Statement Showing details of pay and allowances paid to

xyz

abc

For the period from 1/3/2012 to 28/02/2013 and authorised deductions admissible U/S 88 of the income tax Sr.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Month Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 VI pay Arrears D.A.arr 12 Yr Arrears V th pay Install Total Basic 20570 20570 20570 20570 21350 21350 21350 21350 21350 21350 21350 21350 31748 0 0 0 284828 D.P 5400 5400 5400 5400 5400 5400 5400 5400 5400 5400 5400 5400 0 0 0 0 64800 D.A. 16881 16881 16881 16881 19260 19260 19260 19260 19260 19260 19260 19260 0 0 0 0 221604 H.R.A. 2597 2597 2597 2597 2675 2675 2675 2675 2675 2675 2675 2675 0 0 0 0 31788 CLA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Trav.All. 800 800 0 533 800 800 800 800 800 800 800 800 0 0 0 0 8533 Gross Total 46248 46248 45448 45981 49485 49485 49485 49485 49485 49485 49485 49485 31748 0 0 0 611553 G.P.F 2000 4000 4000 4000 4000 4000 4000 4000 4000 4000 4000 4000 31748 0 0 0 77748 P.T. 200 200 200 200 200 200 200 200 200 200 200 300 0 0 0 0 2500 GIS 400 400 400 400 400 400 400 400 400 400 400 0 0 0 0 4400 PPF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LIC 687 687 687 687 687 687 687 687 687 687 687 687 0 0 0 0 8244 I. Tax 2000 2000 2500 2500 2500 2500 2500 2500 2500 2500 3000 0 0 0 0 27000

Deduction Under 80 C,80CCC & 80CCD 1) 2) 3) 4) 5) 6) 7) 8) Housing Loan Principal G.P.F. L.I.C. G.I.S. P.P.F. Mutual Fund ELSS P.L.I. / U.T.I. Educational Fees 58107 H. Loan Interest u/s10 77748 Mediclaim Insurance 80D Expenditure for medical 24684 treatment for dependent relative. 4400 u/s 80 DD 1000 Interest on educational loan for higher education.u/s 80 E 0 0 Deduction for handicapped 0 person u/s 80 U 165939 Infrastructure Bonds u/s 80CCF 6215 0 0 Name of the Employee xyz Designation PAN No. Fathers Name 0 Date of Birth Gender 0 Bank A/C. Number HRA Rate 10 Total Income Tax Tax payable/ refundable abc ddkdk5454d asaad 5/25/1996 M 4578956123 CLA 0 30,314 3,314 Signature of Employee :

Total Deduction u/s 80 C

FORM NO 16
[ See rule 31 (1) (a)] Cerificate under section 203 of the Income-tax Act,1961 for tax deducted at source from income chargeable under the head " Salaries" Name and Address of the Employer Name and Designation of the Employee

xyz
PAN/GIR NO
Acknowledgement Nos.og all quarterly Statements of TDS under sub sec (3) of section 200 as provided by TIN facilation Centre or NSDL web site.

abc PAN/GIR NO.

ddkdk5454d
PERIOD From To 01-Apr-12 31-Mar-13 Assesment Year

2013-2014 to be filed. DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED 1 Gross Salary a) Salary as per provision contained in sec. 17(1) Rs. 611,553 b) Value of perquisites u/s 17 (2) (as per form no. 12 BA wherever applicable) Rs. 0 c) Profits in lieu of salary u/s 17(3) ( as per Form No.12 BA, wherever applicable) Rs. 0 d) Total 611,553 2 Less: Allowance to the extent exempt u/s10 b) Interest on Home Loan c) H.R.A. d) e) 3 Balance ( 1-2 ) 4 Deductions: a) Conveniance allowance b)Tax on Employment 5 Aggregate of 4(a) & 4 ( b ) 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 b) Income under the head 'Income from other sources c) Total of (a) + (b) 8 Gross Total Income ( 6+7 ) 9 Deduction under Chapter VI-A A) Sections 80C,80CCC and 80CCD (a) Section 80C (i) Housing Loan Principal (ii) G.P.F. (iii) L.I.C. (vi) P.P.F. (v) Mutual Fund ELSS (vi) P.L.I. / U.T.I. (vii) G.I.S. (viii) Education Fees ( b)Section 80CCC ( c)Section 80CCD
133860753.xls.ms_office 3/12/2013

Quarter Quarter1 Quarter2 Quarter3 Quarter4

Acknowldgement No.

