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. MCTWBZI

Last updated on

Name and address of the Employer

19-May-2015

Name and address of the Employee

PRIVI ORGANICS LIMITED

A71, PRIVI HOUSE, THANE BELAPUR ROAD,
TTC, KOPAR KHAIRANE, MUMBAI - 400709
Maharashtra
+(91)22-9167980586
ravi@privi.co.in

RAMDAS NIVRUTTI BHALEGHARE

13 PRIYADARSHANI APTS, BHUVANESHWAR, VARSE, ROHA,
RAIGAD - 402109 Maharashtra

PAN of the Deductor

TAN of the Deductor

AAACP4717A

MUMP17382B

PAN of the Employee

Employee Reference No.

provided by the Employer
(If available)

ALYPB1738P

CIT (TDS)

Assessment Year

The Commissioner of Income Tax (TDS)

Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital
Building, Charni Road , Mumbai - 400002

2015-16

Period with the Employer

From

To

01-Apr-2014

31-Mar-2015

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

Quarter(s)

Receipt Numbers of original

quarterly statements of TDS
under sub-section (3) of
Section 200

Q1

QQSKSHJD

83037.00

0.00

0.00

Q2

QQVRLYSE

119967.00

0.00

0.00

Q3

QRADOUDD

117140.00

0.00

0.00

Q4

QRFGRPCB

103902.00

0.00

0.00

424046.00

0.00

0.00

Total (Rs.)

Amount of tax deposited / remitted

(Rs.)

Amount of tax deducted

(Rs.)

Amount paid/credited

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)
Sl. No.

Tax Deposited in respect of the

deductee
(Rs.)

Receipt Numbers of Form

No. 24G

DDO serial number in Form no.

24G

Date of transfer voucher Status of matching

(dd/mm/yyyy)
with Form no. 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)

Sl. No.

Tax Deposited in respect of the

deductee
(Rs.)

Challan Identification Number (CIN)

BSR Code of the Bank
Branch

Date on which Tax deposited Challan Serial Number

(dd/mm/yyyy)

Status of matching with

OLTAS*

0.00

07-05-2014

0.00

07-06-2014

0.00

07-07-2014

0.00

06-08-2014

Page 1 of 2

Certificate Number: MCTWBZI

Sl. No.

TAN of Employer: MUMP17382B

Tax Deposited in respect of the

deductee
(Rs.)

PAN of Employee: ALYPB1738P

Assessment Year: 2015-16

Challan Identification Number (CIN)

BSR Code of the Bank
Branch

Date on which Tax deposited Challan Serial Number

(dd/mm/yyyy)

Status of matching with

OLTAS*

0.00

05-09-2014

0.00

07-10-2014

0.00

05-11-2014

0.00

05-12-2014

0.00

07-01-2015

10

0.00

06-02-2015

11

0.00

05-03-2015

12

0.00

07-04-2015

Total (Rs.)

0.00
Verification

I, RAVIKUMAR VALLATH MENON, son / daughter of VALLATH RADHAKRISHNAN MENON working in the capacity of AUTHORISED PERSON (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

26-May-2015

Designation: AUTHORISED PERSON

(Signature of person responsible for deduction of Tax)

Full Name:RAVIKUMAR VALLATH MENON

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

Unmatched

Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
details in bank match with details of deposit in TDS / TCS statement

Provisional

Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
verification of payment details submitted by Pay and Accounts Officer (PAO)

Final

In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
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)

Overbooked

Payment details of TDS / TCS deposited in bank by deductor have matched

with details mentioned
in the TDS / TCS statement but the
RAVIKUMAR
VALLATH
amount is over claimed in the statement. Final (F) credit will be reflected
only when
deductor reduces
claimed amount in the statement or
Date:
2015.05.27
17:30:41
makes new payment for excess amount claimed in the statement

Signature Not Verified

Digitally signed by MENON

GMT+05:30

Page 2 of 2

Emp Name :Ramdas N Bhaleghare

PAN No :ALYPB1738P

Emp No :10120

ASSESSMENT YEAR : 2015-2016

FINANCIAL YEAR : 2014 - 2015

PART B (Annexure)

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.

424,046.00

b) Value of Perquisites U/S 17(2)

(as per Form No.12BA, wherever applicable)

Rs.

0.00

c) Profits in lieu of salary U/S 17(3)

(as per Form No.12BA,wherever applicable)

Rs.

0.00

d) Total

Rs.

424,046.00

Rs.

