FORM NO.

16
[see rule 31 (1) (a) ]
Certificate under section 203 of the income tax Act, 1961 fot tax deducted at source from income chargeable
under the head “ salaries”

Name and address of the Employer Name and designation of the Employee
BURDWAN DENTAL COLLEGE & HOSPITAL. Ranajit Mitra
Burdwan. (Power House Para) 713101 L.D.C
PAN NO. of the Deductor TAN No. of the Deductor PAN NO. of the Employee

CALB12599G BFOPM4870E
Acknowledgement Nos. Of all quarterly statements TDS under From To Assessment Year
sub-section (3) of section 200 as provided by TIN Facilitation 01-04-2013 31-03-2014 2014-2015
center of NSDL web site

Quarter Acknowledgement No Date (DD/MM/YYYY)

Q1 050520200195673 07/10/2013
Q2 050520200198764 29/10/2013
Q3 050529600005032 30/01/2014
Q4 05052 /2014
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

SL. NO. Particulars Amount ( Rs.) Amount ( Rs.) Amount ( Rs.)

1 Gross salary
(a) Salary as Per Provision contained in Section 17 (1) Rs. 193216

(b) Value of perquisites under section 17(2) nil

( as per Form No 12B A, wherever applicable)

(c) Profit in lieu of salary under section 17(3) nil

( as per Form No 12B A, wherever applicable)

(d) TOTAL nil Rs. 193216

2 Less: Allowance to the extent exempt under section
10(14)
3 Balance (1-2) Rs. 193216
4 Deduction
(a) Entertainment allowance

(b) Tax on Employment Rs. 1560

5 Aggregate of 4 (a) and (b) Rs. 1560

6 Income Chargeable under the head “Salaries” (3-5) Rs. 191656
7 Add
Any other income reported by the employee
(a) Income from house property
(b) Interest from NSC and others
(c) Any other income (Bank interest) Rs. Nil
8 Aggregate of 7(a), (b) and (c)
9 Less
Borrowed interest on capital for house property U/S Rs. Nil
23(2)(a)/24 (b)
10 Gross total income (6+8) Rs. 191656
11 Deduction under Chapter VI- Rs. 191656
(A) Section 80C, 80CC, and 80CCD Gross Amount Qualifying Amount Deducible Amount
(a) Section 80C
(i) G.P.F. Rs. 18000 Rs. 18000
(ii) Insurance Premium
(iii) N.S.C.
(iv) Accrued Interest on NSC
(v) Repayment of House Building Loan Rs. Rs.
(vi) GISS Rs. 240 Rs. 240
(vii) Tuition fees.
(viii) Others (PPF) Rs. Rs.
(b) Section 80CC
(c) Section 80CCD Rs. Rs.
(B) Other Section (e.g. 80E, 80G etc.)
(a) 80D--Medical Insurance Premium Rs. Rs.
(b) 80DD-- Medical Treatment of handicapped Dependant
(c) 80DDB--Deduction for Medical Treatment
(d) 80E --Repayment of loan for higher education Rs. Rs.
(e) 80G- -Donation to Charitable institution
(f) 80GG--Deduction for rent paid
(g) 80GGA-- Donation for Scientific research
(h) 80U--person with Disability
12 Aggregate of deducible amount under Chapter VI-A Rs. 18240
13 Total Income Rs . 173416
14 Tax on total income Rs. nil
15 Surcharge
16 Education Cess @ 3% Rs .
17 Tax Payable (13+14+15) Rs.
18 Relief under section 89 9attach details)
19 Tax Payable(16-17) Rs.
20 Less:- (a) Tax deducted at source u/s 192 (1) Rs.
(b) Tax paid by the employer on behalf of the employee u/s 192 (1A) on perquisites u/s 17(2)
21 Tax Payable/Refundable NIL
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENTACCOUNT
(The Employer is to provide transaction –wise details of tax deducted and deposited
Month TDS Surcharge Edu.-Cess Total Tax Vouvc- BSR Code of Bank Deposit Voucher/Chal
No. Date No.
March/13 Rs. Bdn-Treasur-2
April/13 Rs. Bdn-Treasur-2
May/13 Rs. Bdn-Treasur-2
June/13 Rs. Bdn-Treasur-2
July/13 Rs. Bdn-Treasur-2
Aug. /13 Rs. Bdn-Treasur-2
Sept./13 Rs. Bdn-Treasur-2
Oct./13 Rs. Bdn-Treasur-2
Nov./13 Rs. Bdn-Treasur-2
Dec./13 Rs. Bdn-Treasur-2
Jan./14 Rs. Bdn-Treasur-2
Feb./14 Rs. Bdn-Treasur-2
TOTAL Rs.nil

I certify that a sum of Rs.Nil (Nil) has been deducted at source and paid to the credit of the Central Government. I
further certify that information given above is true and correct based on the books of account, documents and other
available records.

