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. MFBQBNA Last updated on 26-Jun-2019

Name and address of the Employer Name and address of the Employee
CAPGEMINI TECHNOLOGY SERVICES INDIA LIMITED
Plot No. 14, Rajiv Gandhi, Infotech Park, Hinjewadi,, Phase-III, MIDC-
SEZ,, GNANA KUMAR CHINNAPPAN
Village Man,Taluka Mulshi, Pune - 411057 62, JAI NAGAR KANCAYAM MAIN R, NALLUR TOWN
Maharashtra PANCHAYAT, TIRUPUR - 641604 Tamil Nadu
+(91)22-2066991000
chandra.bhandari@capgemini.com
Employee Reference No.
PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

AABCM4573E PNEI06594A AIHPC7751K

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
4th Floor, .A. Wing, PMT Commercial Complex, Shankar Sheth 2019-20 01-Apr-2018 31-Mar-2019
Road , Swargate, Pune - 411037

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 QTEIHTKG 199218.00 2796.00 2796.00

Q2 QTHXSWUG 199468.00 2811.00 2811.00
Q3 QTKLGENC 231046.00 6627.00 6627.00
Q4 QTPXRDEG 305506.00 22116.00 22116.00
Total (Rs.) 935238.00 34350.00 34350.00
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*

1 932.00 0510075 04-05-2018 17286 F

2 932.00 0510075 07-06-2018 13269 F
3 932.00 0510075 05-07-2018 21405 F
4 932.00 0510075 06-08-2018 22741 F

Page 1 of 2
 Certificate Number: MFBQBNA TAN of Employer: PNEI06594A PAN of Employee: AIHPC7751K 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*

5 946.00 0510075 04-09-2018 13832 F

6 933.00 0510075 04-10-2018 17707 F
7 2015.00 0510075 05-11-2018 22758 F
8 2223.00 0510075 06-12-2018 25064 F
9 2389.00 0510075 04-01-2019 21224 F
10 1432.00 0510075 06-02-2019 31114 F
11 1743.00 0510075 06-03-2019 33128 F
12 18941.00 0510075 23-04-2019 11765 F
Total (Rs.) 34350.00

Verification

I, CHANDRA SINGH BHANDARI, son / daughter of HUKUM SINGH BHANDARI working in the capacity of SENIOR DIRECTOR (designation) do hereby certify that a
sum of Rs. 34350.00 [Rs. Thirty Four Thousand Three Hundred and Fifty Only (in words)] has been deducted and a sum of Rs. 34350.00 [Rs. Thirty Four Thousand
Three Hundred and Fifty 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 PUNE

Date 27-Jun-2019 (Signature of person responsible for deduction of Tax)

Designation: SENIOR DIRECTOR Full Name:CHANDRA SINGH BHANDARI

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. MFBQBNA Last updated on 26-Jun-2019

Name and address of the Employer Name and address of the Employee
CAPGEMINI TECHNOLOGY SERVICES INDIA LIMITED
Plot No. 14, Rajiv Gandhi, Infotech Park, Hinjewadi,, Phase-III, MIDC-
SEZ,, GNANA KUMAR CHINNAPPAN
Village Man,Taluka Mulshi, Pune - 411057 62, JAI NAGAR KANCAYAM MAIN R, NALLUR TOWN
Maharashtra PANCHAYAT, TIRUPUR -641604 Tamil Nadu
+(91)22-2066991000
chandra.bhandari@capgemini.com

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

AABCM4573E PNEI06594A AIHPC7751K

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
4th Floor, .A. Wing, PMT Commercial Complex, Shankar Sheth 2019-20 01-Apr-2018 31-Mar-2019
Road , Swargate, Pune - 411037

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) 935238.00

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 935238.00

(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) 0.00

(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) 140220.00

Page 1 of 4
Certificate Number: MFBQBNA TAN of Employer: PNEI06594A PAN of Employee: AIHPC7751K 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) 140220.00
+2(c)+2(d)+2(e)+2(g)]

3. Total amount of salary received from current employer [1(d)-2(h)] 795018.00

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) 2400.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 42400.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 752618.00

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) 0.00
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. 0.00
(b)]
9. Gross total income (6+8) 752618.00
10. Deductions under Chapter VI-A

Deduction in respect of life insurance premia, contributions to

(a) 150000.00
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) 150000.00

Deductions in respect of amount paid/deposited to notified

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

Page 2 of 4
 Certificate Number: MFBQBNA TAN of Employer: PNEI06594A PAN of Employee: AIHPC7751K 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) 0.00
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) 150000.00
10(j)+10(l)]

12. Total taxable income (9-11) 602618.00

13. Tax on total income 33024.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 1321.00

17. Tax payable (13+15+16-14) 34345.00

18. Less: Relief under section 89 (attach details) 0.00

19. Net tax payable (17-18) 34345.00

Verification
I, CHANDRA SINGH BHANDARI, son/daughter of HUKUM SINGH BHANDARI .Working in the capacity of SENIOR
DIRECTOR (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.

