Certificate No. | Last updated on | |||
Name and address of the Employer/Specified Bank | Name and address of the Employee/ Specified senior citizen | |||
PAN of Deductor | TAN of the Deductor | PAN of the Employee/ specificed senior citizen | Employee Reference No./ Pension Payment order no. provided by the Employer (If available) |
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CIT (TDS) Address…………………………… …………………………………….. |
Assessment Year | Period with the Employer | ||
From | To | |||
City…………………………………. Pin code………………… |
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Summary of amount paid/credited and tax deducted at source thereon in respect of the employee | |||||||
Quarter(s) | Receipt Numbers of original quarterly statement of TDS under sub section (3) of Section 200 | Amount paid/ credited | Amount of tax deducted (Rs.) |
Amount of tax deposited/ remitted (Rs.) |
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Total (Rs.) |
Sl. No. | Tax Deposited in respect of the deductee (Rs. ) | Book Identification Number (BIN) | |||
Receipt numbers of Form No. 24G |
DDO serial number in Form No. 24G |
Date of transfer voucher dd/mm/yyyy | Status of matching with Form No. 24G | ||
Total (Rs. ) |
Sl. No. | Tax Deposited in respect of the deductee (Rs. ) | Challan Identification Number (CIN) | |||
BSR Code of the Bank |
Date on which tax | Challan Serial |
Status of matching |
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Branch | deposited | Number | with | ||
(dd/mm/yyyy) | OLTAS | ||||
TOTAL (Rs.) |
Details of Salary Paid and any other income and tax deducted | ||||
A | Whether opting for taxation u/s 115BAC? | [YES/NO] | ||
1. | Gross Salary | |||
(a) | Salary as per provisions contained in section 17(1) | Rs. ... | ||
(b) |
Value of perquisites under section 17(2) (as per Form No. 12BA, wherever applicable) | Rs. ... |
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(c) |
Profits in lieu of salary under section 17(3) (as per Form No. 12BA, wherever applicable) | Rs. ... |
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(d) | Total | Rs. ... | ||
(e) |
Reported total amount of salary received from other employer (s) | Rs. ... |
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2. | Less: Allowances to the extent exempt under section 10 | |||
(a) | Travel concession or assistance under section 10(5) | Rs. ... | ||
(b) | Death-cum-retirement gratuity under section 10(10) | Rs. ... | ||
(c) | Commuted value of pension under section 10(10A) | Rs. ... | ||
(d) |
Cash equivalent of leave salary encashment under section 10(10AA) | Rs. ... |
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(e) | House rent allowance under section 10(13A) | Rs. ... |
(f) | Amount of any other exemption under section 10 | |||
clause … | Rs. ... | |||
clause … | Rs. ... | |||
clause … | Rs. ... | |||
clause … | Rs. ... | |||
clause … | Rs. ... | |||
… | Rs. ... | |||
(g) | Total amount of any other exemption under section 10 | Rs. ... | ||
(h) | Total amount of exemption claimed under section 10 | Rs. ... | ||
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)] | ||||
3. | Total amount of salary received from current employer | Rs. ... | ||
[1(d)-2(h)] | ||||
4. | Less: Deductions under section 16 | |||
(a) | Standard deduction under section 16(ia) | Rs. ... | ||
(b) | Entertainment allowance under section 16(ii) | Rs. ... | ||
(c) | Tax on employment under section 16(iii) | Rs. ... | ||
5. | Total amount of deductions under section 16 | Rs. ... | ||
[4(a)+4(b)+4(c)] | ||||
6. | Income chargeable under the head "Salaries" [(3+1(e)-5] | Rs. ... | ||
7. | Add: Any other income reported by the employee under as per section 192 (2B) | |||
(a) | Income (or admissible loss) from house property reported | Rs. ... | ||
by employee offered for TDS |
(b) | Income under the head Other Sources offered for TDS | Rs. ... | ||
8. |
Total amount of other income reported by the employee[7(a)+7(b)] | Rs. ... |
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9. | Gross total income (6+8) | Rs. ... | ||
10. | Deductions under Chapter VI-A | |||
Gross Amount |
Deductible Amount | |||
(a) | Deduction in respect of life insurance premia, contributions to provident fund etc. under section 80C | Rs. ... | Rs. ... | |
(b) |
Deduction in respect of contribution to certain pension funds under section 80CCC | Rs. ... |
Rs. ... |
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(c) | Deduction in respect of contribution by taxpayer to pension scheme under section 80CCD (1) |
Rs. ... | Rs. ... | |
(d) | Total deduction under section 80C, 80CCC and 80CCD(1) | Rs. ... | Rs. ... |
(e) |
Deductions in respect of amount paid/deposited to notified pension scheme under section 80CCD (1B) | Rs. ... |
