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. ATOIRIA Last updated on 20-Jun-2019

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

KPMG
8TH FLOOR,, TOWER C ,BUILDING NO -10, DLF PHASE-2, AMAN AGRAWAL
DLF CYBER CITY, GURGAON - 122002 VISHAL ENTERPRISES SHOPZ, BH CAFE CREAM OPP SHELL,
Haryana PETROL PUMP WAKAD ROAD, MULSHI HINJEWADI, PUNE -
411057 Maharashtra
[email protected]

Employee Reference No.

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

AAAFK1415H RTKK01220C BWTPA7740M

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
2019-20 01-Apr-2018 31-Mar-2019
C.R. Building, Sector 17 . E, Himalaya Marg Chandigarh - 160017

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 QTDCLBOD 50349.00 0.00 0.00

Q2 QTHYZVCC 72349.00 0.00 0.00
Q3 QTKTGZUD 50349.00 0.00 0.00
Q4 QTOHOJQE 50349.00 0.00 0.00
Total (Rs.) 223396.00 0.00 0.00
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

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)

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*

1 0.00 - 07-10-2017 - F
2 0.00 - 07-05-2018 - F
3 0.00 - 07-06-2018 - F
4 0.00 - 07-07-2018 - F

Page 1 of 2
 Certificate Number: ATOIRIA TAN of Employer: RTKK01220C PAN of Employee: BWTPA7740M Assessment Year: 2019-20

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*

5 0.00 - 07-08-2018 - F
6 0.00 - 07-08-2018 - F
7 0.00 - 07-09-2018 - F
8 0.00 - 05-10-2018 - F
9 0.00 - 06-11-2018 - F
10 0.00 - 07-01-2019 - F
11 0.00 - 07-02-2019 - F
12 0.00 - 07-03-2019 - F
13 0.00 - 30-04-2019 - F
Total (Rs.) 0.00

Verification

I, GIRRAJ SHALLYA, son / daughter of HARENDRA KUMAR SHALLYA working in the capacity of AUTHORISED SIGNATORY (designation) do hereby certify that a
sum of Rs. 0.00 [Rs. Zero Only (in words)] has been deducted and a sum of Rs. 0.00 [Rs. Zero 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 GURGAON

Date 29-Jun-2019 (Signature of person responsible for deduction of Tax)

Designation: AUTHORISED SIGNATORY Full Name:GIRRAJ SHALLYA

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

Signature Not Verified

Digitally signed by GIRRAJ SHALLYA
Date: 2019.07.02 16:13:51 +05:30
Reason: Form 16 Digital Signature
Page 2 of 2
 FORM NO. 16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. ATOIRIA Last updated on 20-Jun-2019

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

KPMG
8TH FLOOR,, TOWER C ,BUILDING NO -10, DLF PHASE-2, AMAN AGRAWAL
DLF CYBER CITY, GURGAON - 122002 VISHAL ENTERPRISES SHOPZ, BH CAFE CREAM OPP SHELL,
Haryana PETROL PUMP WAKAD ROAD, MULSHI HINJEWADI, PUNE -
411057 Maharashtra
[email protected]

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

AAAFK1415H RTKK01220C BWTPA7740M

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
2019-20 01-Apr-2018 31-Mar-2019
C.R. Building, Sector 17 . E, Himalaya Marg Chandigarh - 160017

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) 223396.00

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 223396.00

(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

Page 1 of 4
Certificate Number: ATOIRIA TAN of Employer: RTKK01220C PAN of Employee: BWTPA7740M Assessment Year: 2019-20

Amount of any other exemption under section 10

[Note: Break-up to be prepared by employer and issued to
(f)
the employee, where applicable , before furnishing of Part B
to the employee]

(g) Total amount of any other exemption under section 10 0.00

Total amount of exemption claimed under section 10 [2(a)+2(b)

(h) 0.00
+2(c)+2(d)+2(e)+2(g)]

3. Total amount of salary received from current employer [1(d)-2(h)] 223396.00

4. Less: Deductions under section 16

(a) Standard deduction under section 16(ia) 40000.00

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

(c) Tax on employment under section 16(iii) 2500.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 42500.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 180896.00

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 [7(a)+7

8. 0.00
(b)]
9. Gross total income (6+8) 180896.00
10. Deductions under Chapter VI-A

Deduction in respect of life insurance premia, contributions to

(a) 21600.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00

Deduction in respect of contribution by taxpayer to pension

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

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 21600.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 0.00

Page 2 of 4
 Certificate Number: ATOIRIA TAN of Employer: RTKK01220C PAN of Employee: BWTPA7740M Assessment Year: 2019-20

Deduction in respect of contribution by Employer to pension

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

Deduction in respect of health insurance premia under section

(g) 0.00
80D

Deduction in respect of interest on loan taken for higher

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

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

[Note: Break-up to be prepared by employer and issued to
(k)
the employee, where applicable , before furnishing of Part B
to the employee]

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

(l) 0.00
Chapter VI-A
Aggregate of deductible amount under Chapter VI-A [10(d)+10
11. (e)+10(f)+10(g)+10(h)+10(i) 21600.00
10(j)+10(l)]

12. Total taxable income (9-11) 159296.00

13. Tax on total income 0.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 0.00

17. Tax payable (13+15+16-14) 0.00

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

19. Net tax payable (17-18) 0.00

Verification
I, GIRRAJ SHALLYA, son/daughter of HARENDRA KUMAR SHALLYA .Working in the capacity of AUTHORISED
SIGNATORY (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.

