1) This document is a Form 16 issued by SABS Architects and Engineers Pvt Ltd to their employee Anil Kumar Sagar for the fiscal year 2012-2013. 2) It details the taxes deducted at source from Sagar's salary over four quarters totaling Rs. 40,000 and includes calculations of his taxable income and tax deductions. 3) Key information provided includes Sagar's gross salary of Rs. 769,049, taxable income of Rs. 525,066, and tax payable of Rs. 38,124.

1. 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
Name and address of Employer Name & Designation of Employee
SABS ARCHITECTS AND ENGINEERS PVT LTD ANIL KUMAR SAGAR,
GH-14/1058, PASCHIM VIHAR, STUDIO MANAGER
NEW DELHI- 110063,
DELHI
PAN of the Deductor TAN of the Deductor PAN of the Employee
AAICS6118C DELS27230A AOGPK9955E
CIT (TDS) Assessment Year Period
Address From To
2012-13
City Pin Code 13/06/2011 31/03/2012
Summary of tax deducted at source
Receipt Number of original statements of Amount of tax deducted in Amount of tax deposited remitted
Quarter
TDS under sub-section (3) of section 200 respect of the employee in respect of the employee
Quarter1 - Rs. 0.00 Rs. 0.00
Quarter2 - Rs. 10,000.00 Rs. 10,000.00
Quarter3 - Rs. 15,000.00 Rs. 15,000.00
Quarter4 - Rs. 15,000.00 Rs. 15,000.00
Total Rs. 40,000.00 Rs. 40,000.00
PART B (Refer Note 1)
Details of Salary paid and any other income and tax deducted
1. Gross Salary
(a) Salary as per provisions contained in section 17(1) Rs. 769,049.00
(b) Value of perquisites u/s 17(2)(as per Form No. 12BA, wherever
applicable) Rs. 0.00
(c) Profits in lieu of salary under section 17(3) (as per Form No. 12BA,
wherever applicable) Rs. 0.00
(d) Total Rs. 769,049.00
2. Less: Allowance to the extent exempt under section 10 Rs. 182,680.00
Allowance Rs.
House Rent allowance Rs. 192,262.00 Rs. 175,000.00 Rs. 175,000.00
Conveyance allowance Rs. 7,680.00 Rs. 7,680.00 Rs. 7,680.00
Medical allowance Rs. 12,000.00 Rs. 0.00 Rs. 0.00
Rs. 0.00 Rs. 0.00 Rs. 0.00
Rs. 0.00 Rs. 0.00 Rs. 0.00 Rs. 182,680.00
3. Balance (1-2) Rs. 586,369.00
4. Deductions:
(a) Entertainment Allowance Rs. 0.00
(b) Tax on Employment Rs. 0.00
5. Aggregate of 4(a) and (b) Rs. 0.00
6. Income chargeable under the head "Salaries" (3-5) Rs. 586,369.00
7. Add: Any other income reported by the employee
(a) From House property Rs. 0.00
(b) From other sources Rs. 0.00
(c) Others Rs. 0.00 Rs. 0.00
8. Gross Total Income (6 + 7) Rs. 586,369.00
SureTDS Enterprise - Cynosure Technologies (P) Ltd.

2. 9. Deduction under Chapter VI-A
(A) Sections 80C, 80CCC and 80CCD
Gross Amount Deductible Amount
(a) Section 80C
(i) LIC Rs. 45,818.00
(ii) PPF Rs. 500.00
(iii) EPF Rs. 14,985.00
(iv) Rs. 0.00
(v) Rs. 0.00
(vi) Rs. 0.00 Rs. 61,303.00 Rs. 61,303.00
(b) Section 80CCC Rs. 0.00 Rs. 0.00
(c) Section 80CCD Rs. 0.00 Rs. 0.00
Note : 1. Aggregate amount deductible under section 80C shall not exceed one lakh rupees
2. Aggregate amount deductible under the three sections. i.e. 80C, 80CCC, 80CCD, shall not exceed one lakh rupees
(B) Other sections (e.g. 80E, 80G etc.) under chapter VI-A
Gross Amount Qualifying Amount Deductible Amount
(i) Section 80CCF Rs. 0.00 Rs. 0.00 Rs. 0.00
(ii) Rs. 0.00 Rs. 0.00 Rs. 0.00
(iii) Rs. 0.00 Rs. 0.00 Rs. 0.00
(iv) Rs. 0.00 Rs. 0.00 Rs. 0.00
(v) Rs. 0.00 Rs. 0.00 Rs. 0.00
10. Aggregate of deductible amounts under chapter VIA Rs. 61,303.00
11. Total Income (8 -10) Rs. 525,066.00
12. Tax on Total Income Rs. 37,014.00
13. Education cess @ 3% (on tax computed at S. No. 12) Rs. 1,110.00
14. Tax Payable ( 12+13) Rs. 38,124.00
15. Less: Relief under section 89 (attach details) Rs. 0.00
16. Tax payable (14 - 15) Rs. 38,124.00
Verification
I, AJIT KUMAR PADHI Son/Daughter of B.B.PADHI working in the capacity of
ACCOUNTANT (designation) do hereby certify that a sum of Rs. 40,000.00
(InWords) Rupees Forty Thousand has been deducted and
deposited to the credit of the Central Government. I further certify that the information given about is true ,complete and correct and is
based on the books of account, documents, TDS statement, TDS deposited and other available records.
Signature of the person responsible for deduction of tax
Place: NEW DELHI Full Name : AJIT KUMAR PADHI
Date: 30/05/2012 Designation : ACCOUNTANT
This certificate pertains to ANIL KUMAR SAGAR
SureTDS Enterprise - Cynosure Technologies (P) Ltd.

3. ANNEXRE - B
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH
CHALLAN
( The Employer to provide payment wise details of tax deducted and deposited with respect to the employee )
Tax Deposited in respect
S. No. Challan Identification Number(CIN)
on of the employee (Rs.)
BSR Code of the Bank Date on which tax deposited
Branch Challan Serial No
(dd/mm/yyyy)
1 5,000.00 6390310 21/11/2011 00733
2 5,000.00 6390310 21/11/2011 00733
3 5,000.00 6390310 31/05/2012 02307
4 5,000.00 6390310 31/05/2012 02307
5 5,000.00 6390310 31/05/2012 02307
6 5,000.00 6390310 31/05/2012 02307
7 10,000.00 6390310 31/05/2012 02307
Total 40,000.00
This certificate pertains to ANIL KUMAR SAGAR
SureTDS Enterprise - Cynosure Technologies (P) Ltd.