Form 16 21-22
Form 16 21-22
Form 16 21-22
16
PART B
Certificate under section 203 of the Income-tax Act, 1961 f or tax deducted at source on salary paid to an employee un der section 192 or pension/interest income
of specified senior citizen under section 194P
Certificate No. Last updated on 18-July-2021
Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen
PAN of the Deductor TAN of the Deductor PAN of the Employee/Specified senior citizen
From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2021- 22 01-Apr-2020 31-Mar-2021
Building, Charni Road , Mumbai – 400002
Annexure - I
Details of Salary Paid and any other income and tax deducted
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 873180.00
(e) Reported total amount of salary received from other employer(s) 0.00
Page 1 of 4
7. Add: Any other income reported by the employee under as per section 192 (2B)
(b) Income under the head Other Sources offered for TDS 0.00
(d) Total deduction under section 80C, 80CCC and 80CCD(1) 73354.00 73354.00
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Verification
I, AMIT GOYAL ,son/daughter of PREM GOYAL Working in the capacity of XEN (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.
Page 3 of 4
Signature Not Verified
Signed By:AMIT GOYAL Signing
Date:18/07/2021
Certificate Number: AYORYOA TAN of Employer:DELH01586E PAN of Employee:HVJPS1752L Assessment Year: 2020-21
2. (f) Break up for‘Amount of any other exemption under section10’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
any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
Sl.
No. Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.
Page 4 of 4
Signature Not Verified
Signed By:AMIT GOYAL Signing
Date:18/07/2021