FORM 16

Inser
AssessmentYear:
Assessment Year:
2021-22

FinancialYear:
Financial Year 2020-21

Employee ID: DC00619

Employee Name:

Employee
EmployeeName:
Pan:
GOPAL HARISH

Employee
EmployeePAN:
Designation: AEIPH4141P

Employee Designation: Senior Executive - Payroll and Compliance

Employer Name:

Employer Name: G S E-COMMERCE PRIVATE LIMITED

Employer Address:

Employer TAN:
Employer Tan: BLRG20605E

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Digitally Signed
 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

Certificate No. ATSHCBA Last updated on 29-Jun-2021

Name and address of the Employer Name and address of the Employee

G S E-COMMERCE PRIVATE LIMITED

NO41, MEDSOFTBUILDING 2ND FLOOR, KANAKAPURA
MAINROAD, GOPAL HARISH
BASAVANAGUDI, BANGALORE - 560011 NO 94, SRI KRUPA, KOWDENA HALI MAINROAD,
Karnataka RAMAMURTHY NAGAR BANGALOR - 560016 Karnataka

[email protected]
Employee Reference No.
PAN of the Employee provided by the Employer
PAN of the Deductor TAN of the Deductor
(If available)

AAFCG0578B BLRG20605E AEIPH4141P

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 , 2021-22 01-Apr-2020 31-Mar-2021
Ganganagar, Bangalore - 560032

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

Receipt Numbers of
original quarterly Amount of tax deposited / remitted
Amount of tax deducted
Quarter(s) statements of TDS under Amount paid/credited (Rs.)
(Rs.)
sub-section (3) of
Section 200
Q1 QUHMKVSG 51392.00 0.00 0.00
Total (Rs.) 51392.00 0.00 0.00
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
(Rs.) Receipt Numbers of Form DDO serial number in Form no.
(dd/mm/yyyy) with Form no. 24G
No. 24G 24G

Total
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.) Date on which Tax deposited Status of matching with
BSR Code of the Bank Challan Serial Number
(dd/mm/yyyy) OLTAS*
Branch

1 0.00 - 01-05-2020 - F
Total 0.00

Verification

I, SHEZAN MOHAMMAD MOBIN BHOJANI, son / daughter of MOBIN MOHAMMAD RAMZANALI BHOJANI working in the capacity of DIRECTOR
(designation) do hereby certify that a sum of Rs. 0.00 [Rs. Zero Only (in words)] has been deducted and a sum of Rs. 0.00 [Rs. Zero Only]
h a s b e e n d e p o s i t e d t o t h e c r e d i t o f t h e C e n t r a l G o v e r n m e n t . I f u r t h e r c e r t i f y t h a t t h e i n f o r m a t i o nSignature
g i v e n a b oNot
v e iVerified
s true, complete and
c o r r e c t a n d i s b a s e d o n t h e b o o k s o f a c c o u n t , d o c u m e n t s , T D S s t a t e m e n t s , T D S d e p o s i t e d a n d o t h e r aDigitally
v a i l a b l esigned
r e c o rby
d sShezan
.
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:24
IST
Page 1 of 2
 Certificate Number: Assessment Year:
ATSHCBA TAN of Employer: BLRG20605E PAN of Employee: AEIPH4141P 2021-22

Place BANGALORE

Date 06-Jul-2021 (Signature of person responsible for deduction of Tax)

Designatio Full
DIRECTOR SHEZAN MOHAMMAD MOBIN BHOJANI
n: Name:

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
U Unmatched
only when payment 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
P Provisional
Final (F) on 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
F Final payment details 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
O Overbooked statement but the 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

Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:24
IST
Page 2 of 2
 FORM NO. 16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. ATSHCBA Last updated on 29-Jun-2021

Name and address of the Employer Name and address of the Employee

G S E-COMMERCE PRIVATE LIMITED

NO41, MEDSOFTBUILDING 2ND FLOOR, KANAKAPURA
MAINROAD, GOPAL HARISH
BASAVANAGUDI, BANGALORE - 560011 NO 94, SRI KRUPA, KOWDENA HALI MAINROAD,
Karnataka RAMAMURTHY NAGAR BANGALOR - 560016 Karnataka

[email protected]

PAN of the Deductor TAN of the Deductor PAN of the Employee

AAFCG0578B BLRG20605E AEIPH4141P

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 , 2021-22 01-Apr-2020 31-Mar-2021
Ganganagar, Bangalore - 560032

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) 51392.00

Value of perquisites under section 17(2) (as per Form

(b) 0.00
No. 12BA, wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form
(c) 0.00
No. 12BA, wherever applicable)
(d) Total 51392.00
Reported total amount of salary received from other
(e) 0.00
employer(s)
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

(d) 0.00
section 10(10AA)

(e) House rent allowance under section 10(13A) 0.00

Signature Not Verified

Page 1 of 4
Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:25
IST
Certificate Number: Assessment Year:
ATSHCBA TAN of Employer: BLRG20605E PAN of Employee: AEIPH4141P 2021-22

Amount of any other exemption under section 10

[Note: Break-up to be filled and signed by employer in the table
(f)
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) 0.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 51392.00
[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) 200.00

Total amount of deductions under section 16 [4(a)+4(b)

