(1A) on perquisite u/s 17(2). Place: Date: 31.03.2012 ___________________________________________ Signature of the person responsible for deduction of tax for State Bank of India/SBI Employees Pension Fund Full Name: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 : State Bank of India 2) TAN: MUMS63193E 3) TDS Assesment Range of the employer : ,,,, 4) Name, designation and PAN of employee : Mr/Ms: Amit Kumar Verma , Desig.: Branch Manager , Emp #: 00298040 , PAN: ADEPV4880G 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 : 574466.62 (other than from perquisites) 7) Financial year : 2011-2012 8) Valuation of Perquisites S.No (1) 1 2 3 Nature of perquisite (see rule 3) (2) Accommodation/Furniture Cars/Conveyance Sweeper, gardener, watchman, personal attendant or Casual Labour Gas, electricity, water Interest free or concessional loans Holiday expenses Free or concessional travel Free meals Free Education Gifts, vouchers, etc. Credit card expenses Club expenses Use of movable assets by employees Transfer of assets to employees Value of any other benefit /amenity/service/privilege Stock options ( non-qualified options ) Other benefits or amenities Cleansing material News Paper Entertainment Perquisite tax along with grossing borne by bank Total value of perquisites Total value of profits in lieu of salary as per section 17 (3) Value of perquisite as per rules (INR) (3) 771.00 0.00 0.00 Amount, if any, recovered from the employee (INR) (4) 771.00 0.00 0.00 Amount of perquisite chargeable to tax(INR) Col(3)-Col(4) (5) 0.00 0.00 0.00

4 5 6 7 8 9 10 11 12 13 14 15

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

16 17 a) b) c) d)

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

18 19

771.00

771.00

0.00

9. Details of tax, (a) Tax deducted from salary of the employee under section 192(1) 20030.00 (b) Tax paid by employer on behalf of the employee under section192(1A) 0.00 (c) Tax deposited under different TAN 0.00 (d) Total tax paid 20030.00 (e) Date of payment into Government treasury * * Refer to page 3 of form 16 under Details of tax deducted and deposited into Central Government Account.

Note:1)The Perquisite Value of the Concessional / Interest free loans has not been taken into consideration while calculating Income Tax as per the Interim Injunction of Hon#ble High Court of Madras vide writ petitions Nos.6266/2010, 6388/2010, 6380/2010 and 6426/2010 filed by All India State Bank Officers Federation, SBI Officers Association (ChennaiCircle) , All India State Bank of India Staff Federation and State Bank#s Staff Union respectively. 2)Scholarship of 2 Children of employee not considered as Perquisite(161 ITR 544) Bombay. 3)Club admission & Annual subscription INR 0.00 incurred for official purpose not included.

DECLARATION BY EMPLOYER
I son/daughter of working as do hereby declare on behalf of State Bank of India ( 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. Signature of the person responsible for deduction of tax Full Name : Designation :

Place: Date : 31.03.2012