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. Last updated on

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

DISTRICT MALARIA OFFICE RAIGAD, ALIBAG KOLEKAR ANKUSH BHAGWAN

ALIBAG
410206
Maharashtra
PAN of the Deductor TAN of the Deductor PAN of the Employee Employee Reference No. provided
by the Employer (If available)
PANNOTREQD PNED53120G BBMPK6412J

CIT (TDS) Assessment year Period with the Employer

Address
2024-2025 From To

City Pin Code 01/04/2023 31/03/2024

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

Quarter 1 0 0
Quarter 2 0 0
Quarter 3 0 0
Quarter 4 0 0
Total 0 0 22000
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)
S.No. Tax Deposited in Book Identification Number (BIN)
respect of the
deductee (Rs.)

Receipt number of DDO serial number Date of transfer Status of matching

Form No. 24G in Form No. voucher with Form No.24G
24G (dd/mm/yyyy)
1
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)

S.No. Tax Deposited in Challan Identification number (CIN)

respect of the deductee
( Rs. )

BSR Code of the Bank Date of which tax Challan Serial Status of matching
Branch deposited (dd/mm/yyyy) Number with OLTAS
1
Total(Rs.)
 Verification
I RAJARAM BHOSALE Son of working in the capacity of DMO (designation) do here by certify that a sum of Rs.22000
[Rs.Twenty Two Thousand Only (in words) ] has been deducted and deposited to the credit of Central Government. I further
certify that the information given above is true, complete and correct and is based on the books of accounts, documents, TDS
statement, TDS deposited and other available records.

Place : ALIBAG

Date : 16/02/2024 (Signature of the person responsible for deduction of tax)

Designation: Full RAJARAM BHOSALE

Name :
DMO

Notes:
1. Government deductors to fill information in item I if tax is paid without production of an income-tax challan and in item II if tax
is paid accompanied by an income-tax challan
2. Non-Government deductors to fill information in item II.
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. 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.
6. In items I and II, in column for tax deposited in respect of deductee, furnish total amount of TDS and education cess.
 FORM NO. 16

PART B
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source on salary paid to an employee section 192
or pension/Interest income of specified senior citizen under section 194P
Certificate No. Last updated on

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

DISTRICT MALARIA OFFICE RAIGAD, ALIBAG KOLEKAR ANKUSH BHAGWAN

ALIBAG
410206
Maharashtra

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

PANNOTREQD PNED53120G BBMPK6412J

Assessment year
CIT (TDS) Period with the Employer

Address From To
2024-2025

City Pin Code 01/04/2023 31/03/2024

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 839189

(b) Value of perquisites u/s 17(2) (as per Form No. Rs NIL
12BA, wherever applicable)
(c) Profits in lieu of salary under section 17(3)(as per Rs NIL
Form No. 12BA, wherever applicable)
(d) Total Rs 839189
(e) Reported total amount of salary received from other Rs NIL
employer(s)
2 Less: Allowance to the extent exempt u/s 10
(a) Travel concession or assistance under section 10(5) Rs NIL
(b) Death-cum-retirement gratuity under section 10(10) Rs NIL
(c) Commuted value of pension under section 10(10A) Rs NIL
(d) Cash equivalent of leave salary encashment under section Rs NIL
10(10AA)
(e) House rent allowance under section 10(13A) Rs 33809
(f) Amount of any other exemption under section 10
Rs

(g) Total amount of any other exemption under section 10 Rs 0

(h) Total amount of exemption claimed under section 10 Rs 33809

[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]
3 Total amount of salary received from current employer Rs 805380
[1(d)-2(h)]

4 Less:Deduction under section 16

(a) Standard Deduction under section 16(ia) Rs 50000

(b) Entertainment Allowance under section 16(ii) Rs NIL

(c) Tax on employment under section 16(iii) Rs 2500

5 Total amount of deductions under section Rs 52500

16[4(a)+4(b)+4(c)]
6 Income chargeable under the head 'salaries' [(3+1(e)-5] Rs 752880

DISTRICT MALARIA OFFICE RAIGAD, ALIBAG Page 3 of 5

 A.Y. : 2024-2025 Name (PAN) : KOLEKAR ANKUSH BHAGWAN ( BBMPK6412J
)

7 Add: Any other income reported by the employee

under as per section 192 (2B)
(a) Income (or admissible loss) from house property Rs NIL
reported by employee offered for TDS
(b) Income under the head Other Sources offered for TDS Rs NIL
8 Total amount of other income reported by the employee Rs 0
[7(a)+7(b)]
9 Gross total income (6+8) Rs 752880

10 Deductions under Chapter VIA Gross Amount Deductible

Amount
(a)Deduction in respect of life insurance premia, Rs 74320 Rs 74320
contribution to provident fund etc. under section 80C
(b) Deduction in respect of contribution to certain pension Rs 0 Rs 0
funds under section 80CCC
(c) Deduction in respect of contribution by taxpayer to Rs 56195 Rs 56191
pension scheme under section 80CCD (1)
(d) Total Deduction under section 80C,80CCC and Rs 130515 Rs 130511
80CCD(1)
(e) Deductions in respect of amount paid/deposited to Rs 0 Rs 0
notified pension scheme under section 80CCD(1B)
(f) Deductions in respect of contribution by Employer to Rs 80512 Rs 78668
pension scheme under section 80CCD(2)
(g) Deductions in respect of health insurance premia Rs 14365 Rs 14365
under section 80D
(h) Deductions in respect of interest on loan taken for Rs 0 Rs 0
higher education under section 80E
Gross Amount Qualifying Amount Deductible Amount
(i) Total Deductions in respect of donations to certain Rs 0 Rs 0 Rs 0
funds, charitable institutions, etc. under section 80G
(i) Deductions in respect of interest on deposits in saving Rs 0 Rs 0 Rs 0
account under section 80TTA
(k Amount deductible under any other provision(s) of
Chapter VI-A
1) Section 80DDB Rs 40000 Rs 40000 Rs 400

(l) Total of amount deductible under any other provision Rs 40000 Rs 40000 Rs 40000
of Chapter VI-A
11 Aggregate of deductible amount under Chapter VIA Rs 263544
[10(a)+10(b)+10(c)+10(d)+10(e)+10(f)+10(g)+10(h) .
+10(i)+10(j)+10(l)]
12 Total taxable income (9-11) Rs 489336
13 Tax on total income Rs 11967
14 Rebate under section 87A, if applicable Rs 11967
15 Surcharge, wherever applicable Rs NIL
16 Health and education cess Rs NIL
17 Tax payable (13+15+16-14) Rs 0
18 Less: Relief under section 89 (attach details) Rs NIL
19 Net tax payable (17-18) Rs 0

Verification
I RAJARAM BHOSALE Son of working in the capacity of DMO (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.

DISTRICT MALARIA OFFICE RAIGAD, ALIBAG Page 4 of 5

 Place : ALIBAG

Date : 16/02/2024 (Signature of the person responsible for deduction of tax)

Designation: Full RAJARAM BHOSALE

Name :
DMO

DISTRICT MALARIA OFFICE RAIGAD, ALIBAG Page 5 of 5