FORM NO.

16

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 address of the Employee
SANT FRANNCIS SHIKSHAK SANSTHA PARVEZ AHMAD
SANJAY NAGAR, BAREILLY-243001 BAREILLY
PAN of the Deductor TAN of the Deductor PAN of the Employee
AAETS7856G LKNS05903C AHTPA2695R
CIT(TDS)
Assessment Year Period
Address THE COMMISSIONER OF INCOME TAX (TDS)

5-ASHOK ROAD From To

2020-21
City LUCKNOW Pin code 226001 1/Apr/2019 31/Mar/2020
Summary of amount paid/credited and tax deducted at source thereon in respect of the employee
Quarter(s) Receipt Numbers of original quarterly Amount Amount of tax Amount of tax
statements of TDS paid/credited deducted deposited/remitted
under sub-section (3) of section 200 (Rs. ) (Rs. )

Quarter 1
Quarter 2
Quarter 3
Quarter 4
Total 0 0 0
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)
Sl. No Tax Deposited in Book Identification Number (BIN)
respect of the deductee
(Rs. ) Receipt numbers of DDO serial number Date of transfer Status of matching
Form No. 24G in Form No. 24G voucher with Form No. 24G
dd/mm/yyyy

1
2
3
4
5
6
7
8
9
10
11
12
Total ( Rs. ) 0

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

1
2
3
4
5
6
7
8
9
10
11
12
Total ( Rs.) 0

Verification
I, SR. RAISY , son/daughter of KOCHAPPU
working in the capacity of SECRETARY (designation) do hereby certify that a sum of Rs. 0
RUPEES NIL ONLY has been deducted and 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: BAREILLY
Date: 5/15/2020 (Signature of person responsible for deduction of tax)
Designation: SECRETARY Full Name: SR. RAISY

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 PART B (Annexure)
Details of Salary paid and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisions contained in sec.17(1) Rs. 496133
Value of perquisites u/s 17(2) (as per
(b) Rs.
Form No.12BA, wherever applicable)
Profits in lieu of salary under section 17(3)
(c) Rs.
(as per Form No.12BB, wherever applicable)
(d) Total Rs. 496133
2. Less: Allowances to the extent exempt under section 10
(a) Travel concession or assistance under section 10(5) Rs.
(b) Death-cum-retirement gratuity under section 10(10) Rs.
(c) Commuted value of pension under section 10(10A) Rs.
Cash equivalent of leave salary encashment under
(d) Rs.
section 10(10AA)
(e) House rent allowance under section 10(13A) Rs.
(f) Amount of any other exemption under section 10
clause Rs.
clause Rs.
clause Rs.
clause Rs.
clause Rs.
Rs.
(g) Total amount of any other exemption under section 10 Rs. 0
Total amount of exemption claimed under section 10
(h) Rs. 0
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]
Total amount of salary received from current employer
3. Rs. 496133
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) Rs.
(b) Entertainment allowance under section 16(ii) Rs.
(c) Entertainment allowance under section 16(ii) Rs.
Total amount of deductions under
5. Rs. 0
section 16 [4(a)+4(b)+4(c)]
Income chargeable under the head "Salaries"
6. Rs. 496133
[(3+1(e)-5]
7. Add: Any other income reported by the employee under as per section 192 (2B)
Income (or admissible loss) from house property
(a) Rs.
reported by employee offered for TDS
(b) Income under the head Other Sources offered for TDS Rs.
Total amount of other income reported by the
8. Rs. 0
employee [7(a)+7(b)]
9. Gross total income (6+8) Rs. 496133
10. Deductions under Chapter VI-A
Gross Amount Deductible Amount
Deduction in respect of life insurance premia,
(a) Rs. Rs. 0
contributions to provident fund etc. under section 80C

Deduction in respect of contribution to certain pension

(b) Rs. Rs.
funds under section 80CCC
Deduction in respect of contribution by taxpayer to
(c) Rs. Rs.
pension scheme under section 80CCD (1)

Total deduction under section 80C, 80CCC

(d) Rs. Rs.
and 80CCD(1)

Deductions in respect of amount paid/deposited to

(e) Rs. Rs.
notified pension scheme under section 80CCD (1B)

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 Deduction in respect of contribution by Employer to
(f) Rs. Rs.
pension scheme under section 80CCD (2)

Deduction in respect of health insurance premia

(g) Rs. Rs.
under section 80D

Deduction in respect of interest on loan taken for

(h) Rs. Rs.
higher education under section 80E
Gross Amount Qualifying Amount Deductible Amount
Total Deduction in respect of donations to certain
(i) Rs. Rs. Rs.
funds, charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in
(j) Rs. Rs. Rs. 0
savings account under section 80TTA / 80TTB
(k) Amount deductible under any other provision(s) of Chapter VI‐A
section PF Rs. 21600 Rs. 21600 Rs. 21600
section Rs. Rs. Rs.
section Rs. Rs. Rs.
section Rs. Rs. Rs.
section Rs. Rs. Rs.
section Rs. Rs. Rs.
Rs. Rs. Rs.
Total of amount deductible under any other
(l) Rs. 21600 Rs. 21600 Rs. 21600
provision(s) of Chapter VI‐A
Aggregate of deductible amount under Chapter VI-A
11. [10(a)+10(b)+10(c)+10(d)+10(e)+10(f)+10(g)+10(h) Rs. 21600
+10(i)10(j)+10(l)]
12. Total taxable income (9-11) Rs. 474533
13. Tax on total income Rs. 11227
14. Rebate under section 87A, if applicable Rs. 11227
15 Surcharge, wherever applicable Rs.
16. Health & Education cess Rs. 0
17. Tax payable (13+15+16-14) Rs. 0
18. Less: Relief under section 89 (attach details) Rs.
19. Net tax payable (17-18) Rs. 0

Verification
I, SR. RAISY , son/daughter of KOCHAPPU
working in the capacity of SECRETARY (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: BAREILLY
Date: 5/4/2020 (Signature of person responsible for deduction of tax)
Designation: SECRETARY Full Name: SR. RAISY
Notes:
1. Government deductors to fill information in item I of Part A if tax is paid without production of an income-tax challan
and in item II of Part A if tax is paid accompanied by an income-tax challan.

2. Non-Government deductors to fill information in item II of Part A.

3. The deductor shall furnish the address of the Commissioner of Income-tax (TDS) having jurisdiction as regards TDS
statements of the assessee.

4. If an assessee is employed under one employer only during the year, 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.

5. (i) 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.
(ii) 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.

6. In Part A, in items I and II, in the column for tax deposited in respect of deductee, furnish total amount of tax,
surcharge and health and education cess.

7. Deductor shall duly fill details, where available, in item numbers 2(f) and 10(k) before furnishing of Part B (Annexure)
to the employee.”;
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