Tax Information Network of Income Tax Department

Certificate No.: SETQGI Last Updated 11/01/2012

FORM NO.16A
[See rule 31(1)(b)] Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source Name and address of the Deductor RELIANCE LIFE INSURANCE COMPANY LIMITED 9TH & 10TH FLOOR R TECH PARK BUILDING NO 2, OFF W E HIGHWAY NIRLON COM GOREGAON E, MUMBAI MAHARASHTRA 400063 Name and address of the Deductee INSAN VARUN KUMAR VPO RANIA, SIRSA HARYANA 125076 Note : Name and address is as present in Income Tax PAN database. Apply for PAN change request to update details. PAN of the Deductor AADCA1410E CIT (TDS) The Commissioner of Income Tax (TDS) Room No. 900A 9th Floor K.G. Mittal Ayurvedic Hospital Building Charni Road Mumbai 400002 Summary of Payment Amount paid/credited ( ) 1,648.65 3,941.69 181.00 Nature of payment 194D - Insurance commission 194D - Insurance commission 194D - Insurance commission Date of payment/credit (dd/mm/yyyy) 25/10/2011 12/11/2011 28/12/2011 Status of Booking MATCHED MATCHED MATCHED TAN of the Deductor MUMR22066C Assessment Year From 2012-13 01/10/2011 31/12/2011 PAN of the Deductee ABLPI5301A Period To

Summary of tax deducted at source in respect of deductee Quarter Receipt Numbers of original quarterly statements of TDS under sub-section (3) of section 200 KKSXCZQG Amount of tax deducted in respect of the deductee ( ) 579.00 Amount of tax deposited/ remitted in respect of the deductee ( ) 579.00

Q3

I. 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) S. No. Tax Deposited in respect of the deductee ( ) ) N.A. Book Identification number (BIN) Receipt numbers of Form No. 24G DDO sequence Number in the Book Adjustment Mini Statement N.A. Date on which tax deposited (dd/mm/yyyy) Status of Booking

Total (

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 S. No. Tax Deposited in respect of the deductee ( ) 165.00 395.00 Challan Identification number (CIN) BSR Code of the Bank Branch 0510308 0510308 Date on which tax deposited (dd/mm/yyyy) 05/11/2011 07/12/2011 Challan Serial Number 1212 5773 Status of Booking

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MATCHED MATCHED

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Tax Information Network of Income Tax Department

TAN of the Deductor MUMR22066C PAN of the Deductee ABLPI5301A Assessment Year 2012-13 Quarter Q3

Certificate No.: SETQGI

Last Updated 11/01/2012

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 S. No. Tax Deposited in respect of the deductee ( ) 19.00 ) 579.00 Verification I, VAIBHAV KABRA, son/daughter of RADHESHYAM KABRA working in the capacity of AVP (designation) do hereby certify that a sum of ( ) 579.00 [Rupees Five Hundred Seventy Nine only] has been deducted and a sum of ( ) 579.00 [Rupees Five Hundred Seventy Nine 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 Date MUMBAI 12/01/2012 Signature of person responsible for deduction of tax Challan Identification number (CIN) BSR Code of the Bank Branch 0510308 Date on which tax deposited (dd/mm/yyyy) 07/01/2012 Challan Serial Number 2211 Status of Booking

3 Total (

MATCHED

Notes: 1.Form 16A is generated on the basis of the details provided in the quarterly TDS statement filed by deductor in TIN. 2.To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Signature Not Verified

Digitally signed by VAIBHAV RADHESHYAM KABRA Date: 2012.01.12 10:08:39 IST

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