FORM 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
Last updated on

Certificate No.

Name and address of the Employer

Name and Address of the Emplo

United Bank Of India

PAN of the Deductor

ABCDE1256A

Mr. Rathin De, G.M.

TAN of the Deductor

CALU00267B
CIT (TDS)

Address:
City

The Commissioner of Income Tax,

Kolkata

Pin code

PAN of the Employee

APPKE1235A
Assessment Year
Period with th
From

2014-2015

700064

4/1/2013

PART B (Annexure)
Details of Salary Paid and any other income and tax deducted

1. Gross Salary
(a) Salary as per provisions contained in sec. 17(1)

Rs. 1,100,001

(b) Value of perquisites u/s 17(2)

(c) Profits in lieu of salary under section 17(3)

Rs. 0
Rs. 0

(d) Total
2. Less: Allowance to the extent exempt U/s 10
Allowance
H.R.A. U/s 10(13A)
Medical Reimbursment [U/s 17(2)]
Conveyance Allowance
Children Education Allowances
Children Hostel Allowances
L.T.A.
Uniform Allowance
Exemption Gratuity Amount U/s 10(10)

Rs. 1,100,001

Rs.

Rs. 45,000
Rs. 12,000
Rs. 9,600
Rs. 2,400
Rs. 3,600
Rs. 22,000
Rs. 12,000
Rs. 600,000

3. Balance (1-2)
4. Deductions : U/s 16

Rs. 706,600

(a) Entertainment allowance

(b) Tax on employment

Rs. 0
Rs. 800
Rs. 0

(c ) H.B.Loan Interest paid

U/s 24(b)
5. Aggregate of 4(a) to 4(b)
6. Income chargebale under the head 'Salaries' (3-5)
7. Add: Any other income reported by the employee

Income
Income from Pension /Family Pension
Income from Savings Bank interest
Income other than Savings Bank interest
(Loss) from House Property(H.B.Loan Int) U/s 24B

8. Gross Total income (6+7)

Rs. 393,401

Rs. 800

Rs.
Rs. 1,000

Rs. 11,000
Rs. 0

- Rs. 12,000

Rs. 12,000

- Rs. 12,000

Rs. 404,601

9. Deductions under Chapter VI A

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

(a) Section 80 C
(i) G.P.F / C.P.F./ V.P.F.

ii)G.I.(Group Insurance)..
(iii)P.L.I
(iv)U.LIP
(v)Tution Fees
(vi)N.S.C
(vii) L.I.C
(viii) P. P. F
ix) Stamp Duty & Registration Fees
(x)
Any Other Deduction U/s 80 C
xi
Any Other Deduction U/s 80C
(xii) H.B. Loan Principal
(xiii) Fixed Deposite above 5 years
(xiv)Eqity Link savings Bond
b) Section 80CCC
c) Section 80CCD
d) Section 80 CCD(2)
(B) Other sections (e.g. 80E,80G etc.) under Chapter VI-A
(i) section 80E
(ii) Section 80 EE ( Additional HBL Int. Max Rs. 1,00,000/)
(iii) section 80G
(iv) section 80GG
(v) Section 80U
(vi) Section 80DD
(vii) Section 80D
(viii) Section 80DDB
[ Exempt Savings Bank Int.Max Rs.10,000/-]
(ix) U/s 80 TTA
[New Rajiv Gandhi Equity Savings Schm]
(x) U/s 80CCG
10. Aggregate of deductible amount under Chapter VI A
[ Round off U/s 288 A]
11. Total Income
12. Tax on total income
13. Rebate U/s 87 A (Taxable Income below Rs. 5,00,000/-)
14. Education cess @ 3% (on tax computed at S.No. 12)
15. Tax Payable (12+13)
16. Less: Relief under section 89 (attach Form 10E)
17. Tax Payable (14-15) [ Round off U/s 288B]
18. Tax deducted at source u/s 192(1)

Gross Amount

Rs. 10,000
Rs. 450
Rs. 10,000
Rs. 10,000
Rs. 10,000
Rs. 10,000
Rs. 10,000

Rs. 10,000
Rs. 10,000
Rs. 0
Rs. 0
Rs. 12,000
Rs. 5,000
Rs. 50,000
Rs. 0
Rs. 0
Rs. 0
Rs. 2,000

Rs. 147,450
Qualifying
Amount
Rs. 2,000

Rs. 0

Rs. 0

Rs. 5,000

Rs. 2,500

Rs. 6,000

Rs. 6,000

Rs. 50,000

Rs. 50,000

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 11,000

Rs. 10,000

Rs. 0

Rs. 0

Gross Amount

18. Tax paid by the employer on behalf of the employee u/s 192(1A) on U/s 17(2) for perquisite

19.Total Tax paid

Refundable
20. Tax

Verification
Chabi Das (Biswas)

in the Capacity of

Prem Kumar Mohini

son/daughter of

Ch.Manager

(designation) do hereby certify that a sum of

Rupees Four Thousand Ninety Only

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.

Place

Kolkata

Date

4/4/2013

Designation:-

Chief Manager

Signature of person responsible for deduction of tax

Full Name :

Chabi Das (Biswas)

at source on Salary

nd Address of the Employee

Mr. Rathin De, G.M.
Employee Reference No.
provided by the employer

Period with the employer

From
To
4/1/2013

3/31/2014

Rs. 1,100,001

Rs. 393,401

Rs. 800
Rs. 392,601

Rs. 404,601

Rs. 392,601

Gross Amount

Deductible
Amount

Rs. 147,450
Qualifying
Amount
Rs. 2,000

Rs. 100,000
Deductible
Amount
Rs. 2,000

Rs. 0

Rs. 0

Rs. 2,500

Rs. 2,500

Rs. 6,000

Rs. 6,000

Rs. 50,000

Rs. 50,000

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 0

Rs. 10,000

Rs. 10,000

Rs. 0

Rs. 0
Rs. 170,500
Rs. 222,100
Rs. 2,210
Rs. 2,000
Rs. 6
Rs. 216
Rs. 0
Rs. 220
Rs. 4,090
Rs. 0
Rs. 4,090
-Rs. 3,870

Kumar Mohini

ation given about

posited and other

duction of tax

working
Rs. 4,090
(in words)] has