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. VJOXUMA Last updated on 20-Jul-2020

Name and address of the Employer Name and address of the Employee

OFFICE OF THE JOINT SECRETARY (TRG) & CHIEF

ADMINISTRATIVE OFFICER
SHAILENDRA KUMAR SAXENA
E-BLOCK, DALHOUSI ROAD - 110011
BSES SUB STATION FLAT-2, OPPOSITE BLOCK 93, PUSHP
Delhi
VIHAR SECTOR-1, NEW DELHI - 110017 Delhi

Employee Reference No.

PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

PANNOTREQD DELO02574F AWZPS9110L

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2020-21 01-Apr-2019 31-Mar-2020
4 , Luxmi Nagar, Delhi - 110092

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

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q1 QTRKRROF 531588.00 76440.00 76440.00

Q2 QTUKGYTC 384864.00 50856.00 50856.00
Q3 QTXJIDEF 413544.00 60216.00 60216.00
Q4 QUAZCIBC 266136.00 34674.00 34674.00
Total (Rs.) 1596132.00 222186.00 222186.00
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)

Book Identification Number (BIN)

Tax Deposited in respect of the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

1 19968.00 1011497 00001 30-04-2019 F

2 16952.00 1011497 00001 30-04-2019 F
3 16952.00 1011501 00002 31-05-2019 F
4 16952.00 3011499 00004 30-06-2019 F
5 5616.00 3011499 00004 30-06-2019 F
6 16952.00 4029696 00002 31-07-2019 F
7 16952.00 3029695 00001 31-08-2019 F
8 16952.00 5029697 00005 30-09-2019 F
9 16952.00 2042798 00002 31-10-2019 F
10 25792.00 0042807 00007 30-11-2019 F
11 17472.00 6042806 00001 31-12-2019 F

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 Certificate Number: VJOXUMA TAN of Employer: DELO02574F PAN of Employee: AWZPS9110L Assessment Year: 2020-21

Book Identification Number (BIN)

Tax Deposited in respect of the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

12 17472.00 3059782 00007 31-01-2020 F

13 17202.00 2059779 00003 29-02-2020 F
Total (Rs.) 222186.00
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)

Challan Identification Number (CIN)

Tax Deposited in respect of the
Sl. No. deductee
(Rs.) BSR Code of the Bank Date on which Tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

Total (Rs.)

Verification

I, PAWAN KUMAR TIWARI, son / daughter of SADA SHIV TIWARI working in the capacity of DEPUTY DIRECTOR (designation) do hereby certify that a sum of
Rs. 222186.00 [Rs. Two Lakh Twenty Two Thousand One Hundred and Eighty Six Only (in words)] has been deducted and a sum of Rs. 222186.00 [Rs. Two Lakh
Twenty Two Thousand One Hundred and Eighty Six Only] has been 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 DELHI

Date 22-Jul-2020 (Signature of person responsible for deduction of Tax)

Designation: DEPUTY DIRECTOR Full Name:PAWAN KUMAR TIWARI

Notes:
1. Part B (Annexure) of the certificate in Form No.16 shall be issued by the employer.
2. If an assessee is employed under one employer during the year, Part 'A' of the 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.
3. 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.
4. To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Legend used in Form 16

* Status of matching with OLTAS

Legend Description Definition
Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
U Unmatched
details in bank match with details of deposit in TDS / TCS statement
Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
P Provisional
verification of payment details submitted by Pay and Accounts Officer (PAO)
In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
F Final mentioned in the TDS / TCS statement filed by the deductors. In case of government deductors, details of TDS / TCS booked in Government
account have been verified by Pay & Accounts Officer (PAO)
Payment details of TDS / TCS deposited in bank by deductor have matched with details mentioned in the TDS / TCS statement but the
O Overbooked amount is over claimed in the statement. Final (F) credit will be reflected only when deductor reduces claimed amount in the statement or
makes new payment for excess amount claimed in the statement

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 FORM NO. 16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. VJOXUMA Last updated on 20-Jul-2020