5. 50200.00
+4(c)]

Income chargeable under the head "Salaries" [(3+1(e)

6. 1192.00
-5]

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

Income (or admissible loss) from house property

(a) 0.00
reported by 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. 0.00
[7(a)+7(b)]
9. Gross total income (6+8) 1192.00

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

Deduction in respect of life insurance premia,

(a) 1192.00 1192.00
contributions to provident fund etc. under section 80C

Deduction in respect of contribution to certain pension

(b) funds 0.00 0.00
under section 80CCC
Deduction in respect of contribution by taxpayer to
(c) pension 0.00 0.00
scheme under section 80CCD (1)

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 1192.00 1192.00

Deductions in respect of amount paid/deposited to

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

Signature Not Verified

Page 2 of 4
Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:25
IST
 Certificate Number: Assessment Year:
ATSHCBA TAN of Employer: BLRG20605E PAN of Employee: AEIPH4141P 2021-22

Deduction in respect of contribution by Employer to

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

Deduction in respect of health insurance premia under

(g) 0.00 0.00
section 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
(j) 0.00 0.00 0.00
account

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

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

Total of amount deductible under any other provision(s)

(l) 0.00 0.00 0.00
of

Aggregate of deductible amount under Chapter VI-A

11. 1192.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 0.00

13. Tax on total income 0.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 0.00

17. Tax payable (13+15+16-14) 0.00

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

19. Net tax payable (17-18) 0.00

Verification
I, SHEZAN MOHAMMAD MOBIN BHOJANI, son/daughter of MOBIN MOHAMMAD RAMZANALI BHOJANI .Working in
the capacity of DIRECTOR (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 BANGALORE (Signature of person responsible for deduction of

Full
Date 06-Jul-2021 SHEZAN MOHAMMAD MOBIN BHOJANI
Name:

Signature Not Verified

Page 3 of 4
Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:26
IST
Name: GOPAL HARISH PAN: AEIPH4141P

2.(f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
S No Amount of any other exemption under Gross Amount Qualifying Amount Deductible Amount
section 10 (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
S No Amount deductible under any other Gross Amount Qualifying Amount Deductible Amount
provision(s) of Chapter (Rs.) (Rs.) (Rs.)

Place BANGALORE
Date 06-Jul-2021
Designation DIRECTOR
Full Name SHEZAN M BHOJANI Signature of Person Responsible for Deduction of Tax

Signature Not Verified

Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:26
IST
G S E-COMMERCE PRIVATE LIMITED Page 1 of 3
Name: GOPAL HARISH PAN: AEIPH4141P

FORM NO. 12BA

[See rule 26A(2)(b)]
Statement Showing particular of perquisites, other fringe benefits or amenities and profits in lieu of salary with value
thereof

(1) Name and address of Employer G S E-COMMERCE PRIVATE LIMITED

NO41, MEDSOFTBUILDING 2ND FLOOR, KANAKAPURA
MAINROAD, BASAVANAGUDI, BANGALORE, Karnataka,
560011
(2) TAN BLRG20605E
(3) TDS Assessment Range of the employer
(4) Name, designation and PAN of employee GOPAL HARISH
Senior Executive - Payroll and Compliance
AEIPH4141P
(5) Is the employee a director or a person with No
substantial interest in the company(Where the
employer is a company)
(6) Income under the head Salaries of the employee 1,192.00
(Other than from Perquisites)
(7) Financial Year 2020-2021
(8) Valuation of Perquisites
S No Nature of Perquisite (See rule 3) Value of Amount, if any Amount of
Perquisite as Recovered from perquisite
per rules the employee chargeable to
(Rs.) (Rs.) tax
col(3) - col(4)
(Rs.)
(1) (2) (3) (4) (5)
1 Accomodation 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 / 0.00 0.00 0.00
privilege
16 Stock options allotted or transferred by employer being 0.00 0.00 0.00
an eligigble startup as referred to in Section 80-IAC
17 Stock options (non-qualified options) other than ESOP 0.00 0.00 0.00
above
18 Contribution by employer to fund and scheme (taxable 0.00 0.00 0.00
under section 17(2)(vii))
Signature Not Verified
Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:27
IST
G S E-COMMERCE PRIVATE LIMITED Page 2 of 3
Name: GOPAL HARISH PAN: AEIPH4141P

19 Annual accretion of taxable interest/dividend to fund 0.00 0.00 0.00

referred to above
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 17(3) 0.00
(9) Details of tax
(a) Tax Deducted from salary of the employee under section 192(1) 0.00
(b) Tax paid by the employer on behalf of the employee under -
section 192(1A)
(c) Total Tax paid 0.00

DECLARATION BY EMPLOYER
I, SHEZAN M BHOJANI, son/daughter of MOBIN MOHAMMAD working in the capacity of DIRECTOR (designation) do
hereby declare on behalf of G S E-COMMERCE PRIVATE LIMITED (name of the employer) 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 06-Jul-2021
Designation DIRECTOR
Full Name SHEZAN M BHOJANI Signature of Person Responsible for Deduction of Tax

Signature Not Verified

Digitally signed by Shezan
Mohammad Mobin Bhojani
Date: 2021.07.14 12:39:27
IST
G S E-COMMERCE PRIVATE LIMITED Page 3 of 3