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

Certificate No. SONFAAK Last updated on 11-Jun-2017

Name and address of the Employer Name and address of the Employee
UNITED SPIRITS LIMITED
UNITED SPIRITS LIMITED, UB TOWERS UB CITY, #24 VITTAL
MALLYA ROAD,
UDHAVESH POPATRAO PATIL
BANGALORE - 560001
SAVARGAON, NANDGAON, NASHIK - 423106 Maharashtra
Karnataka
+(91)91-9900899334
lakshmi@ubmail.com
Employee Reference No.
PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

PANNOTREQD BLRM02795C BDFPP2869B

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2017-18 01-Apr-2016 31-Mar-2017
Ganganagar, Bangalore - 560032

Summary of amount paid/credited and tax deducted at source thereon in respect of the employee

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q1 QRYTZTKE 90006.00 1197.00 1197.00

Q2 QSCEQPGA 121553.00 417.00 417.00
Total (Rs.) 211559.00 1614.00 1614.00
I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Book Identification Number (BIN)

Tax Deposited in respect of the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

Total (Rs.)
II. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Challan Identification Number (CIN)

Tax Deposited in respect of the
Sl. No. deductee
(Rs.) BSR Code of the Bank Date on which Tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

1 399.00 6910333 06-05-2016 17212 F

2 399.00 6910333 07-06-2016 19700 F
3 399.00 6910333 07-07-2016 11986 F
4 417.00 6910333 07-10-2016 Signature Not Verified
20511 F
Signed By:MAHALAKSHMI
Total (Rs.) 1614.00 MANARGUDI SUNDERRAJ
Signing Date:19.06.2017
18:06

Page 1 of 2
 Certificate Number: SONFAAK TAN of Employer: BLRM02795C PAN of Employee: BDFPP2869B Assessment Year: 2017-18

Verification

I, MAHALAKSHMI MANARGUDI SUNDERARAJ, son / daughter of SUNDERARAJ MANARGUDI CHELLAPILLAI working in the capacity of GENERAL MANAGER
(designation) do hereby certify that a sum of Rs. 1614.00 [Rs. One Thousand Six Hundred and Fourteen Only (in words)] has been deducted and a sum of
Rs. 1614.00 [Rs. One Thousand Six Hundred and Fourteen Only] has been deposited to the credit of the Central Government. I further certify that the information
given above is true, complete and correct and is based on the books of account, documents, TDS statements, TDS deposited and other available records.

Place BANGALORE

Date 19-Jun-2017 (Signature of person responsible for deduction of Tax)

Designation: GENERAL MANAGER Full Name:MAHALAKSHMI MANARGUDI SUNDERARAJ

Notes:
1. Part B (Annexure) of the certificate in Form No.16 shall be issued by the employer.
2. If an assessee is employed under one employer during the year, Part 'A' of the certificate in Form No.16 issued for the quarter ending on 31st March of the financial year shall contain the details
of tax deducted and deposited for all the quarters of the financial year.
3. If an assessee is employed under more than one employer during the year, each of the employers shall issue Part A of the certificate in Form No.16 pertaining to the period for which such
assessee was employed with each of the employers. Part B (Annexure) of the certificate in Form No. 16 may be issued by each of the employers or the last employer at the option of the assessee.
4. To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Legend used in Form 16

* Status of matching with OLTAS

Legend Description
U Unmatched
P Provisional
F Final
O Overbooked
Definition
Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
details in bank match with details of deposit in TDS / TCS statement
Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
verification of payment details submitted by Pay and Accounts Officer (PAO)
In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
mentioned in the TDS / TCS statement filed by the deductors. In case of government deductors, details of TDS / TCS booked in Government
account have been verified by Pay & Accounts Officer (PAO)
Payment details of TDS / TCS deposited in bank by deductor have matched with details mentioned in the TDS / TCS statement but the
amount is over claimed in the statement. Final (F) credit will be reflected only when deductor reduces claimed amount in the statement or
makes new payment for excess amount claimed in the statement

Signature Not Verified

Signed By:MAHALAKSHMI
MANARGUDI SUNDERRAJ
Signing Date:19.06.2017
18:06

Page 2 of 2
Emp Code :113136 Region:WEST Page number:1

FORM NO. 16-PART B

[ 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
UNITED SPIRITS LIMITED UDHAVESH POATRAO PATIL
BANGALORE
PAN/GIR No. TAN No. PAN/GIR No.
AACCM8043J BLRMO2795C BDFPP2869B
Acknowledgement Nos. of all quarterlystatements of TDS Period Assessment
under sub-section (3) of section 200 as provided by TIN From | To Year
FacilitationCentre or NSDL web-site Period Assessment
year
Apr-2016 - Jun-2016 030409601457620 01-Apr-2016 | 30-Sep-2016 2017 | 2018
Jul-2016 - Sep-2016 030409601583056
Oct-2016 - Dec-2016
Jan-2017 - Mar-2017

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1. Gross salary
(a) Salary as per provisions contained in sec. 262007.00
17(1)
(b) Value of perquisites u/s 17(2) 0.00
(c) Profits in lieu of salary under section 17(3) (as a.Loan Int:0.00 0.00
b.Food
per Form No. 12BA, wherever applicable)
Coupon:0.00
c.Club Subc:0.00

(d) Total 262007.00

2. Less : Allowance to the extent exempt under section
10
(a) HRA
(1)RENT PAID 35327.70
(b) CONVEYANCE 9280.00
(c) HOSP_EXMP 0.00
Total 44608.00
3. Balance (1-2) 217399.00