Name and address of the Employer Name and address of the Employee

OFFICE OF THE JOINT SECRETARY (TRG) & CHIEF

ADMINISTRATIVE OFFICER
SHAILENDRA KUMAR SAXENA
E-BLOCK, DALHOUSI ROAD - 110011
BSES SUB STATION FLAT-2, OPPOSITE BLOCK 93, PUSHP
Delhi
VIHAR SECTOR-1, NEW DELHI - 110017 Delhi

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

PANNOTREQD DELO02574F AWZPS9110L

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2020-21 01-Apr-2019 31-Mar-2020
4 , Luxmi Nagar, Delhi - 110092

Details of Salary Paid and any other income and tax deducted Rs. Rs.

1. Gross Salary

(a) Salary as per provisions contained in section 17(1) 1596132.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 0.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 1596132.00

(e) Reported total amount of salary received from other employer(s) 0.00

2. Less: Allowances to the extent exempt under section 10

(a) Travel concession or assistance under section 10(5) 0.00

(b) Death-cum-retirement gratuity under section 10(10) 0.00

(c) Commuted value of pension under section 10(10A) 0.00

Cash equivalent of leave salary encashment under section 10

(d) 0.00
(10AA)

(e) House rent allowance under section 10(13A) 0.00

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Certificate Number: VJOXUMA TAN of Employer: DELO02574F PAN of Employee: AWZPS9110L Assessment Year: 2020-21

Amount of any other exemption under section 10

(f) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(g) Total amount of any other exemption under section 10 1200.00

Total amount of exemption claimed under section 10

(h) 1200.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 1594932.00
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) 50000.00

(b) Entertainment allowance under section 16(ii) 0.00

(c) Tax on employment under section 16(iii) 0.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 50000.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 1544932.00

7. Add: Any other income reported by the employee under as per section 192 (2B)

Income (or admissible loss) from house property reported by

(a) 0.00
employee offered for TDS

(b) Income under the head Other Sources offered for TDS 0.00

Total amount of other income reported by the employee

8. 0.00
[7(a)+7(b)]
9. Gross total income (6+8) 1544932.00

10. Deductions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life insurance premia, contributions to

(a) 150000.00 150000.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 150000.00 150000.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 50000.00 50000.00

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 Certificate Number: VJOXUMA TAN of Employer: DELO02574F PAN of Employee: AWZPS9110L Assessment Year: 2020-21

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 0.00 0.00

Deduction in respect of health insurance premia under section

(g) 7800.00 7800.00
80D

Deduction in respect of interest on loan taken for higher

(h) education under section 80E 0.00 0.00

Gross Qualifying Deductible

Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(i) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(j) 0.00 0.00 0.00
under section 80TTA

Amount Deductible under any other provision (s) of Chapter VI-A

(k) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

Total of amount deductible under any other provision(s) of

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 207800.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 1337132.00

13. Tax on total income 213639.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 8546.00

17. Tax payable (13+15+16-14) 222185.00

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

19. Net tax payable (17-18) 222185.00

Verification
I, PAWAN KUMAR TIWARI, son/daughter of SADA SHIV TIWARI .Working in the capacity of DEPUTY DIRECTOR
(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, and other available records.

Place DELHI (Signature of person responsible for deduction of tax)

Full
Date 22-Jul-2020 PAWAN KUMAR TIWARI
Name:

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 Certificate Number: VJOXUMA TAN of Employer: DELO02574F PAN of Employee: AWZPS9110L Assessment Year: 2020-21

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Particular's of Amount for any other
Sl. exemption under section 10 Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2..
3.
4.
5.
6.

10(k). Break up for ‘Amount deductible under any other provision(s) of Chapter VIA ‘to be filled in the table below
Particular's of Amount deductible under
Sl. any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

DELHI (Signature of person responsible for deduction of

Place
tax)
Full
Date 22-Jul-2020 PAWAN KUMAR TIWARI
Name:

Page 4 of 4