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. ANQTLKA Last updated on 08-Jul-2020

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

RELIANCE CORPORATE IT PARK LIMITED

3RD FLOOR, COURT HOUSE,, LOKMANYA TILAK MARG,,
PARIKSHIT MANUBHAI MODI
DHOBI TALAO,, MUMBAI - 400002
C 56, PRAMUKHPARK I BEHIND, SAHIYOG OPPOSITE
Maharashtra
AMBALAL, PARK GORWA, VADODARA - 390016 Gujarat

Employee Reference No.

PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

AABCD7169H MUMR17044G AMDPM5871C

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2020-21 01-Apr-2019 31-Mar-2020
Building, Charni Road , Mumbai - 400002

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

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q1 FFXHUXXT 93018.00 0.00 0.00

Q2 FXHZVUBT 107783.00 0.00 0.00
Total (Rs.) 200801.00 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
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

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

1 0.00 - 07-05-2019 - F
2 0.00 - 07-05-2019 - F
3 0.00 - 07-06-2019 - F
4 0.00 - 07-06-2019 - F
5 0.00 - 06-07-2019 - F
6 0.00 - 06-07-2019 - F

Page 1 of 2
 Certificate Number: ANQTLKA TAN of Employer: MUMR17044G PAN of Employee: AMDPM5871C Assessment Year: 2020-21

Challan Identification Number (CIN)

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

7 0.00 - 07-08-2019 - F
8 0.00 - 07-09-2019 - F
Total (Rs.) 0.00

Verification

I, HARISH DHANSUKHLAL SHAH, son / daughter of working in the capacity of AUTHORISED SIGNATORY (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] has been 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 MUMBAI

Date 16-Jul-2020 (Signature of person responsible for deduction of Tax)

Designation: AUTHORISED SIGNATORY Full Name:HARISH DHANSUKHLAL SHAH

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 only when payment
U Unmatched
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 Final (F) on
P Provisional
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 payment details
F Final 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 statement but the
O Overbooked 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 Harish Dhansukhlal Shah
Date: Jul 20, 2020 01:51:16 IST
Reason: Form 16
Location: Mumbai

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. ANQTLKA Last updated on 08-Jul-2020

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

RELIANCE CORPORATE IT PARK LIMITED

3RD FLOOR, COURT HOUSE,, LOKMANYA TILAK MARG,,
PARIKSHIT MANUBHAI MODI
DHOBI TALAO,, MUMBAI - 400002
C 56, PRAMUKHPARK I BEHIND, SAHIYOG OPPOSITE
Maharashtra
AMBALAL, PARK GORWA, VADODARA - 390016 Gujarat

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

AABCD7169H MUMR17044G AMDPM5871C

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2020-21 01-Apr-2019 31-Aug-2019
Building, Charni Road , Mumbai - 400002

Details of Salary Paid and any other income and tax deducted Rs. Rs.

1. Gross Salary

(a) Salary as per provisions contained in section 17(1) 271212.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 0.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 271212.00

(e) Reported total amount of salary received from other employer(s) 0.00

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 section 10

(d) 0.00
(10AA)

(e) House rent allowance under section 10(13A) 18410.00

Page 1 of 4
Certificate Number: ANQTLKA TAN of Employer: MUMR17044G PAN of Employee: AMDPM5871C Assessment Year: 2020-21

Amount of any other exemption under section 10

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

(g) Total amount of any other exemption under section 10 1000.00

Total amount of exemption claimed under section 10

(h) 19410.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 251802.00
[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) 1000.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 51000.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 200802.00

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

Income (or admissible loss) from house property reported by

(a) -21252.00
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. -21252.00
[7(a)+7(b)]
9. Gross total income (6+8) 179550.00

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

Deduction in respect of life insurance premia, contributions to

(a) 150000.00 150000.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 150000.00 150000.00

Deductions in respect of amount paid/deposited to notified

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

Page 2 of 4
 Certificate Number: ANQTLKA TAN of Employer: MUMR17044G PAN of Employee: AMDPM5871C Assessment Year: 2020-21

Deduction in respect of contribution by Employer to pension

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

Deduction in respect of health insurance premia under section

(g) 0.00 0.00
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 account
(j) 0.00 0.00 0.00
under section 80TTA

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

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

Total of amount deductible under any other provision(s) of

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 150000.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 29550.00

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, HARISH DHANSUKHLAL SHAH, son/daughter of .Working in the capacity of AUTHORISED SIGNATORY (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.
Signature Not Verified
Place MUMBAI (Signature of person responsible for deduction of tax)
Digitally signed by Harish Dhansukhlal Shah
Date: Jul 20, 2020 01:51:16 IST
Full
Date 16-Jul-2020 HARISH
Reason: Form 16 DHANSUKHLAL SHAH
Name:
Location: Mumbai

Page 3 of 4
 Certificate Number: ANQTLKA TAN of Employer: MUMR17044G PAN of Employee: AMDPM5871C Assessment Year: 2020-21

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Particular's of Amount for any other
Sl. exemption under section 10 Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2..
3.
4.
5.
6.

