FORM NO.

16AA
[ See third provision to rule 12(1)(b) and rule 31(1)(a) ]

"NON-ORIGINAL"

Certificate for tax deducted at source from income chargeable

under the head "Salaries"-cum-Return of Income
For an individual, resident in India, wherea) his total income includes income chargeable to income-tax under the head 'Salaries';
b) the income from salaries before allowing deductions under section 16 of the Income-tax Act, 1961 does not exceed rupees one lakh fifty thousand;
c) his total income does not include income chargeable to income-tax under the head 'Profits and gains of business or profession' or 'Capital gains' or
agricultural income; and
d) he is not in receipt of any other income from which tax had been deducted at source by any person other than the employer.
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
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
Rs. 0.00
Rs. 0.00
Rs. 135733.33

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

Rs. 11733.33

3. Balance(1-2)

Rs. 124000.00

4. DEDUCTIONS Under Section 16:

a) Standard Deduction
b) Entertainment allowance
c) Tax on Employment

Rs. 0.00
Rs. 0.00
Rs. 0.00

5. Aggregate of 4 (a to c)

Rs. 0.00

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

7. Add: Any other Income reported by the employee
a) Income under the head 'Income from house property'
b) Income under the head 'Income from other sources'
c) Total of (a) + (b) above

Rs.124000.00
Rs. 0.00
Rs. 0.00
Rs. 0.00

8. GROSS TOTAL INCOME (6+7)

9. DEDUCTIONS UNDER CHAPTER VI-A
(a) 80C(01)

Rs.124000.00
Gross Amount
Rs. 8448.00

Qualifying Amount
Rs. 8448.00

Deductible Amount
Rs. 8448.00

10. Aggregate of deductible amounts under Chapter VI-A

Rs. 8448.00

11. Total Income(8-10)

Rs. 115550.00

12. Tax on total income

Rs. 555.00

13. Rebate and relief under Chapter VIII

I. Under Section 88(please specify)

Gross Amount

Qualifying Amount

Tax rebate

II. (a) Under Section 88B

Rs.

(b) Under Section 88C

Rs.

(c) Under Section 88D

Rs.

14. Aggregate of tax rebates at 13 above

[I+II(a)+II(b)+II(c)]

Rs.

15. Tax payable on total income (12-14) and surcharge thereon

15 A. Education cess

Rs. 561.00
Rs. 11.00

16. Relief under section 89 (attach details)

Rs. 0.00

17. Tax Payable (15+15A-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)

Rs. 572.00
Rs. 52.00
Rs. 0.00

Rs. 52.00
Rs. 520.00

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

Sl.
No.

TDS
Rs.

Surcharge
Rs.

Education
Cess Rs.

Total Tax
deposited

Cheque /DD No.

(if any)

BSR Code of
Bank Branch

Date on which
Tax deposited
(dd/mm/yy)

Transfer
voucher/challan
identification No.

_______________________________________________________________________________________________________________________________________________________________

I SINGAL son of working in the capacityof do hereby certify that

a sum of Rs 52.00 [ Rupees FIFTY TWO ]
has been deducted at source and paid to the credit of the CentralGovernment. I further certify that the information given
above is true and correct based on the book of accounts , documentsand 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:

TO BE FILLED IN BY THE ASSESSEE

1. NAME OF THE ASSESSEE:yadav ramseh
2. ADDRESS:
PIN:203207
CITY:srikakulam
TELEPHONE:
3. DATE OF BIRTH:03.06.1981
4. SEX M/F:M
5. ASSESSMENT YEAR:2009-2010
6. WARD/CIRCLE/SPECIAL RANGE:
7. RETURN: ORIGINAL OR REVISED :
8. PARTICULARS OF BANK ACCOUNT(Mandatory in Refund cases)
Name of the Bank
MICR Code
Address of Bank Branch

Type of Account

Account Number

ECS(Y/N)

VERIFICATION BY THE ASSESSEE

I, yadav ramseh (Name in full and block letters), son/daugther of Shri. solemnly declare that to
the best of my knowledge and belief, the information given in this return is correct, complete and truly stated and in accordance with the
provisions of the Income-tax Act, 1961, in respect of income chargeable to income-tax for the previous year relevant to the assessment year
2009-2010.

......................................
Signature of the assessee
Date:
Place:

Receipt No :
Date :
SEAL
Signature of the receiving official

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 :