PUNE (Signature of person responsible for deduction of

Place
tax)
Full
Date 28-Jun-2019 CHANDRA SINGH BHANDARI
Name:

Page 3 of 4
 Certificate Number: MFBQBNA TAN of Employer: PNEI06594A PAN of Employee: AIHPC7751K 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.

PUNE (Signature of person responsible for deduction of

Place
tax)
Full
Date 28-Jun-2019 CHANDRA SINGH BHANDARI
Name:

Page 4 of 4
 EMPID:39968

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 the employer: CAPGEMINI TECHNOLOGY SERVICES INDIA LIMITED
Plot No.14, Rajiv Gandhi, Infotech Park,
Hinjewadi,, Phase-III, MIDC-SEZ,
Village Man,Taluka Mulshi, Pune
MAHARASHTRA
INDIA
2. TAN PNEI06594A
3. TDS Assessment Range of the employer:
4. Name,designation and PAN of the employee: Gnana Kumar Chinnappan
MANAGER
AIHPC7751K
5. Is the employee a director or a person with No
substantial interest in the company (where the
employer is a company):
6. Income under the head 'Salaries' of the employee 752,618.00
(other than from perquisites):
7. Financial Year: 2018-2019
8. Valuation of Perquisites:

SL. Nature of perquisites(see rule 3) Value of perquisite Amount,if any Amount of

No. as per rules (Rs.) recovered from perquisite
employee (Rs.) chargeable to tax
Col(3)-Col(4) (Rs.)
(1) (2) (3) (4) (5)
1 Accommodation 0.00 0.00 0.00
2 Cars/Other automotive 0.00 0.00 0.00
3 Sweeper, gardener, watchman or personal Attendant 0.00 0.00 0.00
4 Gas, electricity, water 0.00 0.00 0.00
5 Interest free or concessional loans 0.00 0.00 0.00
6 Holiday Expenses 0.00 0.00 0.00
7 Free or Concessional Travel 0.00 0.00 0.00
8 Free Meals 0.00 0.00 0.00
9 Free Education 0.00 0.00 0.00
10 Gifts, vouchers, etc. 0.00 0.00 0.00
11 Credit card expenses 0.00 0.00 0.00
12 Club expenses 0.00 0.00 0.00
13 Use of movable assets by employees 0.00 0.00 0.00
14 Transfer of assets to Employees 0.00 0.00 0.00
15 Value of any other benefit/amenity/service/privilege 0.00 0.00 0.00
16 Stock options (non-qualified options) 0.00 0.00 0.00
17 Other benefits or amenities 0.00 0.00 0.00
18 Total value of perquisites 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

9. Details of Tax.
a)Tax deducted from salary of the employee u/s 192(1) 34,350.00
b)Tax paid by employer on behalf of the employee u/s 192(1A) 0.00
c)Total Tax Paid 34,350.00
d)Date of payment into Government treasury Various dates as mentioned on Part A of the Form 16

DECLARATION BY THE EMPLOYER

I, CHANDRA SINGH BHANDARI, son of HUKUM SINGH BHANDARI working as SENIOR DIRECTOR do hereby
declare on behalf of CAPGEMINI TECHNOLOGY SERVICES INDIA LIMITED that the information given above is based on the
books of account,documents and other relevant 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.

Place Pune

Date 29-Jun-2019 (Signature of person responsible for deduction of tax)

Designation : SENIOR DIRECTOR Full Name : CHANDRA SINGH BHANDARI

Page 1 of 1(Form 12BA)

 FORM NO. 12BB
(See rule 26C)
Statement showing particulars of claims by an employee for deduction of tax under section 192

1. Name and address of the employee : Gnana Kumar Chinnappan

2. Permanent Account Number of the employee : AIHPC7751K
3. Financial year : 2018-2019

Details of claims and evidence thereof

Sl. No. Nature of claim Amount(Rs.) Evidence / particulars
(1) (2) (3) (4)
House Rent Allowance:
(i) Rent paid to the landlord : Rs.186000
(ii) Name of the landlord
Marry Punto
1. (iii) Address of the landlord Rs.186000 House Rent Receipts
W/O Late P.D.Bangera, 1A-1st Cross, H.No. 487/1-8th Cross, 10th Main, JB
Nagar, Bangalore-560075
(iv) Permanent Account Number of the landlord
AHNPP5398J

