FORM NO.

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 paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. FRXMYHA Last updated on 28-May-2023

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen
MMIS TECHNOLOGY SERVICES INDIA PRIVATE LIMITED
Surya Wave, Sy No 61 (P),, Doddathogur village,, Begur Hobli, Bangalore
BALAJI GOLLAPALLI
So,
7 115/1, NALUGU ROAD, GANDRAJUPALLE POST,
Electronic City Phase II, BANGALORE - 560013
GANGAVARAM MANDAL, GANGAVARAM CHITTOOR - 517432
Karnataka
Andhra Pradesh
+(91)80-9880690987
vinod.s@gainwelltechnologies.com
PAN of the Employee Reference No. provided by the
PAN of the Deductor TAN of the Deductor Employee/Specified senior Employer/Pension Payment order no. provided
citizen by the Employer (If available)

AANCM4253B BLRM34687C AZVPG0585G

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2023-24 01-Apr-2022 31-Mar-2023
Ganganagar, Bangalore - 560032

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

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q1 QUZKAHCD 405555.00 25944.00 25944.00

Q2 QVBWJQRE 426204.00 29502.00 29502.00
Q3 QVFWHNQC 426204.00 29502.00 29502.00
Q4 QVIJBVME 426197.00 29502.00 29502.00
Total (Rs.) 1684160.00 114450.00 114450.00
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 the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

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 8648.00 6910333 04-05-2022 10583 F

2 8648.00 6910333 02-06-2022 10030 F
3 8648.00 6910333 06-07-2022 11455 F
4 9834.00 6910333 02-08-2022 10184 F
Signature Not Verified
VINOD S
Page 1 of 2
10.06.2023 22:07
 Certificate Number: FRXMYHA TAN of Employer: BLRM34687C PAN of Employee: AZVPG0585G Assessment Year: 2023-24

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*

5 9834.00 6910333 02-09-2022 14039 F

6 9834.00 6910333 04-10-2022 10333 F
7 9834.00 6910333 03-11-2022 10780 F
8 9834.00 6910333 02-12-2022 10774 F
9 9834.00 6910219 04-01-2023 02749 F
10 9834.00 6930001 01-02-2023 01827 F
11 9834.00 6939001 01-03-2023 02753 F
12 9834.00 6939001 03-04-2023 04295 F
Total (Rs.) 114450.00

Verification

I, SRINIVASA RAO VINOD, son / daughter of SRINIVASA RAO working in the capacity of PROFESSIONAL II PAYROLL (designation) do hereby certify that a sum of
Rs. 114450.00 [Rs. One Lakh Fourteen Thousand Four Hundred and Fifty Only (in words)] has been deducted and a sum of Rs. 114450.00 [Rs. One Lakh Fourteen
Thousand Four Hundred and Fifty 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.

Place BENGALURU, BANGALORE

Date 07-Jun-2023 (Signature of person responsible for deduction of Tax)

Designation: PROFESSIONAL II PAYROLL Full Name:SRINIVASA RAO VINOD

Notes:
1. Part B (Annexure) of the certificate in Form No.16 shall be issued by the employer.
2. If an assessee is employed under one employer during the year, Part 'A' of the certificate in Form No.16 issued for the quarter ending on 31st March of the financial year shall contain the details
of tax deducted and deposited for all the quarters of the financial year.
3. If an assessee is employed under more than one employer during the year, each of the employers shall issue Part A of the certificate in Form No.16 pertaining to the period for which such
assessee was employed with each of the employers. Part B (Annexure) of the certificate in Form No. 16 may be issued by each of the employers or the last employer at the option of the assessee.
4. To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Legend used in Form 16

* 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

Signature Not Verified

VINOD S
Page 2 of 2
10.06.2023 22:07
 FORM NO. 16
PART B
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source on salary paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. FRXMYHA Last updated on 28-May-2023

