FORM NO.16 [See rule 31 (1) (a)] 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 PAN / GIR NO. TAN PAN / GIR NO. TDS Circle where annual return / statement under section 206 is to be filed PERIOD Assessment Year FROM TO DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED 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. 12 BA, wherever applicable) ( c ) Profits in lieu of Salary under section 17 (3) (as per Form No. 12 BA, wherever applicable) ( d ) Total 2. Less : Allowance to the extent exempt under section 10 3. Balance (1-2) 4. Deductions : (a) Standard deduction Rs. (b) Entertainment allowance Rs. (c) Tax on Employment Rs. 5. Aggregate of 4 (a to c) 6. Income chargeable under the Head 'Salaries'(3-5) 7. Add. : Any other income reported by the employee Less:-Loss From House Properties 8. Gross total income (6+7) 9. Deductions Under Chapter VIA Gross Amount (a) Rs. (b) Rs. (c) Rs. (d) Rs. 10. Aggregate of deductible amount under chapter VI-A 11. Total Income (8-10 ) 12. Tax on total Income b) a) Qualifying Amt. Deductible Amt. 13. Rebate under Chapter VIII-A I. Under section 88 GROSS AMOUNT (Please specify ) (a) Rs. (b) Rs. (c) Rs. (d) Rs. (e) Rs. (f) Total [ (a) to (e) ] Rs. II. (a) Under Section 88B (b) Under Section 88C (c) Under Section 88D 14. Aggregate of tax rebates at 13 above [ I ( f ) + II ( a ) + II ( b ) + II ( c ) ] 15. Tax Payable on total income (12-14) and surcharge thereon 16. Relief under section 89 (attach details) 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) Taxable Income ( up to 150,000 @ Nil) { ( ) indicates refund } Qualifying Amt. Tax Rebate DETAILS TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT AMOUNT DATE/MONTH OF PAYMENT TREASURY VOUCHER NUMBER AND DATE/ NAME OF BANK AND BRANCH WHERE TAX DEPOSITED Total amount Paid has beeen 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 book of accounts, documents and other available records. I, __________________ son of ___________________ working in the capacity of the ______________________________ Designation : _________________________________ Full Name : ________________________________ Place:_____________ Date: _______________ Signature & Seal of the person responsible for deduction of tax do hereby certify that a sum of Rs.____________ (in words) _______________________________________________
