8/6/2019 NewForm16 AY1112

1/6

FORM 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

Name and address of the Employer Name and designation of the Employee

PAN of the Deductor TAN of the Deductor PAN of the Employee

CIT (TDS) Assessment Year Period

Address: From To

City: Pincode:

Summary of tax deducted at source

Quarter

Quarter 1

Quarter 2

Quarter 3

Quarter 4

Total - -

PART B (Refer Note 1)

Details of Salary Paid and any other income and tax deducted

Rs. Rs. Rs.

1. Gross Salary

(a) Salary as per provisions contained in sec. 17(1)

-

-

(d) Total -

Receipt Numbers of original statements of TDS undersub-section (3) of section 200

Amount of taxdeducted in respect of

the employee

Amount of taxdeposited/remitted in

respect of theemployee

(b) Value of perquisites u/s 17(2) (as per Form No. 12BB,

wherever applicable)

(c) Profits in lieu of salary under section 17(3)(as perForm No. 12BB, wherever applicable

8/6/2019 NewForm16 AY1112

2/6

(i) -

(ii) -

(iii) -

(iv) -

(v) -

(vi) -

(vii) -

(viii) Infra Bonds -

(b) section 80 CCC -

(c) section 80 CCD -

- -

(B) other sections (e.g. 80E,80G etc.) under Chapter VI-A Gross Amount Qualifying Amount Deductible Amount

(i) section

(ii) section

(iii) section

(iv) section

(v) section

Note: 1. Aggregate amount deductible under section 80 C shall notexceed one lakh rupees.

2. Aggregate amount deductible under the three sections, i.e.80C,80CCC,80CCD shall not exceed one lakh rupees.

8/6/2019 NewForm16 AY1112

3/6

ANNEXURE - B

DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CH

(The Employer to provide payment wise details of tax deducted and deposited with respect to the

S.No.Challan identification number (CIN)

BSR Code of tbe Bank Branch Date on which tax deposited (dd/mm/yyyy)

Total -

Tax Deposited in respectof the employee (Rs.)

8/6/2019 NewForm16 AY1112

4/6

ALLAN

mployee)

Challan Serial Number

8/6/2019 NewForm16 AY1112

5/6

ANNEXURE - A

S.No.

Book identification number (BIN)

Receipt numbers of Form No.24 G Date on which tax de

Total -

DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN (Tprovide payment wise details of tax deducted and deposited with respect to the Employee)

Tax Deposited inrespect of theemployee (Rs.)

DDO Sequence Num er inthe Book Adjustment Mini

Statement

8/6/2019 NewForm16 AY1112

6/6

osited (dd/mm/yyyy)

he Employer to