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. FDTLCXA Last updated on 19-May-2019

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

CIPLA LIMITED
PENINSULA BUSINESS PARK, CIPLA HOUSE, LOWER PAREL,
SANTOSH MANOHAR PANDIT
GANPATRAO KADAM MARG, MUMBAI - 400013
H.NO.449,, SOUTH KASABA, NEAR SONYA MARUTI TEMPLE,
Maharashtra
SOLAPUR - 413007 Maharashtra
+(91)22-24826807
[email protected]

Employee Reference No.

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

AAACC1450B MUMC00352C BEJPP8460B

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2019-20 01-Apr-2018 31-Mar-2019
Building, Charni Road , Mumbai - 400002

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 QTCCDCLG 115134.00 0.00 0.00

Q2 QTGGDIID 115134.00 0.00 0.00
Q3 QTJKTKNF 137085.00 0.00 0.00
Q4 QTMKEUSB 144216.00 1630.00 1630.00
Total (Rs.) 511569.00 1630.00 1630.00
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 - 07-05-2018 - F
2 0.00 - 07-06-2018 Signature
- Not Verified
F
3 0.00 - 06-07-2018 -
Digitally signed by F
4 0.00 - 07-08-2018 DINESH
- R JAIN F
Date: 2019.05.31 05:35:43
IST
Page 1 of 2
 Certificate Number: FDTLCXA TAN of Employer: MUMC00352C PAN of Employee: BEJPP8460B 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 - 07-09-2018 - F
6 0.00 - 05-10-2018 - F
7 0.00 - 06-11-2018 - F
8 0.00 - 07-12-2018 - F
9 0.00 - 07-01-2019 - F
10 74.00 0510075 07-02-2019 48446 F
11 830.00 0510075 07-03-2019 40930 F
12 726.00 0510075 28-03-2019 12119 F
Total (Rs.) 1630.00

Verification

I, DINESH RAMNIRANJAN JAIN, son / daughter of RAMNIRANJAN CHIRANJILAL JAIN working in the capacity of AUTHORISED SIGNATORY (designation) do
hereby certify that a sum of Rs. 1630.00 [Rs. One Thousand Six Hundred and Thirty Only (in words)] has been deducted and a sum of Rs. 1630.00 [Rs. One
Thousand Six Hundred and Thirty 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 MUMBAI

Date 22-May-2019 (Signature of person responsible for deduction of Tax)

Designation: AUTHORISED SIGNATORY Full Name:DINESH RAMNIRANJAN JAIN

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
DINESH R JAIN
Date: 2019.05.31 05:35:43
IST
Page 2 of 2
EMP CODE: 96810
EMP NAME: Santosh M Pandit

PART B (Annexure)

Details of Salary paid and any other income and tax deducted
1. Gross Salary

(a) Salary as per provisions contained in Sec 17(1) Rs. 511569.00

(b) Value of perquisites Under Section 17(2)

Rs. 0.00
(as Per Form No.12 BA, whenever applicable)

(c) Profits in lieu of salary Under Section 17(3)

Rs. 0.00
(as per Form No.12BA, wherever applicable)

(d) Total Rs. 511569.00

(e) Reported total amount of salary received from other employer(s) Rs. 0

2. Less: Allowance to the extent Exempt under Section 10

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

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

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

(d) Cash equivalent of leave salary encashment under section 10(10AA) Rs. 0.00

(e) House rent allowance under section 10(13A) Rs. 59496.00

(f) Amount of any other exemption under section 10

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

(h) Total amount of exemption claimed

Rs. 59496.00
under section 10[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

3. Total amount of salary received from current employer [1(d)-2(h)] Rs. 452073.00

4. Less: Deductions under section 16:

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

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

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

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

6. Income chargeable under the head 'Salaries' [(3+1(e)-5] Rs. 409573.00

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. 0.00
by employee offered for TDS

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

8. Total amount of other income reported by the employee [7(a)+7(b)] Rs. 0.00

9.Gross total income (6+8) Rs. 409573.00

10. Deductions under Chapter VI-A

Gross amount Deductible amount

(a) Deduction in respect of life insurance premia,

Rs. 78227.00 Rs. 78227.00
contributions to provident fund etc. under section 80C

(b) Deduction in respect of contribution to certain

Rs. 0.00 Rs. 0.00
pension funds under section 80CCC

(c) Deduction in respect of contribution by taxpayer

Rs. 0.00 Rs. 0.00
to pension scheme under section 80CCD (1)

(d) Total deduction under section 80C, 80CCC and 80CCD(1) Rs. 78227.00 Rs. 78227.00

(e) Deductions in respect of amount

Rs. 0.00 Rs. 0.00
paid/deposited to notified pension scheme under section 80CCD (1B)

