Form 16

Assessment Year : 2024-25

Financial Year : 2023-24
Employee ID : 415721
Employee Name : VIVEK KUMAR
Employee PAN : HFNPK4835N
Employee Designation : Senior Quality Assurance Engineer
Employer Name : FLEXERA SOFTWARE INDIA LLP
Employer TAN : BLRF03905G

What is Form-16?
Form 16 is a certificate of tax deduction at source issued by the employers to their
employees specifying the tax deducted, the salary income and its breakup, the investment
details of the employees, etc.

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Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT
 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 paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. UCFNBAA Last updated on 22-May-2024

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen

FLEXERA SOFTWARE INDIA LLP

3,2nd Floor, Prestige, Sigma, Vittal Mallya, Road Bangalore,
VIVEK KUMAR
Bangalore, Bangalore - 560001
VILLAGE POST- PATNER, LAKHISARAI PATNER, SURAJGARHA
Karnataka
- 811311 Bihar
+(91)80-25280406
[email protected]

Employee Reference No. provided by the

PAN of the
Employer/Pension Payment order no. provided
PAN of the Deductor TAN of the Deductor Employee/Specified senior
by the Employer (If available)
citizen

AAFFF0554M BLRF03905G HFNPK4835N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2024-25 11-Mar-2024 31-Mar-2024
Ganganagar, Bangalore - 560032

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

Receipt Numbers of
original quarterly Amount of tax deposited / remitted
Amount of tax deducted
Quarter(s) statements of TDS under Amount paid/credited (Rs.)
(Rs.)
sub-section (3) of
Section 200
Q4 QVRXOEEB 177726.00 0.00 0.00
Total (Rs.) 177726.00 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
(Rs.) Receipt Numbers of Form DDO serial number in Form no.
(dd/mm/yyyy) with Form no. 24G
No. 24G 24G

Total
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.) Date on which Tax deposited Status of matching with
BSR Code of the Bank Challan Serial Number
(dd/mm/yyyy) OLTAS*
Branch

1 0.00 - 06-04-2024 - F
Total 0.00

Verification

I, DOLFRED NORBERT DSOUZA, son / daughter of JOHN ALFRED DSOUZA working in the capacity of DIRECTOR HR AND SITE LEADER
(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]
h a s b e e Signature
n d e p o s i t e dNot
t o Verified
the credit of the Central Government. I further certify that the information given above is true, complete and
c o r r e c t Digitally
a n d i s signed
b a s e d by
o nDOLFRED
the books of account, documents, TDS statements, TDS deposited and other available records.
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT
Page 1 of 2
 Certificate Number: UCFNBAA TAN of Employer: BLRF03905G PAN of Employee: HFNPK4835N Assessment Year: 2024-25

Place BANGALROE

Date 12-Jun-2024 (Signature of person responsible for deduction of Tax)

Designation: DIRECTOR HR AND SITE LEADER Full Name: DOLFRED NORBERT DSOUZA

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
U Unmatched
only when payment 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
P Provisional
Final (F) on 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
F Final payment details 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
O Overbooked statement but the 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 DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT
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 paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. UCFNBAA Last updated on 22-May-2024

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen

FLEXERA SOFTWARE INDIA LLP

3,2nd Floor, Prestige, Sigma, Vittal Mallya, Road Bangalore,
VIVEK KUMAR
Bangalore, Bangalore - 560001
VILLAGE POST- PATNER, LAKHISARAI PATNER, SURAJGARHA
Karnataka
- 811311 Bihar
+(91)80-25280406
[email protected]

PAN of the Employee/Specified senior citizen

PAN of the Deductor TAN of the Deductor

AAFFF0554M BLRF03905G HFNPK4835N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2024-25 11-Mar-2024 31-Mar-2024
Ganganagar, Bangalore - 560032

Annexure - I

Details of Salary Paid and any other income and tax deducted

A Whether opting out of taxation u/s 115BAC(1A)? No

1. Gross Salary Rs. Rs.

(a) Salary as per provisions contained in section 17(1) 177726.00

Value of perquisites under section 17(2) (as per Form

(b) 0.00
No. 12BA, wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form
(c) 0.00
No. 12BA, wherever applicable)
(d) Total 177726.00
Reported total amount of salary received from other
(e) 0.00
employer(s)
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

(d) 0.00
section 10(10AA)

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

(f) Other special allowances under section 10(14) 0.00

Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT Page 1 of 4
 Certificate Number: UCFNBAA TAN of Employer: BLRF03905G PAN of Employee: HFNPK4835N Assessment Year: 2024-25

Amount of any other exemption under section 10

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

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

Total amount of exemption claimed under section 10

(i) 0.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(f)+2(h)]

Total amount of salary received from current employer

3. 177726.00
[1(d)-2(i)]
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

Total amount of deductions under section 16 [4(a)+4(b)

5. 50000.00
+4(c)]

Income chargeable under the head "Salaries" [(3+1(e)

6. 127726.00
-5]

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

Income (or admissible loss) from house property

(a) 0.00
reported by 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) 127726.00

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

Deduction in respect of life insurance premia,

(a) 0.00 0.00
contributions to 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) 0.00 0.00
Deductions in respect of amount paid/deposited to notified
(e) pension scheme under section 80CCD (1B) 0.00 0.00

