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 paid to an
employee under section 192 or pension/interest income of specified senior citizen under section 194P
Certificate No. SQEDJDA Last updated on 0 4 - J u n - 2 0 2 4
Name and address of the Employer/ Specified Bank Name and address of the Employee/ Specified senior citizen
BLOCK EDUCATION OFFICE BARWAHA MOHAN SINGH MORE
11, SANAWAD ROAD, BARWAHA-451115 MADHYA PRADESH

PAN of the Deductor TAN of the Deductor PAN of the Employee/ Employee Reference No./
specified senior citizen Pension Payment order no.
provided by the Employer (If available)
PANNOTREQD BPLB02794B BRYPM1416Q -
CIT (TDS) Assessment Year Period with the Employer
The Commissioner of Income Tax (TDS) From To
Aayakar Bhawan, Hoshangabad Road, Bhopal-462011 2024-25 01-Apr-2023 31-Mar-2024
Summary of amount paid/credited and tax deducted at source thereon in respect of the employee
Quarter(s) Receipt Numbers of original statements of TDS Amount paid/credited Amount of tax deducted Amount of tax
under sub-section (3) of section 200 (Rs.) deposited/remitted
(Rs.)
Q1 QVKGZMKC 277788.00 15000.00 15000.00
Q2 FXBLQEOX 386884.00 20000.00 20000.00
Q3 FXCNHZSS 294288.00 15000.00 15000.00
Q4 FXCTJEFA 195366.00 31300.00 31300.00
Total (Rs.) 1154326.00 81300.00 81300.00
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)
S. Tax Deposited in Book identification number (BIN)
No. respect of the Deductee Receipt numbers of Form No. DDO Sequence Number in the Book Date on which tax Status of matching
(Rs.) 24G Adjustment Mini Statement deposited (dd/mm/yyyy) with Form No. 24G

1 5000.00 1002114 00022 30-04-2023 F

2 5000.00 1007598 00002 31-05-2023 F

3 5000.00 2007599 00033 30-06-2023 F
4 5000.00 4017111 00090 31-07-2023 F
5 5000.00 1026124 00098 31-08-2023 F
6 5000.00 2026125 00048 30-09-2023 F
7 5000.00 2026125 00048 30-09-2023 F
8 5000.00 6039672 00027 31-10-2023 F
9 5000.00 0039673 00014 30-11-2023 F
10 5000.00 3043629 00038 31-12-2023 F
11 5000.00 6055269 00077 31-01-2024 F
12 26300.00 0059392 00071 31-03-2024 F
Total 81300.00
(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 Book identification number (BIN)
respect of the Deductee BSR Code of the Bank Date on which tax deposited Challan Serial Number Status of matching
(Rs.) Branch (dd/mm/yyyy) with OLTAS
Total (Rs.) Nil
Verification
I, BASANT KUMAR VERMA, son/daughter of VASTA JI VERMA working in the capacity of BEO (designation) do hereby certify that a sum of Rs. 81300.00 [Rs.
(Eighty one Thousand Three Hundred Only)] has been deducted and 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 book of accounts, documents, TDS statements, TDS deposited and other available records.

Place BARWAHA

Date 23-Jun-2024 (Signature of person responsible for deduction of tax)