Place: Burdwan Signature of the person responsible for deduction of tax

Date: Full Name: Dr. Tamal Kanti Patra
Designation: Principal cum Superintendent
 FORM NO. 16
[see rule 31 (1) (a) ]
Certificate under section 203 of the income tax Act, 1961 fot tax deducted at source from income chargeable
under the head “ salaries”

Name and address of the Employer Name and designation of the Employee
BURDWAN DENTAL COLLEGE & HOSPITAL. Ranajit Mitra
Burdwan. (Power House Para) 713101 L.D.C
PAN NO. of the Deductor TAN No. of the Deductor PAN NO. of the Employee

CALB12599G BFOPM4870E
Acknowledgement Nos. Of all quarterly statements TDS under From To Assessment Year
sub-section (3) of section 200 as provided by TIN Facilitation 01-04-2014 31-03-2015 2015-2016
center of NSDL web site

Quarter Acknowledgement No Date (DD/MM/YYYY)

Q1 092059600012122 07/07/2014
Q2 050529600024315 14/10/2014
Q3 050529600027771 13/01/2015
Q4 050529600038993 14/05/2015
DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

SL. NO. Particulars Amount ( Rs.) Amount ( Rs.) Amount ( Rs.)

1 Gross salary
(a) Salary as Per Provision contained in Section 17 (1) Rs. 206372

(b) Value of perquisites under section 17(2) nil

( as per Form No 12B A, wherever applicable)

(c) Profit in lieu of salary under section 17(3) nil

( as per Form No 12B A, wherever applicable)

(d) TOTAL nil Rs. 206372

2 Less: Allowance to the extent exempt under section
10(14)
3 Balance (1-2) Rs. 206372
4 Deduction
(a) Entertainment allowance

(b) Tax on Employment Rs. 1560

5 Aggregate of 4 (a) and (b) Rs. 1560

6 Income Chargeable under the head “Salaries” (3-5) Rs. 204812
7 Add
Any other income reported by the employee
(a) Income from house property
(b) Interest from NSC and others
(c) Any other income (Bank interest) Rs. Nil
8 Aggregate of 7(a), (b) and (c)
9 Less
Borrowed interest on capital for house property U/S Rs. Nil
23(2)(a)/24 (b)
10 Gross total income (6+8) Rs.204812
11 Deduction under Chapter VI- Rs. 204812
(A) Section 80C, 80CC, and 80CCD Gross Amount Qualifying Amount Deducible Amount
(a) Section 80C
(i) G.P.F. Rs. 18000 Rs. 18000
(ii) Insurance Premium
(iii) N.S.C.
(iv) Accrued Interest on NSC
(v) Repayment of House Building Loan Rs. Rs.
(vi) GISS Rs. 240 Rs. 240
(vii) Tuition fees.
(viii) Others (PPF) Rs. Rs.
(b) Section 80CC
(c) Section 80CCD Rs. Rs.
(B) Other Section (e.g. 80E, 80G etc.)
(a) 80D--Medical Insurance Premium Rs. Rs.
(b) 80DD-- Medical Treatment of handicapped Dependant
(c) 80DDB--Deduction for Medical Treatment
(d) 80E --Repayment of loan for higher education Rs. Rs.
(e) 80G- -Donation to Charitable institution
(f) 80GG--Deduction for rent paid
(g) 80GGA-- Donation for Scientific research
(h) 80U--person with Disability
12 Aggregate of deducible amount under Chapter VI-A Rs. 18240
13 Total Income Rs . 186572
14 Tax on total income Rs. nil
15 Surcharge
16 Education Cess @ 3% Rs .
17 Tax Payable (13+14+15) Rs.
18 Relief under section 89 9attach details)
19 Tax Payable(16-17) Rs.
20 Less:- (a) Tax deducted at source u/s 192 (1) Rs.
(b) Tax paid by the employer on behalf of the employee u/s 192 (1A) on perquisites u/s 17(2)
21 Tax Payable/Refundable NIL
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENTACCOUNT
(The Employer is to provide transaction –wise details of tax deducted and deposited
Month TDS Surcharge Edu.-Cess Total Tax Vouvc- BSR Code of Bank Deposit Voucher/Chal
No. Date No.
Mar/14 Rs. Bdn-Treasur-2
Apr/14 Rs. Bdn-Treasur-2
May/14 Rs. Bdn-Treasur-2
June/14 Rs. Bdn-Treasur-2
Jul/14 Rs. Bdn-Treasur-2
Aug /14 Rs. Bdn-Treasur-2
Sept/14 Rs. Bdn-Treasur-2
Oct./14 Rs. Bdn-Treasur-2
Nov./14 Rs. Bdn-Treasur-2
Dec./14 Rs. Bdn-Treasur-2
Jan./15 Rs. Bdn-Treasur-2
Feb./15 Rs. Bdn-Treasur-2
TOTAL Rs.nil

I certify that a sum of Rs.Nil (Nil) has been deducted at source and paid to the credit of the Central Government. I
further certify that information given above is true and correct based on the books of account, documents and other
available records.

Place: Burdwan Signature of the person responsible for deduction of tax

Date: Full Name: Dr. Tamal Kanti Patra
Designation: Principal cum Superintendent