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 3
Employer - PAO Code Name and Rank of the Employee
79 ROSHON CHETRI
PAN of the Deductor TAN of the Deductor PAN of the Employee
ACOPT9401E LKNP06178E BNIPC4091F
CIT(TDS) Address Assessment Year / Tax Option Period
5 Ashok Marg, Lucknow 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
Quarter 2
Quarter 3
Quarter 4
Total
PART-B
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
` ` ` `
1. Gross Salary 574801
2. Standard Deduction 50000
3. Less Allowance to the extent exempt under Section 10 0
4. BALANCE (1 - 2) 524801
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) 524801
8. Add: Any other income reported by the employee * 0
9. GROSS TOTAL INCOME (6 + 7) 524801
10. DEDUCTIONS UNDER CHAPTER VI-A GROSS AMT QUAL AMT QUAL AMT DEDUCT AMT
a) Qualified under Sec.80C 120000 120000 120000
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 120000
12. Total Income (8 - 10) Rounded 404800
12. TAX ON TOTAL INCOME - SEC 87A REBATE(Rs.7740) 0
14. Health & Education Cess @4% (on tax computed at Sl.No.12) 0
15. Tax Payable (12 + 13) 0
16. Less: Relief under Section 89(attach Details) 0
17. Less : Tax Deducted 0
18. TAX PAYABLE/REFUNDABLE (15 - 16) 0
VERIFICATION
BREAK UP OF TAXABLE EMOLUMENTS FINANCIAL YEARWISE Page 2 3
I, Lalit Kumar Tiwari, son/daughter of Late L M Tiwari working in the capacity of AAO do hereby certify
that a sum of Rs. 0 (in words) Rupees Zero 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 : 22/05/2023 Full Name Lalit Kumar Tiwari
Designation AAO
BREAK UP OF TAXABLE EMOLUMENTS FINANCIAL YEARWISE Page 3 3
Employer - PAO Code Name and Rank of the Employee
79 ROSHON CHETRI
For the financial year from 01/03/2021 to 28/02/2022 = 25779.0
For the financial year from 01/03/2022 to 28/02/2023 = 549022.0
Total taxable emoluments 574801.0