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

(g) 0.00 0.00
section 80D
Signature Not Verified
Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT Page 2 of 4
 Certificate Number: UCFNBAA TAN of Employer: BLRF03905G PAN of Employee: HFNPK4835N Assessment Year: 2024-25

Deduction in respect of interest on loan taken for higher

(h) 0.00 0.00
education under section 80E

Deduction in respect of contribution by the employee to

(i) 0.00 0.00
Agnipath Scheme under section 80CCH

Deduction in respect of contribution by the Central

(j) 0.00 0.00
Government to Agnipath Scheme under section 80CCH
Gross Qualifying Deductible
Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(k) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(l) under section 80TTA
0.00 0.00 0.00

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

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

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

(n) Chapter VI-A 0.00 0.00 0.00

Aggregate of deductible amount under Chapter VI-A

11. [10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(k)+10 0.00
(l)+10(n)]

12. Total taxable income (9-11) 127726.00

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, DOLFRED NORBERT DSOUZA, son/daughter of JOHN ALFRED DSOUZA .Working in the capacity of DIRECTOR HR
AND SITE LEADER (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 BANGALROE (Signature of person responsible for deduction of tax)

Full
Date 12-Jun-2024 DOLFRED NORBERT DSOUZA
Name:

Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT Page 3 of 4
Employee Name : Vivek Kumar Employee PAN : HFNPK4835N
Employee ID : 415721 Financial Year : 2023-24

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

10. (k) Break up for ‘Amount deductible under any other provision(s) of Chapter VIA’ to be filled in the table below
Deductible
Particulars of Amount deductible under any other provision(s) of Qualifying
S.No. Gross Amount (Rs.) Amount
Chapter VIA Amount (Rs.)
(Rs.)
1

Place BANGALORE Full Name Dolfred Norbert Dsouza

Date 12-Jun-2024 Designation Director HR

Signature of the person responsible for deduction of tax

Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT
Employee Name : Vivek Kumar Employee PAN : HFNPK4835N
Employee ID : 415721 Financial Year : 2023-24

FORM NO. 12BA

[See rule 26A(2)(b)]
Statement Showing particular of perquisites, other fringe benefits or amenities and profits in lieu
of salary with value thereof

(1) Name and address of Employer : FLEXERA SOFTWARE INDIA LLP

3,2ND FLOOR, PRESTIGE SIGMA,
VITTAL MALLYA ROAD BANGALORE
BANGALORE BANGALORE
KARNATAKA 560001
(2) TAN : BLRF03905G
(3) TDS Assessment Range of the Employer :
(4) Name, designation and PAN or Aadhar Number of employee : Vivek Kumar Senior Quality Assurance
Engineer HFNPK4835N
(5) Is the employee a director or a person with substantial interest in the : No
company (Where the employer is a company)
(6) Income under the head Salaries of the employee (Other than from : 127726.00
Perquisites)
(7) Financial Year : 2023-24
(8) Valuation of Perquisites
Amount of
Amount, if any, perquisite
Value of perquisite Value of perquisite
S.No. recovered from the chargeable to
(See Rule 3) as per rules (Rs.)
employee (Rs.) tax Col. (3) -
Col. (4) (Rs.)
(1) (2) (3) (4) (5)
1. Accommodation 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 any other benefit/amenity/service/privilege 0.00 0.00 0.00
Stock options allotted or transferred by employer being an eligible
16. 0.00 0.00 0.00
start-up referred to in section 80-IAC- Tax to be deferred
Stock options (non-qualified options) other than ESOP in col 16
17. 0.00 0.00 0.00
above
Contribution by employer to fund and scheme taxable under section
18. 0.00 0.00 0.00
17(2)(vii)
Annual accretion by way of interest, dividend etc. to the balance at
19. the credit of fund and scheme referred to in section 17(2)(vii) and 0.00 0.00 0.00
taxable under section 17(2)(viia).
Stock options allotted or transferred by employer being an eligible
20. 0.00 0.00 0.00
start-up referred to in section 80-IAC-Tax not to be deferred
21. Other Benefits or Perquisites 0.00 0.00 0.00
22. Total value of perquisites 0.00 0.00 0.00
23. Total value of profits in lieu of salary as per section 17(3)

Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT
Employee Name : Vivek Kumar Employee PAN : HFNPK4835N
Employee ID : 415721 Financial Year : 2023-24

(9) Details of tax

(a) Tax Deducted from salary of the employee under section 192(1) : 0.00
(b) Tax paid by the employer on behalf of the employee under section 192(1A) : 0.00
(c) Total Tax Paid : 0.00
(d) Date of payment into Government treasury : As per the dates mentioned in Part A of Form
16

DECLARATION BY EMPLOYER

I, Dolfred Norbert Dsouza , son/daughter of John Alfred Dsouza working as Director HR (designation) do hereby declare on behalf of
FLEXERA SOFTWARE INDIA LLP (name of the employer) 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 section 17 and rules framed thereunder and that such information is true and correct.

Place BANGALORE Full Name Dolfred Norbert Dsouza

Date 12-Jun-2024 Designation Director HR

Signature of the person responsible for deduction of tax

Signature Not Verified

Digitally signed by DOLFRED
NORBERT DSOUZA
Date: 2024.06.19 01:08:09
PDT