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. IAEABPA Last updated on 26-May-2019

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

RAYMOND UCO DENIM PRIVATE LIMITED

PLOT C-1, M.I.D.C., LOHARA,
VITTHAL SAUDAGAR KANDE
YAVATMAL - 445001
RAYMOND HOUSING COLONY, PLOT NO C1 MIDC, LOHARA -
Maharashtra
445001 Maharashtra
+(91)7232-304509
CHETAN.RATHI@RAYMOND.IN

Employee Reference No.

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

AAACU8272H NGPU01513B BLSPK6426Q

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 102, Ground Floor, Aayakar Bhawan, Telangkhedi 2019-20 01-Apr-2018 31-Mar-2019
Road , Civil Lines, Nagpur - 440001

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

Q1 QTDPRCGB 156014.00 0.00 0.00

Q2 QTGGWZPE 132868.00 0.00 0.00
Q3 QTIHLBNF 143014.00 0.00 0.00
Q4 QTNZLKGC 133671.00 0.00 0.00
Total (Rs.) 565567.00 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
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 0.00 - 07-05-2018 - F
2 0.00 - 07-06-2018 - F
3 0.00 - 07-07-2018 - F
4 0.00 - 07-08-2018 - F

Page 1 of 2
 Certificate Number: IAEABPA TAN of Employer: NGPU01513B PAN of Employee: BLSPK6426Q Assessment Year: 2019-20

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*

5 0.00 - 07-09-2018 - F
6 0.00 - 06-10-2018 - F
7 0.00 - 06-11-2018 - F
8 0.00 - 07-12-2018 - F
9 0.00 - 07-01-2019 - F
10 0.00 - 07-02-2019 - F
11 0.00 - 07-03-2019 - F
12 0.00 - 30-04-2019 - F
Total (Rs.) 0.00

Verification

I, KAILASH SANGIDAS TAORI, son / daughter of SANGIDAS CHUNNILAL TAORI working in the capacity of GENERAL MANAGER FINANCE (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] 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.

Place YAVATMAL

Date 05-Jun-2019 (Signature of person responsible for deduction of Tax)

Designation: GENERAL MANAGER FINANCE Full Name:KAILASH SANGIDAS TAORI

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

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

Certificate No. IAEABPA Last updated on 26-May-2019

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

RAYMOND UCO DENIM PRIVATE LIMITED

PLOT C-1, M.I.D.C., LOHARA,
VITTHAL SAUDAGAR KANDE
YAVATMAL - 445001
RAYMOND HOUSING COLONY, PLOT NO C1 MIDC, LOHARA -
Maharashtra
445001 Maharashtra
+(91)7232-304509
CHETAN.RATHI@RAYMOND.IN

PAN of the Deductor TAN of the Deductor PAN of the Employee

AAACU8272H NGPU01513B BLSPK6426Q

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 102, Ground Floor, Aayakar Bhawan, Telangkhedi 2019-20 01-Apr-2018 31-Mar-2019
Road , Civil Lines, Nagpur - 440001

Details of Salary Paid and any other income and tax deducted Rs. Rs.

1. Gross Salary

(a) Salary as per provisions contained in section 17(1) 565567.00

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 565567.00

(e) Reported total amount of salary received from other employer(s) 0.00

2. Less: Allowances to the extent exempt under section 10

(a) Travel concession or assistance under section 10(5) 19295.00

(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 section 10

(d) 0.00
(10AA)

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

Page 1 of 4
Certificate Number: IAEABPA TAN of Employer: NGPU01513B PAN of Employee: BLSPK6426Q Assessment Year: 2019-20

Amount of any other exemption under section 10

[Note: Break-up to be prepared by employee and issued to
(f)
the employee, where applicable , before furnishing of Part B
to the employee]

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

Total amount of exemption claimed under section 10 [2(a)+2(b)

(h) 19295.00
+2(c)+2(d)+2(e)+2(g)]

3. Total amount of salary received from current employer [1(d)-2(h)] 546272.00

4. Less: Deductions under section 16

(a) Standard deduction under section 16(ia) 40000.00

(b) Entertainment allowance under section 16(ii) 0.00

(c) Tax on employment under section 16(iii) 2500.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 42500.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 503772.00

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

Income (or admissible loss) from house property reported by

(a) -192112.00
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 [7(a)+7

8. -192112.00
(b)]
9. Gross total income (6+8) 311660.00
10. Deductions under Chapter VI-A

Deduction in respect of life insurance premia, contributions to

(a) 108894.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 108894.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 0.00

Page 2 of 4
 Certificate Number: IAEABPA TAN of Employer: NGPU01513B PAN of Employee: BLSPK6426Q Assessment Year: 2019-20

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 0.00

Deduction in respect of health insurance premia under section

(g) 1020.00
80D

Deduction in respect of interest on loan taken for higher

(h) education 0.00
under section 80E
Total Deduction in respect of donations to certain funds,
(i) 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(j) 0.00
under section 80TTA

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

[Note: Break-up to be prepared by employee and issued to
(k)
the employee, where applicable , before furnishing of Part B
to the employee]

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

(l) 0.00
Chapter VI-A
Aggregate of deductible amount under Chapter VI-A [10(d)+10
11. (e)+10(f)+10(g)+10(h)+10(i) 109914.00
10(j)+10(l)]

12. Total taxable income (9-11) 201746.00

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, KAILASH SANGIDAS TAORI, son/daughter of SANGIDAS CHUNNILAL TAORI .Working in the capacity of GENERAL
MANAGER FINANCE (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.

