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Ref. No.

- EMP-137
Provisional Form No. 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 and address of the Employer Name and designation of the Employee

Samagra Development Associates Pvt. Ltd. Abhishek

,New Delhi,New Delhi


Emerging Leader

PAN / GIR No. TAN PAN / GIR No.


AASCS5052P DELS51192B CJKPA4180N

CIT (TDS) Assessment year Period


Address : From
2024-2025 To
City : PinCode :
12/06/2023 12/09/2023

Receipt Numbers of original Amount of tax deducted in Amount of tax


Quarter
statements of TDS under respect of employee deposited / remitted
sub-section in respect of
(3) of section 200. employee

Quarter 1 23805 0
Quarter 2 45654 0

Quarter 3 0 0

Quarter 4 0 0

Total 69459 0

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

1. Gross Salary
a) Salary as per provisions contained in sec.17(1) 563523
b) Value of perquisites u/s. 17(2) (as per Form No.12BA, 0
wherever applicable)
c) Profits in lieu of salary u/s 17(3)(as per Form No.12BA, 0
wherever applicable)
d) Total 563523

2. Less: Allowance to the extent exempt u/s. 10 :


a)

Total 0
3. Balance(1-2) 563523
4. Deductions :
a) Entertainment Allowance 0
b) Tax on Employment 0
5. Aggregate of 4(a) and (b) 50000
6. Income chargeable under the head 'Salaries'(3-5) 513523

7. Add: Any other income reported by the employee 0

8. Gross total income (6+7) 513523

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Ref. No.- EMP-137
9. Deductions under Chapter VIA
(A) Sections 80C,80CCC and 80CCD Gross Amount Deductible Amoun

Provident Fund 13,740 13,740


Gross Amount Qualifying Amoun Deductible
Amount
(B) Other sections (for e.g.,80E,80G etc.) under chapter VIA

10.Aggregate of deductible amounts under Chapter VI-A 0


11. Total Income (8-10) 513523
12. Tax on total income 0
13. Education Cess (on tax at S.No. 12 surcharge at S. No.13) 0
14. Tax payable (12 + 13) 0
15. Relief under section 89 ( attach details ) 0
16. Tax payable (14-15) 0

I son/daughter of working in the capacity of (designation) do hereby certify that a sum of Rs. .[ (in words)]
has been deducted at source and paid to the credit of the Central Government. I further certify that the
information given above is true and correct based on the books of accounts, documents and other available
records.

Signature of the person responsible for deduction of tax

Place : Full Name :

Date 08/12/2023 Designation

ANNEXURE-B

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT

S Amount Challan identification number (CIN)


No.
BSR Code of Bank Date on which tax deposited Transfer Voucher / Challan
branch (dd/MM/yyyy) Identification No.
0

Total

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