83,785.00

2. Less : Allowance to the extent exempt U/S 10

HRA Exemption
Conveyance Exemption
Medical Exemption
LTA Exemption
Child Exemption
Leave Exemption

Rs.
Rs.
Rs.
Rs.
Rs.
Rs.

58,800.00
9,600.00
12,985.00
0.00
2,400.00
0.00

Gratiuty Exemption

Rs.

0.00

3. Balance (1-2)

Rs.

340,261.00

Rs.

337,761.00

Rs.

337,761.00

4. Deductions:
(a) Entertainment allowance

Rs.

0.00

(b) Tax on Employment

Rs.

2,500.00
Rs.

5. Aggregate of 4(a) and (b)

2,500.00

6. Income Chargeable Under the Head "Salaries" (3 - 5)

7. Add : Any other income reported by the employee
(a)Income under the Head
"Income from House Property"

Rs.

0.00

(b)Income under the Head

"Income from Other sources"

Rs.

0.00

0.00

Rs.

8. Gross total income (6+7)

9. Deductions under Chapter VI A
(A) Sections 80C, 80CCC and 80CCD

Gross Amount

Deductible Amount

(I) Section 80C

23,040.00

(a)

Provident Fund

Rs.

(b)

VPF

Rs.

0.00

(c)
(d)

Insurance Premium
NSC

Rs.
Rs.

23,346.00
0.00

(e)
(f)

Accrued Interest on NSC

PPF

Rs.
Rs.

0.00
10,000.00

(g)

Mutual Funds

Rs.

0.00

(h)

ULIP

Rs.

0.00

(i)

Educational Expences of Children

Rs.

13,000.00

(j)

Principal repayment on Housing Loan

Rs.

0.00

(k)

Fixed Deposit

Rs.

0.00

(l)

ELSS

Rs.

0.00

(m)

Term Deposit

Rs.

0.00

(II) Section 80CCC

(III) Section 80CCD

Rs.

0.00

Rs.

0.00

Rs.

0.00

Rs.

0.00

Rs.

69,386.00

Rs.

69,386.00

Emp Name :Ramdas N Bhaleghare

PAN No :ALYPB1738P

Emp No :10120

ASSESSMENT YEAR : 2015-2016

FINANCIAL YEAR : 2014 - 2015

Note : 1. Aggregate amount deductible under section 80C, 80CCC and 80CCD(I) shall not exceed one lakh fifty thousand rupees.

(B) Other sections (e.g. 80E, 80G etc.) Under Chapter VI-A.
(a) Mediclaim Insurance Premium (80D)

Gross Amount
Rs.

Qualifying Amount
0.00

Rs.

Deductible Amount
0.00

Rs.

0.00

(b) Med-Exp on Handicapped Dep (80DD)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(c) Medical Exp Chronic Diseases (80DDB)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(d) Education Loan Int Repayment (80E)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(e) Donation (80G)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(f) Physical Handicapped (80U)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(g) Rajiv Gandhi Equity Saving Scheme (80CCG)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(h) Int. paid on resi. housing loan (80EE)

Rs.

0.00

Rs.

0.00

Rs.

0.00

10. Aggregate of deductible amount under Chapter VI-A

Rs.

69,386.00

11. Total Income (8-10)

Rs.

268,380.00

12. Tax on total Income

Rs.

1,838.00

13. Rebate u/s 87(A)

Rs.

1,838.00

14. Surcharge

Rs.

0.00

15. Education cess @ 3% (13+14)

Rs.

0.00

16. Tax Payable (13+14+15)

Rs.

0.00

17. Less : Relief under section 89 (attach details)

Rs.

0.00

18. Tax payable (16-17)

Rs.

0.00

19. Less: (a) Tax deducted at source u/s 192(i)

Rs.

0.00

Rs.

0.00

Rs.

0.00

(b) Tax paid by the employer on behalf of

the employee u/s 192(1A) on perquisites
u/s 17(2)
20. Tax payable / refundable (18-19)

Verification
I, RAVIKUMAR VALLATH MENON, SON of VALLATH RADHAKRISHNAN MENON,
working in the capacity of
AUTHORISED PERSON do
hereby 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.

Signature Not Verified

Digitally signed by MENON
RAVIKUMAR VALLATH
Date: 2015.05.27 17:30:41
GMT+05:30
..........................................................................................
Signature of the person responsible for deduction of tax
Place :

MUMBAI

Full Name

: RAVIKUMAR VALLATH MENON

Date :

27-May-2015

Designation

AUTHORISED PERSON