Form No. 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 address of Employer

Name & Designation of Employee

EmployerName

EmployerAddress

lblEmployeeName

EmployeeDesignation

PAN of the Deductor	TAN of the Deductor
PAN Deductor	TAN Deductor

PAN of the Employee
PAN

CIT (TDS)

Address

CITAddress

City

CITCity

Pin Code

CITPinCode

Assessment Year

Period

2016-17

From	To
01/04/2015	31/03/2016

Summary of tax deducted at source

Quarter

Receipt Number of original statements of TDS under sub-section (3) of section 200

Amount of tax deducted in respect of the employee

Amount of tax deposited remitted in respect of the employee

To be Downloaded from Traces Portal

www.tdscpc.gov.in

PART B (Refer Note 1)

Details of Salary paid and any other income and tax deducted

1. Gross Salary
(a) Salary as per provisions contained in section 17(1)	Rs. 0.00
(b) Value of perquisites u/s 17(2)(as per Form No. 12BA, wherever applicable)	Rs. 0.00
(c) Profits in lieu of salary under section 17(3) (as per Form No. 12BA, wherever applicable)	Rs. 0.00
(d) Total		Rs. 0.00

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

Rs. 0.00

Rs.

1	Rs. 0.00	Rs. 0.00	Rs. 0.00
2	Rs. 0.00	Rs. 0.00	Rs. 0.00
3	Rs. 0.00	Rs. 0.00	Rs. 0.00
4	Rs. 0.00	Rs. 0.00	Rs. 0.00
5	Rs. 0.00	Rs. 0.00	Rs. 0.00
			Rs. 0.00

3. Balance (1-2)

Rs. 0.00

4. Deductions:
(a) Standard Deduction	Rs. 0.00
(b) Entertainment Allowance	Rs. 0.00
(c) Tax on Employment	Rs. 0.00

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

Rs. 0.00

6. Income chargeable under the head "Salaries" (3-5)

Rs. 0.00

7. Add: Any other income reported by the employee
(a) From House property	Rs. 0.00
(b) From other sources	Rs. 0.00
(c) Others	Rs. 0.00

Rs. 0.00

8. Gross Total Income (6 + 7)

Rs. 0.00

9. Deduction under Chapter VI-A

(A) Sections 80C, 80CCC and 80CCD

(a) Section 80C

Gross Amount

Deductible Amount


	Rs. 0.00	Rs. 0.00
(b) Section 80CCC	Rs. 0.00	Rs. 0.00
(c) Section 80CCD	Rs. 0.00	Rs. 0.00

Note : 1. Aggregate amount deductible under section 80C shall not exceed one lakh fifty thousand rupees

2. Aggregate amount deductible under the three sections. i.e. 80C, 80CCC, 80CCD, shall not exceed one lakh fifty thousand rupees

(B) Other sections (e.g. 80E, 80G etc.) under chapter VI-A

Gross Amount

Qualifying Amount

Deductible Amount

Aggregate of Other sections (e.g. 80E, 80G etc.) under chapter VI-A				0.00
10. Aggregate of deductible amounts under chapter VIA				0.00
11. Total Income (8 -10)				0.00
12. Tax on Total Income				0.00
13. Relief u/s 87A				0.00
14. Tax after relief				0.00
15. Education cess @ 4% (on tax computed at S. No. 12)				0.00
16. Tax Payable ( 14+15)				0.00
17. Less: Relief under section 89 (attach details)				0.00
18. Tax payable (16-17)				0.00

Verification

I, MANOJ VEYYAT Son/Daughter of RAMA KRISHNAN working in the capacity of ACCOUNTS (designation) do hereby certify that a sum of Rs. 8,000.00 (In Words) Eight Thousand has been deducted and deposited to the credit of the Central Government. I further certify that the information given about is true ,complete and correct and is based on the books of account, documents, TDS statement, TDS deposited and other available records.

Signature of the person responsible for deduction of tax

Place: JAIUPR

Date: 10/07/2016

Full Name:

Designation:

This certificate pertains to