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FORM NO.16A

Financial year

Whether Original / Duplicate / Amended If Amended give Previous TDS Certificate number

TAN of Deductor Name of the Deductor

PAN of Deductee Name of the Deductee

Gross Amount Paid TDS

Gross TDS amount Total TDS amount where PAN was found valid by Income Tax Department

Place

Date Signature of person responsible for deduction of tax

Designation Full Name

# TDS certificate number is an internal reference number to be given by the Deductor (optional)

[See rule 31(1)(b)]

Certificate under section 203 of the Income-tax Act, 1961for Tax deducted at source

TDS Certificate number#

TDS Unique Transaction Number (UTN) as provided by Income Tax Department

Whether PAN uploaded was validated by Income Tax Department? (Y/N)

I _____________________________________, son/daughter of ___________________________________ working in the capacity of ______________________________________ (designation) do hereby certify that a sum of Rs. ____________________________ [Rupees _____________________________________ ________________________________________________________________________________ (in words)] has been deducted at source and paid to the credit of the Central Government. I further certify that the information given above is true and correct based on the books of accounts, documents and other available records.

FORM NO.16

Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source on Salary

Financial year 2009-2010 36/2010

Whether Original / Duplicate / Amended N/A

TAN of Deductor DELG08919G Name of Deductor

PAN of Deductee CLEPS4130G Name of Deductee

TDS/TCS Amount

Quarter 1 011420100118210Quarter 2 011420100118221Quarter 3 011420200100993Quarter 4 011420200100982

Gross amount of TDS / TCS

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 220347

(b) Rs 000

(c) Rs

(d) Total Rs 220347

2 Less: Allowance to the extent exempt u/s 10 Rs 000

Rs 000

Rs 000 Rs

3 Balance(1-2) Rs 220347

4 Deductions :

(a) Standard deduction Rs. 0

(b) Entertainment allowance Rs. 0

(c) Tax on employment Rs. 0

5 Aggregate of 4(a) to (c) Rs 000

6 Income chargeable under the head 'salaries' (3-5) Rs 220347

[See rule 31(1)(a)]

TDS Certificate number#

If Amended give Previous TDS Certificate number

Deputy Conservator of Forest, Forest and Wildlife Department GNCT of Delhi,Tugalkabad Shooting Range, New DelhiSHEESH RAM S/O RAM SWAROOP

TDS Unique Transaction Number (UTN) as provided by Income Tax Department

Whether PAN uploaded was validated by Income Tax Department? (Y/N)

Gross Amount Paid / Collected

Value of perquisites u/s 17(2) (as per Form No.12BB, wherever applicable) Profits in lieu of salary under section 17(3)(as per Form No.12BB, wherever applicable)

7 Add: Any other income reported by the employee Rs 000

Rs

Rs 0 Rs 0

8 Gross total income (6+7) Rs 220347

9 Deductions under Chapter VIA

Gross Amount

(a) GPF Rs 36000 Rs 36000 Rs 36000

(b) CGEIS Rs 180 Rs 180 Rs 180

(c) Rs Rs Rs

(d) Rs Rs Rs Rs 36180

10 Aggregate of deductible amount under Chapter VIA Rs 36180

11 Total Income (8-10) Rs 184167

12 Tax on total income Rs 2417

13 Rebate and relief under Chapter VIII

I. Under section 88 (please specify)

Gross Amount

(a) Rs Rs 0

(b) Rs Rs 0

(c) Rs Rs 0

(d) Rs Rs 0

(e) Rs Rs 0

Rs Rs 0

II (a) Under section 88B Rs 0

(b) Under section 88C Rs 0

III Under section 89 (attach details) Rs 0

14 Rs 0

15 Tax payable (12-14) and surcharge thereon Rs 2490

16 Less: Tax deducted at source Rs 0

17 Tax payable/refundable (15-16) Rs 2490

Place NEW DELHI

Date 29/04/2010 Signature of person responsible for deduction of tax

Designation: DDO Full Name : PRABHAT TYAGI

Qualifying Amount

Deductible Amount

Qualifying Amount

Tax rebate/ relief

(f) Total [(a) to (e)]

Aggregate of tax rebates and relief at 13 above [I(f) + II(a)+ II(b) + III]

I PRABHAT TYAGI, son/daughter of SH P N TYAGI working in the capacity of D. D. O. (designation) do hereby certify that a sum of Rs.2490/-[Rupees TWO THOUSAND FOUR HUNDRED NINETY ONLY (in words)] has been deducted at source and paid to the credit of the Central Government. I further certify that the information given above is true and correct based on the books of accounts, documents and other available records.