(f) Deduction in respect of contribution by Employer

Rs. 0.00 Rs. 0.00
to pension scheme under section 80CCD (2)

(g) Deduction in respect of health insurance premia under section 80D Rs. 0.00 Rs. 0.00

(h) Deduction in respect of interest on loan taken

Rs. 0.00 Rs. 0.00
for higher education under section 80E

Gross amount Qualifying Amount Deductible amount

Signature Not Verified
(i) Total Deduction in respect of donations to certain funds,
Rs. 0.00 Rs. 0.00 Rs. 0
charitable institutions, etc. under section 80G
Digitally signed by
(j) Deduction in respect of interest on deposits in
Rs. 0.00 DINESH RRJAINs. 0.00 Rs. 0.00
savings account under section 80TTA
Date: 2019.05.31 05:35:43
( k ) A m o u n t d e d u c t i b l e u n d e r a n y o t h e r p r o v i s i o n ( s ) o f C h a p t e r V I‐A IST
( l ) T o t a l o f a m o u n t d e d u c t i b l e u n d e r a n y o t h e r p r o v i s i o n ( s ) o f C h a p t e r V I‐A Rs. 0.00 Rs. 0.00 Rs. 0.00

11. Aggregate of deductible amount under Chapter VI-A

Rs. 78227.00
[10(a)+10(b)+10(c)+10(d)+10(e)+10(f)+10(g)+10(h)+10(i) 10(j)+10(l)]
 12. Total taxable income (9-11) Rs. 331346.00

13. Tax on total income Rs. 4067.00

14. Rebate under section 87A, if applicable Rs. 2500.00

15. Surcharge, wherever applicable Rs. 0.00

16. Health and Education Cess @ 4.00% Rs. 63.00

17. Tax payable (13+15+16-14) Rs. 1630.00

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

19. Net tax payable (17-18) Rs. 1630.00

Verification

I , D i n e s h R J a i n , s o n / d a u g h t e r o f R a m n i r a n j a n J a i n w o r k i n g i n t h e c a p a c i t y o f S r . V i c e P r e s i d e n t - H e a d C o r p o r a t e F i n a n c ed o h e r e b y c e r t i f y t h a t t h e i n f o r m a t i o n g i v e n
above is true, complete and correct and is based on the books of account, documents, TDS statements, and other available records.

Place MUMBAI

Date 31 May 2019

(Signature of person responsible for deduction of tax)

Designation: Sr. Vice President- Head

Full Name: Dinesh R Jain
Corporate Finance

Signature Not Verified

Digitally signed by
DINESH R JAIN
Date: 2019.05.31 05:35:43
IST
EMP CODE: 96810
EMP NAME: Santosh M Pandit

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 : CIPLA LIMITED

PENINSULA BUSINESS PARK CIPLA HOUSE
GANPATRAO KADAM MARG LOWER PAREL
MUMBAI, MAHARASHTRA - 400013

2. TAN : MUMC00352C

3. TDS Assessment Range of the Employer : CIT (TDS)-MUM-2

4. Name Designation and PAN of Employee : Santosh M Pandit , Assistant Manager

BEJPP8460B

5. Is the employee a director or a person with : No

Substantial interest in the company (where the
employer is a company)

6. Income under the head 'Salaries' of the : 452073.00

Employee:(other than from perquisites)

7. Financial year : 2018 - 2019

8. Valuation of Perquisites :

S. No. Name 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 0.00 0.00 0.00

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 0.00 0.00 0.00

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 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 amenties 0.00 0.00 0.00

18 Total value of perquisites 0.00 0.00 0.00

19 Total value of profits in lieu of salary as per section 17(3) 0.00 0.00 0.00

9. Details of tax -

(a) Tax deducted from salary of the employee under sec. 192(1) Rs. 1 6 3 0 . 0 0

(b) Tax paid by employer on behalf of the employee under section 192(1A) Rs. 0 . 0 0

(c) Total tax paid Rs. 1 6 3 0 . 0 0

(d) Date of payment into Government treasury Various Dates as mentioned on Page 2 of the Form 16

DECLARATION BY EMPLOYER

I , D i n e s h R J a i n, s o n / d a u g h t e r o f R a m n i r a n j a n J a i n w o r k i n g a s S r . V i c e P r e s i d e n t - H e a d C o r p o r a t e F i n a n c ed o h e r e b y d e c l a r e o n b e h a l f o f C I P L A L I M I T E D t h a t t h e
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 : MUMBAI Signature of the person responsible for deduction of tax

Date : 31 May 2019 Full Name : Dinesh R Jain

Designation : Sr. Vice President- Head Corporate Finance

Signature Not Verified

Digitally signed by
DINESH R JAIN
Date: 2019.05.31 05:35:43
IST