FORM NO.

16A
[See rule 31(1)(b)]

Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source

Certificate No. WONYAPA Last updated on 28-Jul-2021

Name and address of the deductor Name and address of the deductee
MAX LIFE INSURANCE COMPANY LIMITED
Corr.Add 3rd Floor,90-A, Sec-18, Gurgaon-122001, Regd.Off:1,Dr.Jha
Marg, KIRTIMAYEE PATRA
Okhla, NEW DELHI - 110020 SIRRIA PUR,
Delhi PATTANAIKIA, PURI - 752001 Odisha
+(91)124-4219090
finance.taxdesk@maxlifeinsurance.com
PAN of the deductor TAN of the deductor PAN of the deductee

AACCM3201E DELM06052E ACXPP3732B

CIT (TDS) Assessment Year Period

The Commissioner of Income Tax (TDS) From To

Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 4 , 2021-22
Luxmi Nagar, Delhi - 110092 01-Jan-2021 31-Mar-2021

Summary of payment

Deductee Reference No.

Date of payment/ credit
Sl. No. Amount paid/ credited Nature of payment** provided by the Deductor (if
(dd/mm/yyyy)
any)
1 5636.91 194D 31-01-2021
Total (Rs.) 5636.91

Summary of tax deducted at source in respect of Deductee

Receipt Numbers of Original

Quarterly Statements of TDS Amount of Tax Deducted in respect of Amount of Tax Deposited / Remitted in
Quarter
Under sub-section (3) of Section Deductee respect of Deductee
200

Q4 FXBQTTMA 212.00 212.00

I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
(The deductor to provide payment-wise details of tax deducted and deposited with respect to the deductee)

Book Identification Number (BIN)

Tax deposited in respect of
Sl. No. Status of Matching
deductee (Rs.) Receipt Numbers of Form DDO serial number in Form No. Date of Transfer
with Form No. 24G
No. 24G 24G voucher (dd/mm/yyyy)

Total (Rs.)
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)

Challan Identification Number (CIN)

Tax deposited in respect of the
Sl. No.
deductee (Rs.)
BSR Code of the Bank Date on which tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

1 212.00 6360218 07-02-2021 32637 F

Total (Rs.) 212.00

Verification

I, SUBHASH AGGARWAL, son / daughter of KIRORI MAL AGARWAL working in the capacity of CORPORATE VICE PRESIDENT (designation) do hereby certify that
a sum of Rs. 212.00 [Rs. Two Hundred and Twelve Only (in words)] has been deducted and a sum of Rs. 212.00 [Rs. Two Hundred and Twelve 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.

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 Certificate Number: WONYAPA TAN of Deductor: DELM06052E PAN of Deductee: ACXPP3732B Assessment Year: 2021-22

Place GURUGRAM

Date 30-Jul-2021 (Signature of person responsible for deduction of tax)

Designation: CORPORATE VICE PRESIDENT Full Name: SUBHASH AGGARWAL

Notes:
1. Form 16A contains the latest transaction reported by the deductor in the TDS / TCS Statement. For further details please view your 26AS for same AY on the website https://www.tdscpc.gov.in
2. To update the PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL
3. In items I and II, in column for tax deposited in repect of deductee, furnish total amount of TDS, surcharge (if applicable) and education cess (if applicable).

Legend used in Form 16A

* Status of matching with OLTAS

Legend Description Definition
Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
U Unmatched
details in bank match with details of deposit in TDS / TCS statement
Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
P Provisional
verification of payment details submitted by Pay and Accounts Officer (PAO)
In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
F Final mentioned in the TDS / TCS statement filed by the deductors. In case of government deductors, details of TDS / TCS booked in Government
account have been verified by Pay & Accounts Officer (PAO)
Payment details of TDS / TCS deposited in bank by deductor have matched with details mentioned in the TDS / TCS statement but the
O Overbooked amount is over claimed in the statement. Final (F) credit will be reflected only when deductor reduces claimed amount in the statement or
makes new payment for excess amount claimed in the statement

** Nature of Payment

Section Code Description Section Code Description

193 Interest on Securities 195 Other sums payable to a non-resident
194 Dividends 196A Income in respect of units of non-residents
194A Interest other than 'Interest on securities' 196B Payments in respect of units to an offshore fund
194B Winning from lottery or crossword puzzle Income from foreign currency bonds or shares of Indian company payable to
196C
194BB Winning from horse race non-residents
194C Payments to contractors and sub-contractors 196D Income of foreign institutional investors from securities
194D Insurance commission 206CA Collection at source from alcoholic liquor for human consumption
194E Payments to non-resident sportsmen or sports associations 206CB Collection at source from timber obtained under forest lease
194EE Payments in respect of deposits under National Savings Scheme Collection at source from timber obtained by any mode other than a forest
206CC
Payments on account of repurchase of units by Mutual Fund or Unit Trust of lease
194F
India
206CD Collection at source from any other forest produce (not being tendu leaves)
194G Commission, price, etc. on sale of lottery tickets
194H Commission or brokerage 206CE Collection at source from any scrap
194I Rent Collection at source from contractors or licensee or lease relating to parking
206CF
194I(a) Payment of Rent for the use of any machinery or plant or equipment lots
Payment of Rent for the use of land or building or land appurtenant or
194I(b) 206CG Collection at source from contractors or licensee or lease relating to toll plaza
furniture or fittings
194J Fees for professional or technical services Collection at source from contractors or licensee or lease relating to mine or
206CH
Income payable to a resident assessee in respect of units of a specified mutual quarry
194K
fund or of the units of the Unit Trust of India 206CI Collection at source from tendu Leaves
194LA Payment of compensation on acquisition of certain immovable property 206CJ Collection at source from on sale of certain Minerals
194LB Income by way of Interest from Infrastructure Debt fund 206CK Collection at source on cash case of Bullion and Jewellery
206CL Collection at source on sale of Motor vehicle
194LC Income by way of interest from specified company payable to a non-resident
Collection at source on sale in cash of any goods(other than
206CM
194LBA Certain income from units of a business trust bullion/jewelry)
194LBB Income in respect of units of investment fund Collection at source on providing of any services (other than
206CN
194LBC Income in respect of investment in securitization trust Ch-XVII-B)

Signature Not Verified

Digitally signed by
SUBHASH AGGARWAL
Date: 2021.07.30 17:09:02
IST
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