Designation: BLOCK EDUCATION OFFICER Full Name: BASANT KUMAR VERMA

 TAN of Employer Name of Employee PAN of Employee Assessment Year
BPLB02794B MOHAN SINGH MORE BRYPM1416Q 2024-25
PART B (Annexure-I)
Details of Salary paid and any other income and tax deducted
A Whether opting out of taxation u/s 115BAC(1A)? No
1. Gross Salary Rs Rs
(a) Salary as per provisions contained in section 17(1) Rs. 1171112.00
(b) Value of perquisites under section 17(2) (as per Form No. 12BA, wherever Rs. Nil
applicable)
(c) Profits in lieu of salary under section 17(3) (as per Form No. 12BA, wherever Rs. Nil
applicable)
(d) Total Rs. 1171112.00
(e) Reported total amount of salary received from other employer(s) Rs. Nil
2. Less: Allowance to the extent exempt under section 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 10(10AA) Rs. Nil
(e) House rent allowance under section 10(13A) Rs. Nil
(f) Other special allowances under section 10(14) Rs. Nil
(g) Amount of any other exemption under section 10
(h) Total amount of any other exemption under section 10 Rs. Nil
(i) Total amount of exemption claimed under section 10 Rs. Nil
[2(a) + 2(b) + 2(c) + 2(d) + 2(e) + 2(g) + 2(h)]
3. Total amount of salary received from current employer [1(d)-2(i)] Rs. 1171112.00
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) Rs. 50,000.00
(b) Entertainment allowance under section 16(ii) Rs. Nil
(c) Tax on employment under section 16(iii) Rs. Nil
5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] Rs. 50,000.00
6. Income chargeable under the head “Salaries” [3+1(e)-5] Rs. 1121112.00
7. Add: Any other income reported by the employee under as per section 192 (2B)
(a) Income (or admissible loss) from house property reported by employee offered Rs. 0.00
for TDS
(b) Income under the head Other Sources offered for TDS Rs. Nil
8. Total amount of other income reported by the employee [7(a)+7(b)] Rs. Nil
9. Gross total income (6+8) Rs. 1121112.00
10. Deductions under Chapter VI-A
Gross Amount Deductible Amount
(a) Deduction in respect of life insurance premia, contributions to provident fund Rs. Nil Rs. Nil
etc. under section 80C
(b) Deduction in respect of contribution to certain pension funds under section Rs. Nil Rs. Nil
80CCC
(c) Deduction in respect of contribution by taxpayer to pension scheme under Rs. Nil Rs. Nil
section 80CCD (1)
(d) Total deduction under section 80C, 80CCC and 80CCD(1) Rs. Nil Rs. Nil
(e) Deductions in respect of amount paid/deposited to notified pension scheme Rs. Nil Rs. Nil
under section 80CCD (1B)
(f) Deduction in respect of contribution by Employer to pension scheme under Rs. Nil Rs. Nil
section 80CCD (2)
(g) Deduction in respect of health insurance premia under section 80D Rs. Nil Rs. Nil
(h) Deduction in respect of interest on loan taken for higher education under Rs. Nil Rs. Nil
section 80E
(i) Deduction in respect of contribution by the employee to Agnipath Scheme Rs. Nil Rs. Nil
under section 80CCH
(j) Deduction in respect of contribution by the Central Government to Agnipath Rs. Nil Rs. Nil
Scheme under section 80CCH
Gross Amount Qualifying Amount Deductible Amount
(k) Total Deduction in respect of donations to certain funds, charitable Rs. Nil Rs. Nil Rs. Nil
institutions, etc. under section 80G
(l) Deduction in respect of interest on deposits in savings account under section Rs. Nil Rs. Nil Rs. Nil
80TTA
(m) Amount deductible under any other provision(s) of Chapter VI-A
(n) Total of amount deductible under any other provision(s) of Rs. Nil Rs. Nil Rs. Nil
Chapter VI-A
11. Aggregate of deductible amount under Chapter VI-A [10(d)+10(e)+10(f)+10(g) Rs. Nil
+10(h)+10(i)+10(j)+10(k)+10(l)+10(n)]
12. Total taxable income (9-11) Rs. 0.00
13. Tax on total income Rs. 1121112.00
14. Rebate under section 87A, if applicable Rs. 78166.00
15. Surcharge, wherever applicable Rs. Nil
16. Health and education cess @ 4% Rs. 3127.00
17. Tax payable (13+15+16-14) Rs. 81293.00
18. Less: Relief under section 89 (attach details) Rs. Nil
19. Net tax payable (17-18) Rs. 81293.00
Verification
I, BASANT KUMAR VERMA, son/daughter of VASTA JI VERMA working in the capacity of BLOCK EDUCATION OFFICER (designation) do
hereby certify that the information given above is true, complete and correct and is based on the book of accounts, documents, TDS statements, and other
available records.

Place BARWAHA

Date 23-Jun-2024 (Signature of person responsible for deduction of tax)

Designation: A S C O Full Name: BASANT KUMAR VERMA

12/22/2024

X
BASANT KUMAR VERMA
BEO
Signed by: BASANT KUMAR VERMA