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.1281/192/123 Last updated on: 06/06/2016
Name and address of the Employer Name and address of the Employee
LAURUS LABS PRIVATE LIMITED Kesava M
PLOT NO 21 Executive - 4 -
JN PHARMA CITY
PARAWADA
VISAKHAPATNAM - 531021
ANDHRA PRADESH
PAN of the Deductor TAN of the Deductor PAN of the Employee Employee Reference No.
provided by the
Employer (If available)
AABCL1170C HYDL01327E AVYPM5279N
CIT (TDS) Assessment Year Period
Address: Room No. 411,,Income Tax Towers,,10-2-3 From To
A.C. Guard, 2016-17
City: Hyderabad Pincode: 500004 01/04/2015 31/03/2016
Summary of amount paid/credited and tax deducted at source thereon in respect of the employee

Quarter(s) Receipt Numbers Amount paid/ Amount of tax Amount of tax

of original credited deducted (Rs.) deposited/
quarterly remitted (Rs.)
statements of TDS
under sub-section
(3) of section 200

1 QRHNJHJB
2 QRMTCMEF
3 QRPIOTBG
4 QRURPBKF

Total (Rs.)
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)
Not Applicable
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 Challan Identification Number (CIN)
of the deductee (Rs.)

BSR Code of the Bank Date on which tax Challan Serial Number Status of
Branch deposited (dd/mm/yyyy) matching with
OLTAS
Total 0.00

Verification
I, SITARAMAIAH CH, son of NARASIMHA RAO working in the capacity of ASST VICE PRESIDENT (designation)
do hereby certify that a sum of Rs. Nil [Rupees Zero] has been deducted at source 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 books of account, documents, TDS statements, TDS deposited and other available records.

SITA RAMAIAH CHAGARLAMUDI

Signer Info:
Name : SITA RAMAIAH CHAGARLAMUDI
Place VISAKHAPATNAM Certified Authority: Sify Technologies Limited
Date: 06/06/2016 19:44:18

Date 31/05/2016 Signature of person responsible for deduction of tax

Designation ASST VICE PRESIDENT Full Name: SITARAMAIAH CH

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 Certificate No.: 1281/192/123

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

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. 4,87,539.00
b) Value of perquisites u/s 17(2) Rs.
c) Profits in lieu of salary under section 17(3) Rs.
d) Total Rs. 4,87,539.00
2 Less :Allowance to the extent exempt u/s 10
(a) Medical Allowance Rs. 15,000.00
(b) House Rent Allowance Rs. 71,288.00
(c) Conveyance Rs. 19,200.00
(d) Children Education Allowance Rs. 1,200.00
(e) Total Rs. 1,06,688.00
3 Balance 1-2 Rs. 3,80,851.00
4 Deductions :
b) Tax on Employment Rs. 2,400.00
5 Aggregate of 4 (a) and (b) Rs. 2,400.00
6 Income chargeable under the head 'salaries' (3-5) Rs. 3,78,451.00
7 Add: Any other income reported by the employee
8 Gross total income (6+7) Rs. 3,78,451.00
9 Deductions under chapter VI-A
Gross Amount Deductible Amount
(A) Sections 80C, 80CCC and 80CCD

(a) Deductions in respect of specified investments/savings - 80C

1) Provident Fund Rs. 26,772.00 Rs. 26,772.00
2) Life Insurance Premium Rs. 56,308.00 Rs. 56,308.00
3) Expenditure on children Education (Child 1) Rs. 10,000.00 Rs. 10,000.00
4) Public Provident Fund Rs. 8,000.00 Rs. 8,000.00
5) Post office Savings Bank(Cumulative time deposit) Rs. 3,000.00 Rs. 3,000.00
6) Sukanya Samruddhi Account Scheme Rs. 9,000.00 Rs. 9,000.00
(B) Other Sections under Chapter VIA
10 Aggregate of deductible amount under chapter VI-A Rs. 1,13,080.00
11 Total income (8-10) Rs. 2,65,370.00
12 Tax on total income Rs.
(Tax of Rs.1,537.00 Less Rebate U/s 87A of Rs.1,537.00)
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 Certificate No.: 1281/192/123
13 Education Cess @ 3% (on tax computed at S.No.12) Rs.
14 Tax payable (12 + 13) Rs. Nil
15 Less: Relief under section 89 (attach details) Rs.
16 Tax Payable (14 - 15) Rs. Nil
Verification
I, SITARAMAIAH CH, son of NARASIMHA RAO working in the capacity of ASST VICE PRESIDENT (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, TDS deposited and other available records.

Place VISAKHAPATNAM

Date 31/05/2016 Signature of person responsible for deduction of tax

Designation ASST VICE PRESIDENT Full Name: SITARAMAIAH CH

Employer Name: LAURUS LABS PRIVATE LIMITED TAN: HYDL01327E PAN: AABCL1170C

Employee Name: Kesava M PAN: AVYPM5279N FY: 2015-16 AY: 2016-17

Tax Deducted Summary

(Summary of Tax Payable and Tax Deducted Information)

Sl.No. Particulars Amount

1 Tax payable as per Part-B (Sl No 16) Nil

2 Tax Deducted at Current Employment Nil

3 Tax Deducted at Previous Employment Nil

4 Total Tax Deducted (2+3) Nil

5 Net Tax Payable / (Refundable) (1-4) Nil

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 Certificate No.: 1281/192/123
Name : Kesava M PAN : AVYPM5279N
Status :Individual Asst Year : 2016 - 2017

ANNEXURE FOR FORM 16

SOURCES OF INCOME Amount(Rs) Amount(Rs) Amount(Rs)
INCOME FROM SALARIES
Salary From LAURUS LABS PRIVATE LIMITED
Basic Salary/Wage 2,23,116.00
Children Education Allowance 2,400.00
House Rent Allowance 89,244.00
Medical Allowance 15,000.00
Bonus 4,200.00
Conveyance 19,200.00
Earned Leave Encashment 14,302.00
Leave Travel Assistance 18,593.00
Special Allowance 1,01,484.00
Total Gross Salaries 3,80,851.00
INCOME FROM HOUSE PROPERTY
Total Income From House Property
EXEMPTIONS / DEDUCTIONS
Exemption for Children Education Allowance 1,200.00 1,200.00
Exemption for House Rent Allowance 71,288.00 17,956.00
Exemption for Medical Allowance 15,000.00
Exemption for Conveyance 19,200.00
Deductions U/s 16
Professional Tax Paid 2,400.00
Total Income 3,78,451.00
GROSS TOTAL INCOME 3,78,451.00
DEDUCTIONS U/C VI A
Deductions in respect of specified investments/savings U/s
80C
a) Provident Fund, Gross Amount = 26,772
b) Life Insurance Premium, Gross Amount = 56,308
c) Expenditure on children Education (Child 1), Gross
Amount = 10,000
d) Public Provident Fund, Gross Amount = 8,000
e) Post office Savings Bank(Cumulative time deposit),
Gross Amount = 3,000
f) Sukanya Samruddhi Account Scheme, Gross Amount 1,13,080.00 1,13,080.00
= 9,000
TOTAL INCOME 2,65,371.00
TOTAL INCOME(rounded off) 2,65,370.00

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