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen
MMIS TECHNOLOGY SERVICES INDIA PRIVATE LIMITED
Surya Wave, Sy No 61 (P),, Doddathogur village,, Begur Hobli, Bangalore
BALAJI GOLLAPALLI
So,
7 115/1, NALUGU ROAD, GANDRAJUPALLE POST,
Electronic City Phase II, BANGALORE - 560013
GANGAVARAM MANDAL, GANGAVARAM CHITTOOR - 517432
Karnataka
Andhra Pradesh
+(91)80-9880690987
vinod.s@gainwelltechnologies.com
PAN of the Deductor TAN of the Deductor PAN of the Employee/Specified senior citizen

AANCM4253B BLRM34687C AZVPG0585G

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2023-24 01-Apr-2022 31-Mar-2023
Ganganagar, Bangalore - 560032

Annexure - I

Details of Salary Paid and any other income and tax deducted

Whether opting for taxation u/s 115BAC No

1. Gross Salary Rs. Rs.

(a) Salary as per provisions contained in section 17(1) 1684161.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 0.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 1684161.00

(e) Reported total amount of salary received from other employer(s) 0.00

2. Less: Allowances to the extent exempt under section 10

(a) Travel concession or assistance under section 10(5) 0.00

(b) Death-cum-retirement gratuity under section 10(10) 0.00

(c) Commuted value of pension under section 10(10A) 0.00

Cash equivalent of leave salary encashment under section 10

(d) 0.00
(10AA)

(e) House rent allowance under section 10(13A) 294036.00

Page 1 of 4
Signature Not Verified
VINOD S
10.06.2023 22:07
Certificate Number: FRXMYHA TAN of Employer: BLRM34687C PAN of Employee: AZVPG0585G Assessment Year: 2023-24

Amount of any other exemption under section 10

(f) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(g) Total amount of any other exemption under section 10 0.00

Total amount of exemption claimed under section 10

(h) 294036.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 1390125.00
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) 50000.00

(b) Entertainment allowance under section 16(ii) 0.00

(c) Tax on employment under section 16(iii) 2400.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 52400.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 1337725.00

7. Add: Any other income reported by the employee under as per section 192 (2B)

Income (or admissible loss) from house property reported by

(a) -200000.00
employee offered for TDS

(b) Income under the head Other Sources offered for TDS 0.00

Total amount of other income reported by the employee

8. -200000.00
[7(a)+7(b)]
9. Gross total income (6+8) 1137725.00

10. Deductions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life insurance premia, contributions to

(a) 281029.00 150000.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 281029.00 150000.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 0.00 0.00

Page 2 of 4
Signature Not Verified
VINOD S
10.06.2023 22:07
 Certificate Number: FRXMYHA TAN of Employer: BLRM34687C PAN of Employee: AZVPG0585G Assessment Year: 2023-24

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 0.00 0.00

Deduction in respect of health insurance premia under section

(g) 0.00 0.00
80D

Deduction in respect of interest on loan taken for higher

(h) education under section 80E 0.00 0.00

Gross Qualifying Deductible

Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(i) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(j) 0.00 0.00 0.00
under section 80TTA

Amount Deductible under any other provision (s) of Chapter VI-A

(k) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

Total of amount deductible under any other provision(s) of

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 150000.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 987725.00

13. Tax on total income 110046.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 4402.00

17. Tax payable (13+15+16-14) 114448.00

18. Less: Relief under section 89 (attach details) 0.00

19. Net tax payable (17-18) 114448.00

Verification
I, SRINIVASA RAO VINOD, son/daughter of SRINIVASA RAO .Working in the capacity of PROFESSIONAL II PAYROLL
(Designation) do hereby certify that the information given above is true, complete and correct and is based on the books of account,
documents, TDS statements, and other available records.

Place BENGALURU, BANGALORE (Signature of person responsible for deduction of tax)

Full
Date 07-Jun-2023 SRINIVASA RAO VINOD
Name:

Page 3 of 4
Signature Not Verified
VINOD S
10.06.2023 22:07
 Certificate Number: FRXMYHA TAN of Employer: BLRM34687C PAN of Employee: AZVPG0585G Assessment Year: 2023-24

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Particular's of Amount for any other
Sl. exemption under section 10 Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2..
3.
4.
5.
6.