Rs. ... |
|
(f) |
Deduction in respect of contribution by Employer to pension scheme under section 80CCCD (2) | Rs. ... |
Rs. ... |
|
(g) |
Deduction in respect of health insurance premia under section 80D | Rs. ... |
Rs. ... |
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(h) |
Deduction in respect of interest on loan taken for higher education under section 80E | Rs. ... |
Rs. ... |
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Gross Amount | Qualifying Amount | Deductible Amount | ||
(i) |
Total Deduction in respect of donations to certain funds, charitable institutions, etc. under section 80G | Rs. ... |
Rs. ... |
Rs. ... |
(j) |
Deduction in respect of interest on deposits in savings account under section 80TTA | Rs. ... |
Rs. ... |
Rs. ... |
(k) | Amount deductible under any other provision(s) of Chapter VI‐A | |||
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
… | Rs. ... | Rs. ... | Rs. ... | |
(l) |
Total of amount deductible under any other provision(s) of Chapter VI‐A | Rs. ... |
Rs. ... |
Rs. ... |
11. |
Aggregate of deductible amount under Chapter VI-A [10(a) +10(b) +10(c)+ 10(d)+ 10(e)+ 10(f)+ 10(g)+ 10(h)+ 10(i) + 10(j)+10(l)] |
Rs. ... |
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12. | Total taxable income (9-11) | Rs. ... | ||
13. | Tax on total income | Rs. ... | ||
14. | Rebate under section 87A, if applicable | Rs. ... | ||
15. | Surcharge, wherever applicable | Rs. ... | ||
16. | Health and education cess @ 4% | Rs. ... |
17. | Tax payable (13+15+16-14) | Rs. ... | ||
18. | Less: Relief under section 89 (attach details) | Rs. ... | ||
19. | Net tax payable (17-18) | Rs. ... |
A | Whether opting for taxation u/s 115BAC? | [YES/NO] | |||
1. | Gross Salary | ||||
(a) | Pension as per provisions contained in clause (ii) of section 17(1) | Rs. ... | |||
2. | Total amount of salary received | Rs. ... | |||
3. | Less: Deductions under section 16 | ||||
(a) | Standard deduction undersection 16(ia) | Rs…. | |||
(b) | Tax on employment undersection 16(iii) | Rs. ... | |||
4. | Total amount of deductions under section 16 [3(a)+3(b)] | Rs. ... | |||
5. | Income chargeable under the head "Salaries" [(2-4] | Rs. ... | |||
6. | Interest Income under the head Other Sources paid by the specified bank | Rs. ... | |||
7. | Gross total income (5+6) | Rs. ... | |||
8. | Deductions under Chapter VI-A | ||||
Gross Amount | Deductible Amount | ||||
(a) | Deduction in respect of life insurance premia, contributions to provident fund etc. under section 80C | Rs. ... | Rs. ... | ||
(b) | Deduction in respect of contribution to certain pension funds under section 80CCC | Rs. ... | Rs. ... | ||
(c) | Deduction in respect of contribution by taxpayer to pension scheme under section 80CCD(1) | Rs. ... | Rs. ... |
(d) | Total deduction under section 80C, 80CCC and 80CCD (1) | Rs. ... | Rs. ... | |
(e) | Deductions in respect of amount paid/deposited to notified pension scheme under section 80CCD (1B) | Rs. ... | Rs. ... | |
(b) | Deduction in respect of health insurance premia under section 80D | Rs. ... | Rs. ... | |
(e) | Deduction in respect of interest on loan taken for higher education under section 80E | Rs. ... | Rs. ... | |
Gross Amount | Qualifying Amount | Deductible Amount | ||
(f) | Total Deduction in respect of donations to certain funds, charitable institutions, etc. under section 80G | Rs. ... | Rs. ... | Rs. ... |
(g) | Deduction in respect of interest on deposits in savings account under section 80TTB | Rs. ... | Rs. ... | Rs. ... |
(h) | Amount deductible under any other provision(s) of Chapter VI‐A | |||
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
section … | Rs. ... | Rs. ... | Rs. ... | |
… | Rs. ... | Rs. ... | Rs. ... | |
(i) | Total of amount deductible under any other provision(s) of Chapter VI‐A | Rs. ... | Rs. ... | Rs. ... |
9. | Aggregate of deductible amount under Chapter VI-A [8(a)+8(b)+8(c)+8(d)+8(e)+8(f)+8(g)+8(h)+8(i)] | Rs. ... | ||
10. | Total taxable income (7-9) | Rs. ... | ||
11. | Tax on total income | Rs. ... | ||
12. | Rebate under section 87A, if applicable | Rs. ... | ||
13. | Surcharge, wherever applicable | Rs. ... | ||
14. | Health and education cess | Rs. ... | ||
15. | Tax payable (11+13+14-12) | Rs. ... | ||
16. | Less: Relief under section 89 (attach details) | Rs. ... | ||
17. | Net tax payable (16-17) | Rs. ... |
Verification | |
I, …………………………….., son/daughter of ……………………………………….working in the capacity of .………………………......... (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. |
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Place…………………………......… | (Signature of person responsible for deduction of tax) |
Date………………………….......… | Full Name : …………………………… |
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