FORM NO.

12BA
[ See Rule 26A(2)(b) ]
Statement showing particulars of perquisites, other fringe benefits or amenities and profits in
lieu of salary with value thereof

1. Name and address of employer : BOMBAY MERCANTILE CO-OP. BANK LTD.

78, Mohamedali Road MUMBAI MAHARASHTRA

2. TAN : MUMB17769D
3. TDS assessment Range of the employer :

4. Name, designation and PAN of employee : NEELESH SANKARSHAN KUMAR VYAS ABZPV2023L
Deputy Chief Officer
5. Is the employee a director or a person with
substantial interest in the company (where the
employer is a company) :

6. Income under the head "Salaries" of the employee : Rs. 687,149

(other than from perquisites)

7. Financial Year : 01/04/2018 -- 31/03/2019

8. Value of perquisites :
SNO. Nature of perquisite (see Value of Amount, If any paid Amount of
rule 3) perquisite as per by employee perquisite
rules chargeable to tax
taxable perquisite

(Rs.) (Rs.) (Rs.)

1 Stock option (non qualified 0 0 0
option)
2 Transfer of assets to employees 0 0 0
3 Other benefits or amenities 0 0 0
4 Profit in lieu of salary as per 0 0 0
17(3)
5 Accomodation 0 0 0
6 Cars 0 0 0
7 Sweeper, Gardner, Watchman or 0 0 0
Personal attender
8 Gas, Electricity, Water 0 0 0
9 Interest free or concessional 64535 0 64535
loans
10 Holiday expenses 0 0 0
11 Free or concessional travel 0 0 0
12 Free meals 0 0 0
13 Education 0 0 0
14 Gifts, Vouchers etc. 0 0 0
15 Credit Card expenses 0 0 0
16 Club Expenses 0 0 0
17 Use of movable assets by 0 0 0
employees

18 Total Value of perquisites 64535 64535

19 Total Value of profits in lie of

salary as per section 17(3)
9. Details of tax, -
(a)Tax deducted from salary of the employee under section192(1) Rs. 13200

(b)Tax paid by the employer on behalf of the employee under section192(1A) Rs. 13200
(c)Total tax paid Rs. 13200
(d)Date of payment into Government treasury As per Form16

Declaration by Employer
I ATAUR REHMAN ABDUL REHMAN KAMIL s/o ABDUL REHMAN working as ASST. GENERAL MANAGER do hereby declare on
behalf of BOMBAY MERCANTILE CO-OP. BANK LTD. 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 there under and such information is true and correct.

Signature of the person responsible for deduction of tax

Place : MUMBAI Full Name : ATAUR REHMAN ABDUL REHMAN KAMIL

Date : 01/06/2019 Designation : ASST. GENERAL MANAGER

3
Digitally signed by ATAUR RAHMAN KAMIL
Date: 2019.06.24 15:24:38 +05:30
Reason: 12BA
Location: MUMBAI