FORM NO. 16
[See rule 31(1)(a)]
Certificate 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
…………………………………………………………………………. ………………………………
…………………………………………………………………………. ………………………………
…………………………………………………………………………. ………………………………
…………………………………………………………………………. ………………………………
…………………………………………………………………………. ………………………………
PAN/GIR NO
TAN
PAN/GIR NO.
TDS Circle where Annual Return/Statement under Period Assessment
section 206 is to be filed
year ……….
FROM TO
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1. Gross salary*
Rs. ………
2. Less: Allowance to the extent exempt under
section 10
Rs. ………
3. Balance (1-2)
Rs. ………
4. Deductions:
(a) Standard deduction Rs. ………
(b) Entertainment
allowance Rs. ………
(c) Tax on Employment Rs. ………
5. Aggregate of 4 (a) to (c)
Rs. ………
6. Income chargeable under the head ‘Salaries’
(3 – 5)
Rs. …….
7. Add: Any other income reported by the
employee
Rs. …….
8. Gross total income (6 + 7)
Rs. …….
9. Deductions under Chapter VI-A
GROSS QUALIFYING DEDUCTIBLE
AMOUNT AMOUNT AMOUNT
(a)
Rs. ……… Rs. ……… Rs. ………
(b)
Rs. ……… Rs. …………. Rs. ………
(c)
Rs. ……… Rs. ……… Rs. ………
(d)
Rs. ……… Rs. …………. Rs. ………
10. Aggregate of deductible amounts under
Chapter VI-A
Rs. ………
11. Total income (8 – 10)
Rs. ………
12. Tax on total income
Rs. ………
13. Rebate and relief under Chapter VIII
I. Under section 88 GROSS QUALIFYING TAX REBATE/
(please specify) AMOUNT AMOUNT RELIEF
(a)
Rs. ……… Rs. ………
(b)
Rs. ……… Rs. ………
(c)
Rs. ……… Rs. ………
(d)
Rs. ……… Rs. ………
(e)
Rs. ……… Rs. ………
(f) TOTAL [(a) to (e)] Rs. ……… Rs. ……… Rs. ………
II. Under section 88A GROSS QUALIFYING
(please specify) AMOUNT AMOUNT
(a)
Rs. ……… Rs. ………
(b)
Rs. ……… Rs. ………
(c) TOTAL [(a) + (b)] Rs. ……… Rs. ……… Rs. ………
III. Under section 89
(attach details)
Rs. ………
14. Aggregate of tax rebates and relief at 13 above
[I(f) + II(c) + III)]
Rs. ………
15. Tax payable (12 – 14) and surcharge thereon
Rs. ………
16. Less Tax deducted at source
Rs. ………
17. Tax payable/refundable (15 – 16)
Rs. ………
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO
CENTRAL GOVERNMENT ACCOUNT
AMOUNT DATE OF PAYMENT NAME OF BANK AND BRANCH
WHERE TAX DEPOSITED
Certified that a sum of Rs. (in words)……………………………………………………….. has been deducted
at source and paid to the credit of the Central Government. Further certified that the above information is
true and correct as per records.
Place ……………….
……………………………………..
Signature of the person responsible
for deduction of tax
Date ………………..
Full Name ……………………………………
Designation ………………………………….
*See sections 15 and 17 and rule 3. Furnish separate details of value of the perquisites and profits in lieu of
or in addition to salary or wages.