Signature Not Verified

Signed By:MAHALAKSHMI
MANARGUDI SUNDERRAJ
Signing Date:19.06.2017
18:06
Emp Code :113136 Region:WEST Page number:2
4. Deductions :
(a) Standard deduction: 0
(b) Entertainment allowance 0
(c) Tax on employment 1200.00
5. Aggregate of 4(a) to (c) : 1200.00
6. Income chargeable under the head 'Salaries' 216199.00
7. Add :Any other income reported by the employee 0.00
8. Gross total income (6 + 7) 216199.00
9. Deductions under Chapter VI-A
Gross Qualifying Deductible
Amount Amount Amount
(a) PF 10597.0 10597.0 10597.0
(a) Public Provident Fund 25000.0 150000.0 25000.00
10. Aggregate of deductible amounts under Chapter VI- 35597.00
A
11. Total income (8-10) 180602.00
12. Tax on total income 0.00
13. Exemption Under Sec 87A 0.00
14. Balance Tax Payable 0.00
15. Surcharge (on tax computed at S.No.13) 0.00
16. Education Cess (on tax computed at S. No. 14) 0.00
17. Tax Payable(14 + 15 + 16) 0.00
18. Relief under section 89 (attach details) 0.00
19. Tax Payable(17 - 18) 0.00
20. Less:
(a): Tax deducted at source under section 192(1) 1614.00
(b): Tax paid by the employer on behaif of the 0.00
employee under section 192(1A) on
perquisites under section 17(2)
(c): Total [(a) + (b)] 1614.00
21. Tax payable/ refundable (19-20) -1614.00

Signature Not Verified

Signed By:MAHALAKSHMI
MANARGUDI SUNDERRAJ
Signing Date:19.06.2017
18:06
Emp Code :113136 Region:WEST Page number:3
Details of Tax Deducted and Deposited into Central Government A/C
S.N TDS (in Rs) Surcharge Education Total tax Cheque/D BSR code Date on Transfer
o (in Rs) Cess (in deposited D No.(if of bank which tax Voucher/Ch
Rs) (in Rs) any) branch deposited(d eque
d/mm/yy) Idetification
NO.
1 399 0 0 399.00 - IDBI - 06/05/2016 17212
6910333
2 399 0 0 399.00 - IDBI - 07/06/2016 19700
6910333
3 399 0 0 399.00 - IDBI - 07/07/2016 11986
6910333
4 0 0 0 0.00 - IDBI - 05/08/2016 23761
6910333
5 0 0 0 0.00 - IDBI - 07/09/2016 20595
6910333
6 417 0 0 417.00 - IDBI - 07/10/2016 20511
6910333
7 0 0 0 0.00 - IDBI - 07/11/2016 17691
6910333

I, M S MAHALAKSHMI working in the capacity of GM Payroll(Designation) do hereby certify that a sum

of Rs 1614.00[Rupees One Thousand Six Hundred Fourteen (in words)] has been 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 books of accounts, documents and other available records.
For United Spirits Limited
(formerly McDOWELL and COMPANY LIMITED)

(Signature of the person responsible for deduction of tax)

(Digitally Signed Document)
M S MAHALAKSHMI
GM Payroll
Place: -
Date: 8/06/2017

Signature Not Verified

Signed By:MAHALAKSHMI
MANARGUDI SUNDERRAJ
Signing Date:19.06.2017
18:06
Emp Code :113136 Region:WEST Page number:4
Form No. 12BA
Statement showing the particulars of perquisites, other fringe benefits or amenities and profits in-lieu of
salary with a value thereof
1. Name and address of the employer UNITED SPIRITS LIMITED
2. Name and Designation of the employee UDHAVESH POATRAO PATIL
3. Assessment Year 2017-2018
Sl Nature of Perquisites Value of Perquisites Amount, if any, Amount of
No. as per Rules(Rs.) recovered from the perquisite
employee(Rs.) chargeable to tax
perquisites Col.(3)-
Col.(4)(Rs.)
(1). (2). (3). (4). (5.)
1. Accomodation. 0.00 0.00. 0.00
2. Cars/Other automotive. 0.0 0.00. 0.0
3. Sweeper,gardener,watchman or 0.0 0.00. 0.0
personal attendant
4. Gas, electricity, water 0.0 0.00. 0.0
5. Interest free or concessional loans 0.0 0.00. 0.0
7. Free or concessional travel 0.00 0.00. 0.00
8. Free meals 0.00 0.00. 0.00
8. Free Education 0.00 0.00. 0.00
9. Gifts, vouchers, etc., 0.0 0.00. 0.0
11. Credit card expenses 0.00 0.00. 0.00
12. Club expenses 0.0 0.00. 0.0
13. Use of movable assets by 0.00 0.00. 0.00
employees
14. Transfer of assets to employees 0.0 0.00. 0.0
15. Stock options (non-qualified options) 0.00 0.00. 0.00
16. Other benefits or amenities 0.00 0.00. 0.00
17. Total value of profits in lieu of Salary 0.00 0.00. 0.00
as per section 17(3)
18. Total value of perquisites 0.00 0.00. 0.00

DECLARATION BY EMPLOYER
I M S MAHALAKSHMI;son / daughter of Mr M C SUNDERAJAN working as GM Payroll do hereby
declare on behalf of UNITED SPIRITS LIMITED that the information given above is based on the books
of accounts, 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 thereunder and that
such information is true and correct.
For United Spirits Limited
(formerly McDOWELL and COMPANY LIMITED)
Signature Not Verified
Signed By:MAHALAKSHMI
MANARGUDI SUNDERRAJ
Signature of the person responsible Signing
for Date:19.06.2017
deduction of tax.
18:06

Place: - (Digitally Signed Document)

Date: 8/06/2017