EMP ID : 83362912

FORM NO. 16
[See rule 31(1)(a)]
PART B

Name and address of the Employer Name and Designation of the Employee
MR.BABULAL M LAL
LINE ATTENDANT

PAN of the Deductor TAN of the Deductor PAN of the Employee

AADCM7397N ANUPM7128A
CIT(TDS) Assessment Year Period
Address:
FROM TO
City: Pin Code: 2017-18 01-Apr-2016 31-Mar-2017
Details of Salary paid and any other income and tax deducted

1. Gross salary Rs. Rs. Rs.

a) Salary as per provisions contained in sec.17(1) 599084.00
b) Value of perquisites u/s 17(2) (as per Form No.
12BA, wherever applicable) 46806.00
c) Profits in lieu of salary under section 17(3) (as per Form No.
12BA, wherever applicable) 0.00
d) Total 645890.00

2. Less: Allowance to the extent exempt u/s 10

Transport Allowance 2400.00
2400.00

3. Balance (1-2) 643490.00

4. Deductions:
a) Entertainment Allowance 0.00
b) Tax on employment 2500.00

5. Aggregate of 4 (a) and (b) 2500.00

6. Income chargeable under the head 'salaries' (3-5) 640990.00

7. Add: Any other income reported by the employee

0.00

8. Gross total income (6+7) 640990.00

9. Deductions under Chapter VIA

Gross Amount Deductible Amount

(A) Sections 80C, 80CCC and 80CCD
(a) Section 80C
i) Employee Contribution to Provident 120000.00
Fund
ii) General Insurance Scheme 600.00
Aggregate of 80C 120600.00 120600.00

Aggregate of 80C, 80CCC , 80CCD(1) 120600.00 120600.00

and 80CCD(1B)

Note:
1. Aggregate amount deductible under section 80C shall not exceed
one lakh fifty thousand rupees.
2. Aggregate amount deductible under the three sections, i.e., 80C,
80CCC and 80CCD shall not exceed one lakh fifty thousand
rupees.
Gross amount Qualifying amount Deductible amount
(B) Other sections (e.g. 80E, 80G etc.) 0.00 0.00 0.00
under Chapter VI-A

Page 1 of 3
 EMP ID : 83362912

10. Aggregate of deductible amount under Chapter VIA 120600.00

11. Total Income (8-10) 520390.00

12. Tax on total income 29078.00

13. Education cess @ 3% (on tax computed at S.No. 12) 873.00

14. Tax Payable (12+13) 29951.00

15. Less: Relief under section 89 (attach details) 0.00

16. Tax Payable (14 -15) 29951.00

Verification

I, , son/daughter of working in the capacity of do hereby certify that a sum of Rs.

29951.00 [Rupees twenty nine thousand nine hundred fifty one and zero paise only] 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 the person responsible for deduction of tax
Designation Full Name

Page 2 of 3
 EMP ID : 83362912

FORM NO.12BA
[See rule 26A(2)(b)]
Statement showing particulars of perquisites, other fringe benefits or amenities and profits in lieu of salary with value thereof

1. Name and address of the employer :

2. TAN :
3. TDS Assessment Range of the employer : Same as address provided in Page 1 of Form 16
4. Name, designation and PAN of employee : MR.BABULAL M LAL
LINE ATTENDANT
ANUPM7128A
5. Is the employee a director or a person with substantial interest : No
in the company (where the employer is a company)
6. Income under the head "Salaries" of the employee : 594184.00
(other than from perquisites)
7. Financial year : 2016-17
8. Valuation of Perquisites :

S.No Nature of perquisites (see rule 3) Value of perquisite Amount, if any Amount of perquisite
as per rules (Rs.) recovered from the chargeable to tax
employee (Rs.) Col (3) - Col (4) (Rs.)
(1) (2) (3) (4) (5)
1 Accomodation 41606.00 0.00 41606.00
2 Cars/Other automotive 0.00 0.00 0.00
3 Sweeper, gardener, watchman or personal attendant 0.00 0.00 0.00
4 Gas, electricity, water 5200.00 0.00 5200.00
5 Interest free or concessional loans 0.00 0.00 0.00
6 Holiday expenses 0.00 0.00 0.00
7 Free or concessional travel 0.00 0.00 0.00
8 Free meals 0.00 0.00 0.00
9 Free education 0.00 0.00 0.00
10 Gifts, vouchers, etc. 0.00 0.00 0.00
11 Credit card expenses 0.00 0.00 0.00
12 Club expenses 0.00 0.00 0.00
13 Use of movable assets by employees 0.00 0.00 0.00
14 Transfer of assets to employees 0.00 0.00 0.00
15 Value of any other benefit/amenity/service/privilege 0.00 0.00 0.00
16 Stock options (non-qualified options) 0.00 0.00 0.00
17 Other benefits or amenities 0.00 0.00 0.00
18 Total value of perquisites 46806.00 0.00 46806.00
19 Total value of profits in lieu of salary as per section
0.00 0.00
17(3)
9. Details of tax
a) Tax deducted from salary of the employee u/s 192(1) : 29951.00
b) Tax paid by employer on behalf of the employee u/s 192(1A) : 0.00
c) Total tax paid : 29951.00
d) Date of payment into Government treasury : Various Dates as Mentioned under Annexure B of
Form 16

DECLARATION BY EMPLOYER
I, , son/daughter of working as do hereby declare on behalf of
MADHYA PRADESH PASCHIM KSHETRA VIDHYUT VITRAN CO. LTD that the information given above is based on the books of account,
documents and other relevant records or information available with us and the details of value of each such perquisite are in accordance with
section 17 and rules framed there under and that such information is true and correct.

Place : Signature of the person responsible for deduction of tax

Date : Full Name :
Designation :

Page 3 of 3