FORMNO.

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 & Address of the employer

PAN of the Deductor

Name & Designation of the Employee

TAN of Deductor

PAN of Employee

CIT (TDS) Address

Assesment Year

Period
From

Address
City

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

Acknowledgement No

Amount of tax deducted in respect of

the employee

Amount of tax deposited or remitted

with respect of the employee

Quarter 1
Quarter 2
Quarter 3
Quarter 4
Total
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
Book Identification Number (BIN)
Serial No

Receipt numbers of Form No. 24G

DDO serial number in Form No. 24G

Date of transfer
voucher

March, 2013
April, 2013
May, 2013
June, 2013
July, 2013
Aug, 2013
Sept, 2013
Oct, 2013
Nov, 2013
Dec, 2013
Jan, 2014
Feb, 2014
Total Rs
I,................., son/daughter of .............working in the capacity of ....... (designation) do hereby certify that a sum of Rs. .............. [Rs. .............(in
words)] has been deducted and 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.

Details of Salary paid and any other income and tax deducted
1.Gross Salary
Salary as per provisions contained in sec.17(1)
Value of perquisites u/s 17(2) (as per Form No.12BA, wherever applicable)
Profits in lieu of salary u/s 17(3) as per Form No.12BB,
Total
2.Less: Allowance to the extent exempt u/s 10
H.R.A
Medical Reimbursement
Conveyance Allowances
3.Balance(1-2)
4.Deduction U/S 16
Professional Tax
H.B Loan interest paid

Rs

RS

Children Educational Allowances

Entertainment Allowances
5.Aggregate of 4a-4d:
6.Income chargeable under Head of Salaries: 3-5
7.Add other income reported by employee
Income from house property(put -ve sign if loss)
Income from other sources (Bank int,etc..)
8.Gross Total Income:
9.Deduction under chapter VI-A
Section 80C:(Max qualify amount 100000)
GPF
GSLI
PLI
PPF
ULIP
TUTION FEES
NSC
STAMP DUTIES AND REGISTRATION FEES
HB LOAN PRINCIPAL
FIXED DEPOSIT ABOVE 5 YEAR
EQUITY LINK SAVINGS BOND
Section 80CCC
Section 80CCD
Total of U/S 80C+80CCC+80CCD (Max qualify amount 100000)
Section 80E
Section 80G
Section 80CCF
Section 80D
Section 80GG
Section 80GGA
Section 80GGC
Section 80U
Section 80DD
Section 80DDB
10.Aggregate of Deductible amount under chapter VI-A
11.Total Income (8-10) [Rounded off]

12. tax on Total Income:

13.Education & Cess @3% on tax computed sl no 12
14.Tax payable:
15.Less: Relief under section 89 (attach details)
16.Net Tax payable:
17.Tax deducted at source u/s 192(1)
18.Tax paid by the employer on behalf of the employee u/s 192(1A)
19.Tax Payable/Refundable
Verification
I,.............................., son/daughter of .............................. working in the capacity of ...........................
(designation) do hereby certify that a sum of Rs. .............................. [Rs. .............................. (in words)] has
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
Date

Signature of person responsible for deduction of tax.

Designation

Full Name:

d SALARIES

yee

Period
To

deposited or remitted
ct of the employee

USTMENT

Status of matching

.....(in
ue, complete

Rs

ut is