10(k). Break up for ‘Amount deductible under any other provision(s) of Chapter VIA ‘to be filled in the table below
Particular's of Amount deductible under
Sl. any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

BENGALURU, BANGALORE (Signature of person responsible for deduction of

Place
tax)
Full
Date 07-Jun-2023 SRINIVASA RAO VINOD
Name:

Page 4 of 4
Signature Not Verified
VINOD S
10.06.2023 22:07
Certificate Number: FRXMYHA TAN of Employer:BLRM34687C PAN Of Employee:AZVPG0585G Assessment Year:2023-24 EMPID:3429

Annexure to Form No.16 PART B [for item nos. 2(f) and 10 (k)]

2. (f) Break up for 'Amount of any other exemption under section 10' to be filled in the table below
Sl.
No. Particulars of Amount for any other
exemption under section 10 Gross Amount Qualifying Amount Deductible Amount

Rs. Rs. Rs. Rs.

10(k). Break up for 'Amount deductible under any other provision(s) of Chapter VIA' to be filled in the table below
Sl.
No. Particulars of Amount deductible under
any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount

Rs. Rs. Rs. Rs.

Place
BANGALORE
(Signature of person responsible for deduction of tax)
Date
07-Jun-2023
Designation : PROFESSIONAL II PAYROLL Full Name : SRINIVASA RAO VINOD

Signature Not Verified

VINOD S
10.06.2023 22:07 Page 1 of 1 (Annexure to Form 16 - Part B)
Certificate Number: FRXMYHA EMPID:3429

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 the employer: MMIS TECHNOLOGY SERVICES INDIA PRIVATE LIMITED
Surya Wave, Sy No 61 (P), Doddathogur village, Begur Hobli,
Electronic City Phase II, KAR IND
2. TAN BLRM34687C
3. TDS Assessment Range of the employer:
4. Name, designation and Permanent Account Number or BALAJI GOLLAPALLI, Senior Professional Product Developer,
Aadhaar Number of employee: AZVPG0585G
5. Is the employee a director or a person with substantial No
interest in the company (where the employer is a company):
6. Income under the head 'Salaries' of the employee (other 1,337,725.00
than from perquisites):
7. Financial Year: 2022-2023

8. Valuation of Perquisites:

SL. Nature of perquisites(see rule 3) Value of Amount,if any Amount of

No. perquisite as per recovered from perquisite
rules (Rs.) employee (Rs.) chargeable to tax
Col(3)-Col(4)
(Rs.)
(1) (2) (3) (4) (5)
1 Accommodation 0.00 0.00 0.00
2 Cars/Other automotive 0.00 0.00 0.00
3 Sweeper, gardener, watchman or personal Attendant 0.00 0.00 0.00
4 Gas, electricity, water 0.00 0.00 0.00
5 Interest free or concessional loans 0.00 0.00 0.00
6 Holiday Expenses 0.00 0.00 0.00
7 Free or Concessional Travel 0.00 0.00 0.00
8 Free Meals 0.00 0.00 0.00
9 Free Education 0.00 0.00 0.00
10 Gifts, vouchers, etc. 0.00 0.00 0.00
11 Credit card expenses 0.00 0.00 0.00
12 Club expenses 0.00 0.00 0.00
13 Use of movable assets by employees 0.00 0.00 0.00
14 Transfer of assets to Employees 0.00 0.00 0.00
15 Value of any other benefit/amenity/service/privilege 0.00 0.00 0.00
16 Stock options allotted or transferred by employer being an eligible start-up 0.00 0.00 0.00
referred to in section 80-IAC
17 Stock options (non-qualified options) other than ESOP in col 16 above 0.00 0.00 0.00
18 Contribution by employer to fund and scheme taxable under section 0.00 0.00 0.00
17(2)(vii)
19 Annual accretion by way of interest, dividend etc. to the balance at the 0.00 0.00 0.00
credit of fund and scheme referred to in section 17(2)(vii) and taxable under
section 17(2)(viia)
20 Other benefits or amenities 0.00 0.00 0.00
21 Total value of perquisites 0.00 0.00 0.00
22 Total value of Profits in lieu of salary as per section 17(3) 0.00 0.00 0.00

