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Form 1615072023 161901

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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
Page 1 2

Employer - PAO Code Name and Rank of the Employee


60 ARJUN SINGH RAJPUT
PAN of the Deductor TAN of the Deductor PAN of the Employee
CHAPK1375B JBPPO1632B DFQPR0506N
CIT(TDS) Address Assessment Year / Tax Option Period
ITO WARD 1(2) JABALPUR 2023-2024/OLD 01/04/2022 TO 31/03/2023
Summary of Tax deducted at Source
Quarter Receipt Numbers of original statements of Amount of tax deducted Amount of tax deducted/remitted
TDS under sub-section(3) of section 200 in respect of the employee in respect of the employee
Quarter 1 FXBYJCES 0 0
Quarter 2 FXBAMBYG 0 0
Quarter 3 FXBCYDGG 0 0
Quarter 4 FXBEPWBW 105752 105752
Total 105752 105752
PART-B
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
` ` ` `
1. Gross Salary 1126260
2. Standard Deduction 50000
3. Less Allowance to the extent exempt under Section 10 138
4. BALANCE (1 - 2) 1076122
5. DEDUCTIONS :
a. Interest payable on loan u/s 24 : 0
6. Aggregate of 5 ( a to b ) 0
7. Income chargeable under the Head 'SALARIES' (3 - 5) 1076122
8. Add: Any other income reported by the employee * 0
9. GROSS TOTAL INCOME (6 + 7) 1076122
10. DEDUCTIONS UNDER CHAPTER VI-A GROSS AMT QUAL AMT QUAL AMT DEDUCT AMT
a) Qualified under Sec.80C 130200 130200 130200
b) Qualified for 100% deduction 0 0 0
c) Qualified for 50% deduction 0 0 0
d) Qualified under Sec.80DD 0 0 0
e) Qualified under Sec.80U 0 0 0
11. Aggregate of deductible amount under Chapter VI-A 130200
12. Total Income (8 - 10) Rounded 945920
13. TAX ON TOTAL INCOME 101684
14. Health & Education Cess @4% (on tax computed at Sl.No.12) 4068
15. Tax Payable (12 + 13) 105752
16. Less: Relief under Section 89(attach Details) 0
17. Less : Tax Deducted 105752
18. TAX PAYABLE/REFUNDABLE (15 - 16) 0

VERIFICATION

I, Binod Kumar, son/daughter of S.R. Prajapati working in the capacity of AAO do hereby certify that a
sum of Rs. 105752 (in words) Rupees One Lakh Five Thousand Seven Hundred Fifty Two only. has been
deducted and deposited to the credit of Central Government. I further certify that the above information is true,
complete and correct and is based on the books of account, documents, TDS statements, TDS deposited and
other available records.

Note * : Sl.No.8 above Other Income includes taxable interest accrued on Fund Subscription above 500000 Rupees

Place : Signature of the person responsible for deduction of tax


Date : 18/05/2023 Full Name Binod Kumar
Designation AAO
BREAK UP OF TAXABLE EMOLUMENTS FINANCIAL YEARWISE Page 2 2

Employer - PAO Code Name and Rank of the Employee


60 ARJUN SINGH RAJPUT
For the financial year from 01/03/2020 to 28/02/2021 = 107793.0
For the financial year from 01/03/2021 to 28/02/2022 = 306924.0
For the financial year from 01/03/2022 to 28/02/2023 = 711543.0
Total taxable emoluments 1126260.0

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