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 2

Employer - PAO Code Name and Rank of the Employee

94 SURESH SINGH TOMAR
PAN of the Deductor TAN of the Deductor PAN of the Employee
AICPD1965H CHNP03859C AGAPT8716E
CIT(TDS) Address Assessment Year Period
ITO Kannur 2020-2021 01/04/2019 TO 31/03/2020
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 * 516046
2. Standard Deduction * 50000
3. Less Allowance to the extent exempt under Section 10 49200
4. BALANCE (1 - 2) 466846
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) 466846
8. Add: Any other income reported by the employee 0
9. GROSS TOTAL INCOME (6 + 7) 466846
10. DEDUCTIONS UNDER CHAPTER VI-A GROSS AMT QUAL AMT QUAL AMT DEDUCT AMT
a) Qualified under Sec.80C 151080 150000 150000
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 150000
12. Total Income (8 - 10) Rounded 316850
12. TAX ON TOTAL INCOME - SEC 87A REBATE(Rs.3343) 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

I, V K Dinesh, son/daughter of M. Balan Erady 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 : Health and Education Cess @4% Charged On Income Tax (Rounded off to next higher rupee)

Place : Signature of the person responsible for deduction of tax

Date : 29/05/2020 Full Name V K Dinesh
Designation AAO
 BREAK UP OF TAXABLE EMOLUMENTS FINANCIAL YEARWISE Page 2 2

Employer - PAO Code Name and Rank of the Employee

94 SURESH SINGH TOMAR
For the financial year from 01/03/2018 to 28/02/2019 = 58832.0
For the financial year from 01/03/2019 to 29/02/2020 = 457214.0
Total taxable emoluments 516046.0