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. VYBZDBL Last updated on 26-Apr-2018

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

CODEMANTRA PRIVATE LIMITED

143, 3RD FLOOR, IIFL TOWER, MGR MAIN ROAD,
KISHOREKUMAR JOTHILAKSHMI
KANDANCHAVADI, PERUNGUDI, CHENNAI - 600096
OLD NO 118 NEW NO 6/4, THANGAL STREET,
Tamilnadu
VIRUGAMBAKKAM, CHENNAI - 600092 Tamilnadu
+(91)44-66155300
[email protected]

Employee Reference No.

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

AADCC6839P CHEC08221D AICPJ8650P

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
7th Floor, New Block, Aayakar Bhawan, 121 , M.G. Road, 2018-19 01-Apr-2017 31-Mar-2018
Chennai - 600034

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

Q2 QSPBCPIF 143594.00 2070.00 2070.00

Q3 QSSUKSRF 41774.00 690.00 690.00
Total (Rs.) 185368.00 2760.00 2760.00
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*

1 690.00 6360218 07-08-2017 48998 F

2 690.00 6360218 07-09-2017 59271 F
3 690.00 6360218 13-10-2017 33313 F
4 690.00 0261632 07-11-2017 92356 F
Total (Rs.) 2760.00

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 Certificate Number: VYBZDBL TAN of Employer: CHEC08221D PAN of Employee: AICPJ8650P Assessment Year: 2018-19

Verification

I, VANITHA, son / daughter of VENKATESAN working in the capacity of FINANCE CONTROLLER (designation) do hereby certify that a sum of Rs. 2760.00 [Rs. Two
Thousand Seven Hundred and Sixty Only (in words)] has been deducted and a sum of Rs. 2760.00 [Rs. Two Thousand Seven Hundred and Sixty 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.

VANITHA S
Digitally signed by VANITHA S
Place CHENNAI DN: c=IN, o=Personal, postalCode=600075, st=TAMIL NADU,
serialNumber=4c0639447c7ef02a7681210a49fb3922d1eb8b24a89883b0f2ea58ad87c014de, cn=VANITHA S
Date: 2018.04.30 12:00:20 +05'30'

Date 30-Apr-2018 (Signature of person responsible for deduction of Tax)

Designation: FINANCE CONTROLLER Full Name: VANITHA

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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Employer Name: CODEMANTRA PRIVATE LIMITED TAN: CHEC08221D PAN: AADCC6839P

Employee Name: JOTHI LAKSHMI K PAN: AICPJ8650P FY: 2017-18 AY: 2018-19

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. 2,73,929.00
b) Value of perquisites u/s 17(2) Rs.
c) Profits in lieu of salary under section 17(3) Rs.
d) Total Rs. 2,73,929.00
2 Less :Allowance to the extent exempt u/s 10
(a) HRA Exemption Rs. 33,364.00
(b) Conveyance Exemption Rs. 8,460.00
(c) Medical Rs. 6,611.00
(d) Total Rs. 48,435.00
3 Balance 1-2 Rs. 2,25,494.00
4 Deductions :
b) Tax on Employment Rs. 1,095.00
5 Aggregate of 4 (a) and (b) Rs. 1,095.00
6 Income chargeable under the head 'salaries' (3-5) Rs. 2,24,399.00
7 Add: Any other income reported by the employee
8 Gross total income (6+7) Rs. 2,24,399.00
9 Deductions under chapter VI-A
Gross Amount Deductible Amount
(A) Sections 80C, 80CCC and 80CCD

(a) Deductions in respect of specified investments/savings - 80C

1) Provident Fund Rs. 10,800.00 Rs. 10,800.00
(B) Other Sections under Chapter VIA
10 Aggregate of deductible amount under chapter VI-A Rs. 10,800.00
11 Total income (8-10) Rs. 2,13,600.00
12 Tax on total income Rs.
13 Education Cess @ 3% (on tax computed at S.No.12) Rs.
14 Tax payable (12 + 13) Rs. Nil
15 Less: Relief under section 89 (attach details) Rs.
16 Tax Payable (14 - 15) Rs. Nil
Verification
I, VANITHA, daughter of VENKATESAN working in the capacity of Director - TM & OD (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, TDS deposited and other available records.
Digitally signed by VANITHA S
DN: c=IN, o=Personal,

VANITHA S
postalCode=600075, st=TAMIL NADU,
Place CHENNAI serialNumber=4c0639447c7ef02a76812
10a49fb3922d1eb8b24a89883b0f2ea58
ad87c014de, cn=VANITHA S
Date: 2018.04.30 12:00:41 +05'30'

Date 30/04/2018 Signature of person responsible for deduction of tax

Designation Director - TM & OD Full Name: VANITHA

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