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

Shri

PAN No. of the Deductor TAN No. of the Deductor PAN No. of the Employee

Acknowledgement Nos. of all quarterly statements of TDS under sub-section (3) of

section 200 as provided by TIN Facilitation Centre or NSDL web-site ###
Quarter Acknowledgement No. Period ###
Assessment Year###
From To

###
1/4/2008 31/03/2009 2009-10
###
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED ###
1 Gross Salary
(a) Salary as per provision containing in section 17 (1) Rs. ###
(b) Value of perquisites u/s 17 (2) Rs. ###
(as per Form No.12BA,wherever applicable) ###
(c ) Profit in lieu of salary under section 17(3) Rs. ###
(as per Form No. 12BA,wherever applicable )
(d) Total Rs. -

2 Less:Allowances to the extent exemt u/s 10

Rs
Rs Rs. -
3 Balance ( 1- 2 ) Rs. -
4 Deductions u/s 16
(a ) Entertainment allowances Rs.
(b ) Tax on Enployment Rs.
5 Aggregate of 4 (a) and (b ) Rs. -
6 Income Chargeable under the head "Salaries " (3 - 5) Rs. -
7 Add: Any Other Income reported by the employee
Rs.
Rs. Rs. -
8 Gross total Income ( 6 + 7 ) Rs. -
9 Deduction under Chapter VI-A
(A) Section 80C, 80CCC, and 80CCD
(a) section 80C Gross Amount Deductible Amount
(ii) Providend Fund Rs.
(ii) Rs.
(iii) Rs.
(iv) Rs.
(v) Rs.
(vi) Rs. Rs. - Rs. -
( b ) section 80CCC Rs. Rs. -
( c ) section 80CCD Rs. Rs. Rs. -
 Page 2
(B) Other sections (for e.g. 80E, 80G etc)under Chapter VIA
Section Gross Amount Qualifying Amount Deduction Amount
(a) Rs. Rs. Rs.
(b) Rs. Rs. Rs.
( c) Rs. Rs. Rs.
(d) Rs. Rs. Rs.
(e) Rs. Rs. Rs. Rs. -
10 Aggregate of deductible amounts under chapter VI- A Rs. -
11 Total Income ( 8 - 10 ) Rs. -
12 Tax on Total Income Rs. -
13 Surcharge (on tax computed at S .No. 12) Rs. -
14 Education Cess (on tax at S. No.12 and surcharge at S. No.13) Rs. -
15 Tax payable (12+13+14) Rs. -
16 Relief under section 89 (attach details) Rs.
17 Tax Payable (15 - 16) Rs. -
18 Less:
(a) Tax deduction at source u/s 192(1) Rs. -
(b) Tax paid by the employer on behalf of the Rs.
employee u/s 192(1A) on perqusites u/s 17(2) Rs. -

19 Tax payable /(refundable) (17 - 18 ) Rs. -

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

Education Total tax Transfer Voucher /

Surcharge Cheque / DD No. B S R Code of Date on which tax
S.No TDS Rs Cess deposited Challan
Rs ( if any) Bank branch deposited dd/mm/yy
Rs Rs Identification No.
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12
Total -

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do hereby certify that a sum of Rs - /- {Rupees in words} on how to use and install is given with it.
has been deducted at source and paid to the credit of the Cental Government. I further certify that the information
given above is true and correct based on the books of account, document and other available records

Place: HYDERABAB Signature of the person responsible for deduction of tax

Date: Full Name:
Designation :

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 Certificate No:
FORM NO. 16A
[See rule 31(1)(b)]
Certificate of deduction of tax at source under section 203 of the Income-tax Act, 1961
For interest on securities; dividends; interest other than “interest on securities”; winnings from lottery or crossword puzzle ; winnings from
horse race; payments to contractors and sub-contractors; insurance commission; payments to non-resident sportsmen/sports associations;
payments in re-spect of deposits under National Savings Scheme; payments on account of repurchase of units by Mutual Fund or
Unit Trust of India; commission, remuneration or prize on sale of lottery tickets; rent; fees for professional or technical services;
income in respect of units; other sums under section 195; income of foreign companies referred to in section 196A(2); income
from units referred to in section 196B; income from foreign currency bonds or shares of an Indian company referred to in section 196C;
income of Foreign Institutional Investors from securities re-ferred to in section 196D

Acknowledgement Nos. of all Quarterly Name and address of the person to whom
Name and address of the person deducting Statements of TDS under sub-section (3) of
tax section 200 as provided by TIN Facilitation payment made or in whose account it is
Centre or NSDL web-site credited

Quarter Acknowledgement No.

TAX DEDUCTION A/C NO. OF THE DEDUCTOR NATURE OF PAYMENT PAN/GIR NO. OF THE PAYEE

PAN/GIR NO. OF THE DEDUCTOR FOR THE PERIOD

DETAILS OF PAYMENT, TAX DEDUCTION AND DEPOSIT OF TAX INTOCENTRAL GOVERNMENT ACCOUNT

Transfer
Date on
Amount Date of Education Total tax Cheque/D BSR Code voucher/
Sr TDS Surcharge which tax
paid/credited payment/ Cess deposited D No. (if of Bank Challan
No. Rs Rs. deposited
(Rs.) credit Rs. Rs any) branch Identification
(dd/mm/yy)
No.
- -
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
18 - -
19 - -
20 - -
0 0
0 0 0 0 0

Certified that a sum of Rs. (in words) Use here our num2text addin if you don't know then download it from Files area of our grou
has been deducted at source and paid to the credit of the Central Government as per details given above.

Signature of person responsible for deduction of tax

Place : HYDERABAD Full Name

Date : Designation

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