YAVATMAL (Signature of person responsible for deduction of

Place
tax)
Full
Date 05-Jun-2019 KAILASH SANGIDAS TAORI
Name:

Page 3 of 4
 Certificate Number: IAEABPA TAN of Employer: NGPU01513B PAN of Employee: BLSPK6426Q Assessment Year: 2019-20

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Amount of any other exemption
Sl. under section 1o 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
Amount deductible under any
Sl. other provision(s) of Chapter Gross Amount Qualifying Amount Deductible Amount
No. VIA
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

YAVATMAL (Signature of person responsible for deduction of

Place
tax)
Full
Date 05-Jun-2019 KAILASH SANGIDAS TAORI
Name:

Page 4 of 4
Emp No: 0000212946 PAN: BLSPK6426Q Emp Name :VITTHAL SAUDAGAR KANDE

2.(f) Break up for 'Amount of any other exemption under section 10' to be filled in the table below

Sl.No Amount of any other exemption unser section 10 (Rs). Gross Amount Qualifying Amount Deductible Amount
Rs. Rs. Rs.
1 Children Education Exemption 0.00

10(k).Break up for 'Amount deductible under any other provision(s) of chapter VIA 'to be filled in the table below

Sl.No Amount deductible under any other Provision(s) of Gross Amount Qualifying Amount Deductible Amount
chapter VIA (Rs). Rs. Rs. Rs.

1 Med-Exp on Handicapped Dep (80DD) 0.00

2 Medical Exp Chronic Diseases (80DDB) 0.00

3 Physical Handicapped (80U) 0.00

4 Additional deduction on home Loan Interest (80EE) 0.00

..........................................................................................
Signature of the person responsible for deduction of tax

Place : YAVATMAL Full Name : KAILASH SANGIDAS TAORI

Date : 05/06/2019 Designation : GENERAL MANAGER FINANCE

Emp No: 0000212946 PAN: BLSPK6426Q Emp Name :VITTHAL SAUDAGAR KANDE

FORM No. 12BA

[ See rule 26A(2)(b) ]

Statement showing particulars of perquisites, other fringe benefits or amenities and profits in lieu of
Salary with value thereof
(1) Name and address of employer RAYMOND UCO DENIM PVT. LTD.
Plot No. C - 1, M.I.D.C. Lohara Village
Yavatmal - 445001

(2) TAN NGPU01513B

:
(3) TDS assessment range of the employer ITO(TDS), Nagpur
(4) Name, designation and PAN of employee VITTHAL SAUDAGAR KANDE
EXECUTIVE
BLSPK6426Q

(5) Is the employee a director or a person with substantial No

: interest in the company (Where the employer is a company)

(6) Income under the head "Salaries" of the employee Rs. 565,567.00
(other than from perquisites)

(7) Financial year 2018 - 2019

Value of Amount, if any, Less Exempt Amount of perquisite

SI.
Nature of perquisite (see rule 3) Perquisite as recovered from as per chargeable to tax
No. per rules (Rs) the employee) provision u/s col(1)-col(3) (Rs)
(Rs) 17(2) (Rs)
01. Accommodation 0.00 0.00 0.00 0.00
02. Cars/other automotive 0.00 0.00 0.00 0.00
03. Sweeper, gardener, watchman or personal attendant 0.00 0.00 0.00 0.00
04. Gas, electricity, water 0.00 0.00 0.00 0.00
05. Interest free or concessional loans 0.00 0.00 0.00 0.00
06. Holiday expenses 0.00 0.00 0.00 0.00
07. Free or concessional travel 0.00 0.00 0.00 0.00
08. Free meals 0.00 0.00 0.00 0.00
09. Free education 0.00 0.00 0.00 0.00
10. Gifts, vouchers, etc 0.00 0.00 0.00 0.00
11. Credit card expenses 0.00 0.00 0.00 0.00
12. Club expenses 0.00 0.00 0.00 0.00
13. Use of movable assets by employees 0.00 0.00 0.00 0.00
14. Transfer of assets to employees 0.00 0.00 0.00 0.00
15. Value of any other benefit / amenity / service / privilege 0.00 0.00 0.00 0.00
16. Stock options (non-qualified options) 0.00 0.00 0.00 0.00
17. Other benefits or amenities 0.00 0.00 0.00 0.00
18. Total value of perquisites 0.00 0.00 0.00 0.00
19. Total value of profits in lieu of salary as per section 17(3) 0.00 0.00 0.00 0.00

(8) Details of tax,

(a) Tax deducted at source from salary of the Rs. 0.00
Employee under section 192(1)
(b) Tax paid by the Employer on behalf of the Employee Nil
under section 192(1A) on perquisites under section 17(2)
(c) Total Tax Paid Rs. 0.00
(d) Date of Payment into Government treasury As per Form-16

DECLARATION BY EMPLOYER
I, KAILASH SANGIDAS TAORI, son / daughter of SANGIDAS CHUNNILAL TAORI, working as GENERAL MANAGER FINANCE do hereby
declare on behalf of RAYMOND UCO DENIM PVT. LTD. that the information given above is based on the books of account, documents and other
relevent 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.

..........................................................................................
Signature of the person responsible for deduction of tax

Place : YAVATMAL Full Name : KAILASH SANGIDAS TAORI

Date : 05/06/2019 Designation : GENERAL MANAGER FINANCE

KAILASH SANGIDAS TAORI

Issued by : Gujarat Narmada Valley Fertilizers and Chemicals Limited
Reason : Digitally signed TDS certificate as per Information Technology Act, 2000.
Date : 2019.06.13 17:36:21 +05:30