GURGAON (Signature of person responsible for deduction of

Place
tax)
Full
Date 29-Jun-2019 GIRRAJ SHALLYA
Name:

Page 3 of 4
 Certificate Number: ATOIRIA TAN of Employer: RTKK01220C PAN of Employee: BWTPA7740M Assessment Year: 2019-20

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.

GURGAON (Signature of person responsible for deduction of

Place
tax)
Full
Date 29-Jun-2019 GIRRAJ SHALLYA
Name:

Page 4 of 4
 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 & address of employer : KPMG
: DELHI
2.TAN : RTKK01220C
3.TDS Assessment Range of the employer : HARYANA
4.Name,designation and PAN of employee : AMAN AGRAWAL/ ANALYST/ BWTPA7740M
5.Is the employee a director or a person : NO
with substantial interest in the company:
(where the employer is a company) :
6.Income under the head "Salaries" of the : 223396
employee (other than from perquisites) :
7.Financial year : 2018-2019
8.Valuation of Perquisites :
---------------------------------------------------------------------------------------------------------------
Sr Nature of perquisites Value of Amount,if Amount of
No. (see rule 3) perquisite any,recovered perquisite
as per rules from the chargeable
employee to tax(3-4)
(1) (2) (3) (4) (5)
---------------------------------------------------------------------------------------------------------------
1.Accommodation
2.Cars/Other automotive
3.Sweeper, gardener, watchman or personal attendant
4.Gas, electricity, water
5.Interest free or concessional loans
6.Holiday expenses
7.Free or concessional travel
8.Free meals
9.Free education
10.Gifts, vouchers, etc.
11.Credit card expenses
12.Club expenses
13.Use of movable assets by employees
14.Transfer of assets to employees
15.Value of any other benefit/amenity/service/privilege
16.Stock options (non-qualified options)
17.Other benefits or amenities
18.Total value of perquisites

19.Total value of Profit in lieu of salary as per 17(3)

---------------------------------------------------------------------------------------------------------------
9.Details of Tax, -
(a) Tax deducted from salary of the employee u/s 192(1) : As per Form-16
(b) Tax paid by employer on behalf of the employee u/s 192(1A): NIL
(c) Total tax Paid : As per Form-16
(d) Date of payment into Government treasury : As per Form-16
---------------------------------------------------------------------------------------------------------------
DECLARATION BY EMPLOYER
I, GIRRAJ SHALLYA, S/O HARENDRA KUMAR SHALLYA working as DIRECTOR do hereby declare on behalf of KPMG 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 Sec.17 and rules
framed thereunder and that such information is true and correct.

----------------------------------------------------------------------
This certificate is signed using digital signature
For KPMG
Signed By : GIRRAJ SHALLYA
Place : HARYANA Designation : DIRECTOR
Date : 28/06/2019 Certificate Issuer: e-Mudra CA
---------------------------------------------------------------------------------------------------------------
Emp. No. : 51853 PAN: BWTPA7740M
Employee No.:51853 Name:AMAN AGRAWAL PAN of Employee:BWTPA7740M

Certificate Number: TAN of Employer:RTKK01220C Assessment Year:2019-2020

2. (f) Break up for Amount of any other exemption under section 10

---------------------------------------------------------------------------------------------------------------
SL |Particulars | Amount of any | Gross Amount | Qualifying | Deductible |
No.| |other exemption | | Amount | Amount |
| |under section 10| | | |
| | 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'
---------------------------------------------------------------------------------------------------------------
SL |Particulars |Amount deductible| Gross Amount | Qualifying | Deductible |
No.| |under any other | | Amount | Amount |
| |provision(s) of | | | |
| |Chapter VIA | | | |
| | Rs. | Rs. | Rs. | Rs. |
---------------------------------------------------------------------------------------------------------------
1| | | | | |
2| | | | | |
3| | | | | |
4| | | | | |
5| | | | | |
6| | | | | |
---------------------------------------------------------------------------------------------------------------

Signature of the person responsible for deduction of tax

Place : HARYANA Full Name : GIRRAJ SHALLYA
Date : 28/06/2019 Designation : DIRECTOR
---------------------------------------------------------------------------------------------------------------
 Annexure to Form 16
---------------------------------------------------------------------------------------------------------------

Employee No.:51853 Name:AMAN AGRAWAL PAN of Employee:BWTPA7740M

Certificate Number: TAN of Employer:RTKK01220C Assessment Year:2019-2020

Break up for Salary

---------------------------------------------------------------------------------------------------------------
SL |Particulars | Amount |
No.| | Rs. |
---------------------------------------------------------------------------------------------------------------
1|BASIC | 122652 |
2|PERFORMANCE BONUS | 22000 |
3|SPECIAL ALLOW | 78744 |
---------------------------------------------------------------------------------------------------------------
|TOTAL | 223396 |
---------------------------------------------------------------------------------------------------------------

Break up of 10(d) - Total deduction under section 80C, 80CCC and 80CCD(1)
---------------------------------------------------------------------------------------------------------------
SL |Particulars | Amount |
No.| | Rs. |
---------------------------------------------------------------------------------------------------------------
1|Provident Fund | 21600 |
---------------------------------------------------------------------------------------------------------------
|TOTAL | 21600 |
---------------------------------------------------------------------------------------------------------------