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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.

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Name and address of the Employer

Name and address of the Employee

PAN of the

Employee Reference No.

PAN of the Deductor

TAN of the Deductor

Employee

provided by the Employer

(If available)

Period with the Employer

CIT (TDS)

Assessment Year

Address………………………………………………………

From

……………………………………………………………….

City…………………………….Pin code…………………..,

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

Receipt Numbers of original

Amount

Amount of tax deducted

Quarter(s)

Amount of

( Rs. )

quarterly statements of TDS

paid/credited

tax deposited/ remitted

under

sub-section

(3)

( Rs. )

section 200

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)

Sl. No.

Tax Deposited in respect

Book Identification Number (BIN)

of the deductee

Receipt numbers of

DDO serial number in Form No.

Date of transfer

Status of matching

( Rs. )

Form No. 24G

24G

voucher

with Form No.24G

(dd/mm/yyyy)

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

Challan Identification Number (CIN)

of the deductee

BSR Code of the Bank

Date on which tax deposited

Challan Serial

Status of

( Rs. )

Branch

(dd/mm/yyyy)

Number

matching with

OLTAS

Total ( Rs. )

Verification

I,…………….., son/daughter of ………….working in the capacity of ……. (designation) do hereby certify that a sum of Rs. ………….. [Rs. ………….(in

words)] 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 books of account, documents, TDS statements, TDS deposited and other available records.

Place

Date

(Signature of person responsible for deduction of tax)

Designation:

Full Name:

Notes:

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.

Non-Government deductors to fill information in item II.

The deductor shall furnish the address of the Commissioner of Income-tax (TDS) having jurisdiction as regards TDS statements of the assessee.

If an assessee is employed under one employer only during the year, certificate in Form No. 16 issued for the quarter ending on 31

March of the financial year

shall contain the details of tax deducted and deposited for all the quarters of the financial year.

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.

In items I and II, in column for tax deposited in respect of deductee, furnish total amount of TDS and education cess.