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

6,215 0 0 0 605,338 8,533 2,500 11,033 594,305

Rs. Rs. Rs. Rs. Gross Amt

0 594,305 Qualify Amt Ded. Amount

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

58,107 77,748 24,684 1000 0 0 4400 0 0 0

58,107 77,748 24,684 1000 0 0 4400 0 0 0

58,107 77748 24,684 1000 0 0 4400 0 0 0

(B) Other Sections ( for e,g, 80E,80G) under Chapter VI-A (a) Section 80 D Mediclaim (b) Section 80 DD Med. Expt. Of Dependt (c) Section 80 E Education Loan Interest (d) Section 80 GG HRA not received (e) Section 80 U Handicraft Person (f) Section 80 CCF Infra. Bonds 10 Aggregate of deductible amounts under Chapter VI-A 11 Total Taxable Income ( 8 - 10 ) 12 Tax on Total Income 13 14 15 16

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

0 0 0 0 0 0 165,939

0 0 0 0 0 0 165,939 Rs. Rs. Rs. Rs. Rs. Rs.

0 0 0 0 0 0 100,000 494,305 29,431 0 883 30,314 0 30,314

Surcharge ( On tax Computed at S.No.12 ) Education Cess (On tax at S.No. 12 and surcharge at S.No.13) Tax payable on Total Income (12+13+14) Relief under section 89 ( attach details )

17 Tax Payable ( 15 - 16) 18 Less: (a) Tax deduted at source u/s 192(1) (b) Tax paid by the employer on behalf of the employee u/s192(1A) on perquisites u/s17(2) 19 Tax payable/ refundable ( 17 -18 )

Rs

27,000 0

30,314

Rs.

3,314

Sr.No. 1 2 3 4 5 6 7 8 9 10 11 12

DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVT.ACCOUNT Total Tax BSR Code Date on Surcharge Education Cheque/D Month TDS Rs. Deposited of Bank which tax Rs. Cess Rs. D No. Rs. Branch deposited Mar-11 2000 0 0 2000 Apr-11 2000 0 0 2000 May-11 2500 0 0 2500 Jun-11 2500 0 0 2500 Jul-11 2500 0 0 2500 Aug-11 2500 0 0 2500 Sep-11 2500 0 0 2500 Oct-11 2500 0 0 2500 Nov-11 2500 0 0 2500 Dec-11 2500 0 0 2500 Jan-12 3000 0 0 3000 Feb-12 0 0 0 0

Transfer Voucher/ Challan No.

I, son of working in the the capacity of do hereby certify that a sum of Rs. 30,314 #NAME? ( Rupees ) has been deducted at source and paid to the credit of the Central Government. I further certify that the information given above is true and correct based on the books of accounts, documents and other available records. Signature of the Person responsible for deduction of tax.

Place:Date:- 12-Mar-2013

Full Name:Designation:-

133860753.xls.ms_office 3/12/2013

Computation of Income Tax on Salary Income for the financial 2012-13

Inrespect of :xyz PAN NO :- ddkdk5454d Fathers Name :- asaad Date Of Birth :5/25/1996 Bank A/C Number :1 Salary Income (As per Statement) 2 Direct deduction u/s 10 I) Prof Tax ii)Transport Allowance iii)House loan intersest iv)HRA exempted(Whicheaver is less is exempted) 1.Actual Amount of HRA received Rs 2.Expenditure on Rent in execess of 10% of Salary Including D.A. Rs A) Actual Rent Paid Rs.. B) 1/10 of Salary Rs. 3)40% of the Salary including DA Rs. Designation:- abc M

611553 2500 8533 6215 0

TOTAL INCOME-------3 4 Add any other Income if any Rs. Total Gross Income Rebate u/s 80 I)G.P.F ii)P.P.F iii)G.I,S. iv)L.I.C./PLI v)NSC/Bons vi)ULIP/Tuition fee vii) Donation /CMFUND viii)House Loan Premium ix) Othe Investments Mutul Fund Pesion Plan-II icici. Total( I to iX)Deduction u/s 80 C up to 1 Lack (B) Other Sections ( for e,g, 80E,80G) under Chapter VI-A Taxable Income Tax on Taxable income Surcharge if Taxable Income is 10 lakh & Above @ 10% on IT Education Case @ 2% of Income Tax TOTAL INCOME TAX PAYBLE (6,7,8,9) INCOME TAX ALREADY DEDUCTED NOW INCOME TAX TO BE DEDUCTED

17248 Rs. Rs. Rs. Rs Rs Rs Rs Rs Rs Rs Rs Rs Rs 77748 1000 4400 24684 0 0 0 58107 0 0 165939 0

17248 594305 0 594305

5 6 7 8 9 10 11

Rs Rs Rs Rs

100000 0 494305 29,431 0 883 30314 27000 3314

Certified that the above information is correct to the best of my knowledge & belief.

Signature of the Employee

Date 12-Mar-2013 Place