2. Leave travel concessions or assistance Rs.0 Travel Receipts/Tickets

Deduction of interest on borrowing:

(i) Interest payable/paid to the lender

Self Occupied Interest :

Let-OutInterest :
(ii) Name of the lender
Self Occupied :
Let-Out :
(iii) Address of the lender Provisional Certificate from
3. Rs.0.0 Bank/Financial
Self Occupied : Institution/Lender
Let-Out :
(iv) Permanent Account Number of the lender
Self Occupied :
Let-Out :

(a) Financial Institutions

(b) Employer
(c) Others

Page 1 of 2(Form 12BB)

 Deduction under Chapter VI-A

(A) Section 80C,80CCC and 80CCD

(i) Section 80C

Life Insurance Premium 52626

Children Education Tuition fees 112000

Rs. 206692.0 Photocopy of the investment
4. Provident Fund 42066
proofs
(ii) Section 80CCC :
(iii) Section 80CCD :

(B) Other sections (e.g. 80E, 80G, 80TTA, etc.) under Chapter VI-A.

Verification
I, Gnana Kumar Chinnappan son/daughter of . do hereby certify that the information given above is complete and correct.
Place : BANGALORE 6B GR-3 FLOOR

Date: 29-Jun-2019

(Signature of the employee)

Designation : MANAGER Full Name: Gnana Kumar Chinnappan

Note: The information/details above, as required for deduction of tax u/s 192 of the Income Tax Act, has been entered by the employee through an authorized
login on the portal.

Page 2 of 2(Form 12BB)

 Annexure to Form No.16 Part B

Details of Salary Paid and Allowance Exempted u/s 10, Chapter VI-A and 17(2) Income-tax Act, 1961

Com Name : CAPGEMINI TECHNOLOGY SERVICES INDIA LIMITED TAN : PNEI06594A PAN : AABCM4573E

Fin Year : 2018-2019 Asst. Year : 2019-2020

Name : Gnana Kumar Chinnappan Employee ID : 39968 PAN : AIHPC7751K

Particulars Amount (INR)

Basic 350,550.00
House Rent Allowance 175,272.00
Salary Paid
Personal Allowance 206,106.00
Performance-Bonus 44,173.00
Unclaimed Taxable Telephone 36,000.00
On Call Allowance 12,650.00
Shift Allowance 3,050.00
Other Allowance -Taxable 106,192.00
Unclaimed Taxable Vehicle Reim 1,245.00
Perquisites 0.00

Gross Salary 935,238.00

Income from Other

Sources
Total Income from Other Sources 0.00

If the House Property is Let Out, then furnish the following details:

i Gross rent received/ receivable/ letable value during the year 0.00
ii Tax paid to local authorities 0.00
iii Annual Value (i – ii) 0.00
iv 30% of Annual Value 0.00
v Interest payable on borrowed capital 0.00
vi Previous Year Carried Forward Loss claimed against Income from Let Out Property (to 0.00
be applicable & adjusted only in case of Income from Let Out Property)
Gross Amount Qualifying Deductible
Amount Amount
Exemptions u/s 10

House Rent Allowance 140,220.00 140,220.00 140,220.00

Total of Exemptions u/s 10 140,220.00 140,220.00 140,220.00

Deduction u/s VI-A Sec 80C, Sec 80CCC, Sec 80CCD(1)

Children Education Tuition fees 112,000.00 112,000.00 112,000.00

Provident Fund 42,066.00 42,066.00 42,066.00
Life Insurance Premium 52,626.00 52,626.00 52,626.00
Deduction u/s VI-A Other Sections (e.g. 80E, 80G, 80TTA, etc.) under
Chapter VI-A
Total of Deductible Amount under Chapter VI-A 206,692.00 206,692.00 206,692.00

Aggregate of Deductible Amount under Chapter VI-A 150,000.00

DECLARATION BY EMPLOYER
I, CHANDRA SINGH BHANDARI, son of HUKUM SINGH BHANDARI working in the capacity of SENIOR DIRECTOR 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.
Place : Pune
Date : 29-Jun-2019 (Signature of Person Responsible for Deduction of Tax)
Designation : SENIOR DIRECTOR Full Name :CHANDRA SINGH BHANDARI

Page 1 of 1 (Annexure to Form No. 16)