9. Details of Tax.
a)Tax deducted from salary of the employee u/s 192(1) 114,450.00
b)Tax paid by employer on behalf of the employee u/s 192(1A) 0.00
c)Total Tax Paid 114,450.00
d)Date of payment into Government treasury Various dates as mentioned on Part A of the Form 16

DECLARATION BY THE EMPLOYER

I, SRINIVASA RAO VINOD, son/daughter of SRINIVASA RAO working as PROFESSIONAL II PAYROLL do hereby
declare on behalf of MMIS TECHNOLOGY SERVICES INDIA PRIVATE LIMITED that the information given above is based on
the books of account,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 thereunder and that such information is true and correct.

Place BANGALORE

Date 07-Jun-2023 (Signature of person responsible for deduction of tax)

Designation : PROFESSIONAL II PAYROLL Full Name : SRINIVASA RAO VINOD

Signature Not Verified

VINOD S
10.06.2023 22:07 Page 1 of 1 (Form 12BA)
Certificate Number: FRXMYHA EMPID:3429

FORM NO. 12BB

(See rule 26C)

Statement showing particulars of claims by an employee for deduction of tax under section 192

1. Name and address of the employee : BALAJI GOLLAPALLI

2. Permanent Account Number of the employee : AZVPG0585G
3. Financial year : 2022-2023

Details of claims and evidence thereof

Sl. No. Nature of claim Amount(Rs.) Evidence / particulars
(1) (2) (3) (4)
House Rent Allowance:

Property No : 1
(i) Rent paid to the landlord Rs.420000
(ii) Name of the landlord Muniswamy B
1. Rs.420000 House Rent Receipts
(iii) Address of the landlord #262, GF, Javarayappa Building, 6th Main,
Dharmaya temple street, Ramagondanahalli,
Whitefield, Bangalore, 56066
(iv) Permanent Account Number of the BNNPM0010R
landlord

2. Leave travel concessions or assistance Rs.0 Travel Receipts/Tickets

Deduction of interest on borrowing:

(i) Interest payable/paid to the lender

Self Occupied Interest :Rs.-200000

Let-OutInterest :
(ii) Name of the lender

Self Occupied : Ganesh DAN

Let-Out :

(iii) Address of the lender

Provisional Certificate from
3. Self Occupied : Sree karni nivas, Vibgyour scholl road, Rs.-200000
Near Jundanahalli gate, Munnekollala, Bank/Financial Institution/Lender
Bangalore-560037
Let-Out :

(iv) Permanent Account Number of the lender

Self Occupied : AOLPC5205N

Let-Out :

(a) Financial Institutions

(b) Employer
(c) Others

Signature Not Verified

VINOD S
10.06.2023 22:07 Page 1 of 2 (Form 12BB)
Certificate Number: FRXMYHA EMPID:3429

Deduction under Chapter VI-A

(A) Section 80C,80CCC and 80CCD

(i) Section 80C

Provident Fund : Rs.88215

Housing Loan - Principal Re-payment : Rs.192814

4. Rs. 281029 Photocopy of the investment proofs
(ii) Section 80CCC :
(iii) Section 80CCD :

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.

Verification
I, BALAJI GOLLAPALLI, son/daughter of Gangulappa G do hereby certify that the information given above is complete and correct.
Place : Bangalore

Date: 07-Jun-2023

(Signature of the employee)

Designation : Senior Professional Product Developer Full Name: BALAJI GOLLAPALLI

Note: The information/details above, as required for deduction of tax u/s 192 of the Income Tax Act, has been provided by the employee.

Signature Not Verified

VINOD S
10.06.2023 22:07 Page 2 of 2 (Form 12BB)