10(k). Break up for ‘Amount deductible under any other provision(s) of Chapter VIA ‘to be filled in the table below
Particular's of Amount deductible under
Sl. any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

MUMBAI (Signature of person responsible for deduction of

Place
tax)
Full
Date 16-Jul-2020 HARISH DHANSUKHLAL SHAH
Name:

Signature Not Verified

Digitally signed by Harish Dhansukhlal Shah
Date: Jul 20, 2020 01:51:16 IST
Reason: Form 16
Location: Mumbai

Page 4 of 4
 Annexure to Part B Form No.16

Name of the employer :Reliance Corporate IT Park Ltd.

TAN:MUMR17044G
Assessment Year :2020-2021
Name: Parikshit Modi Emp No.: 55025073 PAN:AMDPM5871C

Part B Annexure Amount(Rs.)

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Details of Sr.2(f)-Other Exemptions u/s 10.

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

CEA Exemption 1,000

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- -------

Total Exemption 1,000

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Details of Srno.10(K) Amount(Rs.)

Chapter VI-A Deduction(Other Provisions)
--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Signature Not Verified

Digitally signed by Harish Dhansukhlal Shah
Date: Jul 20, 2020 01:51:16 IST
Reason: Form 16
Location: Mumbai
Date: 15.07.2020 Full Name: HARISH D SHAH
Place: Mumbai Designation: AUTHORISED SIGNATORY
Annexure to Digitally Signed Certificate.
 FORM No.12BA
See Rule 26A(2)(b)

Statement showing particulars of perquisites , other fringe

benefits or amenities and profits in lieu of salary with value thereof
1) Name and address of employer :
Reliance Corporate IT Park Ltd. , 3rd Floor, Court House, L T Marg, Dhobi Talao, Mumbai - 400002 , Maharashtra
2) TAN: MUMR17044G
3) TDS Assessment Range of the employer :
CIT(TDS), 9thFlr, Smt.KGM Ayurvedic Hosp, Charni Road, Mumbai, 400002,
4) Name, designation and PAN of employee :
Parikshit Modi , Desig.: , Emp #: 55025073 , PAN: AMDPM5871C
5) Is the employee a director or a person with substantial interest in
the company (where the employer is a company): No
6) Income under the head "Salaries" of the employee : 200,802
(other than from perquisites)
7) Financial year : 2019-2020
8) Valuation of Perquisites

S.No Nature of perquisites Value of perquisites Amount, if any recovered Amount of perquisites
(see rule 3) as per rules(Rs.) from the employee(Rs.) chargeable to tax(Rs.)
(1) (2) (3) (4) (5) Col(3)-Col(4)
1 Accommodation 0 0 0
2 Cars/Other automotive 0 0 0
3 Sweeper , gardener , watchman or 0 0 0
personal attendant
4 Gas , electricity , water 0 0 0
5 Interest free or concessional loans 0 0 0
6 Holiday expenses 0 0 0
7 Free or concessional travel 0 0 0
8 Free meals 0 0 0
9 Free Education 0 0 0
10 Gifts,vouchers etc. 0 0 0
11 Credit card expenses 0 0 0
12 Club expenses 0 0 0
13 Use of movable assets by employees 0 0 0
14 Transfer of assets to employees 0 0 0
15 Value of any other benefit 0 0 0
/amenity/service/privilege
16 Stock options ( non-qualified options ) 0 0 0
17 Other benefits or amenities 0 0 0
18 Total value of perquisites 0 0 0
19 Total value of Profits in lieu of salary 0 0 0
as per 17 (3)

9. Details of tax, - (a) Tax deducted from salary of the employee u/s192(1) 0
(b) Tax paid by employer on behalf of the employee u/s 192(1A) 0
(bb) Tax paid by previous employer/or on other income 0
(c) Total tax paid 0
(d) Date of payment into Government treasury *
* Refer PART A of form No 16 under Details of tax deducted and depositedin the Central Government Account.

DECLARATION BY EMPLOYER Signature Not Verified

I HARISH D SHAH son/daughter DHANSUKHLAL SHAH working as AUTHORISED SIGNATORY ( designation ) do hereby declare on behalf
of Reliance Corporate IT Park Ltd. ( name of the employer ) that the informationDigitally signed
given above by Harish
is based on theDhansukhlal Shah
books of account , documents
Date: Apr 30, 2020 01:51:16 IST
and other relevant records or information available with us and the details of valueReason:
of each such perquisite
Form 16 are in accordance with section 17
and rules framed thereunder and that such information is true and correct. Location: Mumbai
Signature of the person responsible
for deduction of tax
Place: MUMBAI Full Name : HARISH D SHAH
Date : 30.04.2020 Designation : AUTHORISED SIGNATORY