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. SUEKXRA Last updated on 27-Jun-2019

Name and address of the Employer Name and address of the Employee
INTEGREON MANAGED SOLUTIONS (INDIA) PRIVATE LIMITED
UNIT NO.602,6TH FLOOR,BLD, NO-3,NESCO LT PARK,NESCO,
COMPLEX,WESTERN EXP HIGHW, VISHAL SHARMA
GOREGAON (E) , MUMBAI - 400063 L 71 72/B FIRST FLOOR, NEAR JAGAT RAM PARK, LAXMI,
Maharashtra NAGAR, DELHI - 110092 Delhi
+(91)22-40601318
INTM.PAYROLL@INTEGREON.COM
Employee Reference No.
PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

AAACI7431A MUMI03901C DCOPS8922N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2019-20 01-Apr-2018 31-Mar-2019
Building, Charni Road , Mumbai - 400002

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 QTCQVSTG 127280.00 2568.00 2568.00

Q2 QTFUWPPA 122026.00 2294.00 2294.00
Q3 QTJTJFZE 122239.00 2306.00 2306.00
Q4 QTNNALWD 128301.00 713.00 713.00
Total (Rs.) 499846.00 7881.00 7881.00
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*

1 812.00 0510075 07-05-2018 38945 F

2 956.00 0510075 07-06-2018 22119 F
3 800.00 0510075 06-07-2018 39366 F
4 730.00 0510075 07-08-2018 32483 F

Page 1 of 2
 Certificate Number: SUEKXRA TAN of Employer: MUMI03901C PAN of Employee: DCOPS8922N 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*

5 712.00 0510075 07-09-2018 10128 F

6 852.00 0510075 05-10-2018 31013 F
7 782.00 0510075 06-11-2018 42465 F
8 812.00 0510075 07-12-2018 42064 F
9 712.00 0510075 07-01-2019 32097 F
10 713.00 0510075 06-02-2019 29601 F
11 0.00 - 07-03-2019 - F
12 0.00 - 30-04-2019 - F
Total (Rs.) 7881.00

Verification

I, RAHUL MALHOTRA, son / daughter of SUBASH MALHOTRA working in the capacity of DIRECTOR (designation) do hereby certify that a sum of Rs. 7881.00 [Rs.
Seven Thousand Eight Hundred and Eighty One Only (in words)] has been deducted and a sum of Rs. 7881.00 [Rs. Seven Thousand Eight Hundred and Eighty One
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 MUMBAI

Date 28-Jun-2019 (Signature of person responsible for deduction of Tax)

Designation: DIRECTOR Full Name:RAHUL MALHOTRA

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

Signature Not Verified

Digitally signed by: RAHUL MALHOTRA
Date: 2019.06.28 16.31.11 Page 2 of 2
Reason:
Location: MUMBAI
 FORM NO. 16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. SUEKXRA Last updated on 27-Jun-2019

Name and address of the Employer Name and address of the Employee
INTEGREON MANAGED SOLUTIONS (INDIA) PRIVATE LIMITED
UNIT NO.602,6TH FLOOR,BLD, NO-3,NESCO LT PARK,NESCO,
COMPLEX,WESTERN EXP HIGHW, VISHAL SHARMA
GOREGAON (E) , MUMBAI - 400063 L 71 72/B FIRST FLOOR, NEAR JAGAT RAM PARK, LAXMI,
Maharashtra NAGAR, DELHI -110092 Delhi
+(91)22-40601318
INTM.PAYROLL@INTEGREON.COM

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

AAACI7431A MUMI03901C DCOPS8922N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2019-20 01-Apr-2018 31-Mar-2019
Building, Charni Road , Mumbai - 400002

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) 499846.00

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 499846.00

(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) 70685.00

Page 1 of 4
Certificate Number: SUEKXRA TAN of Employer: MUMI03901C PAN of Employee: DCOPS8922N 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) 70685.00
+2(c)+2(d)+2(e)+2(g)]

3. Total amount of salary received from current employer [1(d)-2(h)] 429161.00

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) 0.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 40000.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 389161.00

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) 389161.00
10. Deductions under Chapter VI-A

Deduction in respect of life insurance premia, contributions to

(a) 21600.00
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) 21600.00

Deductions in respect of amount paid/deposited to notified

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

Page 2 of 4
 Certificate Number: SUEKXRA TAN of Employer: MUMI03901C PAN of Employee: DCOPS8922N 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) 21600.00
10(j)+10(l)]

12. Total taxable income (9-11) 367561.00

13. Tax on total income 5879.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 235.00

17. Tax payable (13+15+16-14) 6114.00

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

19. Net tax payable (17-18) 6114.00

Verification
I, RAHUL MALHOTRA, son/daughter of SUBASH MALHOTRA .Working in the capacity of 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.

MUMBAI (Signature of person responsible for deduction of

Place
tax)
Full
Date 28-Jun-2019 RAHUL MALHOTRA
Name:

Page 3 of 4
 Certificate Number: SUEKXRA TAN of Employer: MUMI03901C PAN of Employee: DCOPS8922N 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.

MUMBAI (Signature of person responsible for deduction of

Place
tax)
Full
Date 28-Jun-2019 RAHUL MALHOTRA
Name:

Page 4 of 4
 2.(f) Break up for 'Amount of any other exemption under section 10' to be filled in the table below

Sr.No Any other exemption under section 10 Gross Amount Qualifying Amount Deductible Amount

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

Sr.No Any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount

Digitally Signed By RAHUL MALHOTRA

Place: MUMBAI Signature of the person responsible for deduction of tax

Date: 28-Jun-2019 Full Name: RAHUL MALHOTRA

Signature Not Verified

Digitally signed by: RAHUL MALHOTRA
Date: 2019.06.28 16.31.12
Reason:
Location: MUMBAI
VISHAL SHARMA Annexure to Form No. 16
1. Gross Salary Total(Rs.)
BASIC 250,247
HOUSE RENT ALLOWANCE 125,129
TRANSPORT ALLOWANCE 19,200
SPECIAL ALLOWANCE 69,330
HOLIDAY COMP 8,159
OVERTIME 5,639
MEDICAL ALLOWANCE 15,000
ARREARS_BASIC 2,902
ARREARS_HRA 1,450
ARREARS_SPECIAL ALLOW. 1,452
ARR- HOLIDAY COMP 1,338
Gross Salary 499,846
HRA Exemption Calculation
Period Basic Rent Paid HRA Recd Rent Paid Less 40/50% Salary
Non Metro Metro (A) 10% Salary (B) (C)

Apr-2018 20,733 0 8,000 10,367 5,927 10,366

May-2018 20,733 0 8,000 10,367 5,927 10,366
Jun-2018 20,733 0 8,000 10,367 5,927 10,366
Jul-2018 20,733 0 8,000 10,367 5,927 10,366
Aug-2018 20,733 0 8,000 10,367 5,927 10,366
Sep-2018 20,733 0 8,000 10,367 5,927 10,366
Oct-2018 20,733 0 8,000 10,367 5,927 10,366
Nov-2018 20,733 0 8,000 10,367 5,927 10,366
Dec-2018 20,733 0 8,000 10,367 5,927 10,366
Jan-2019 22,184 0 8,000 11,092 5,782 11,092
Feb-2019 22,184 0 8,000 11,092 5,782 11,092
Mar-2019 22,184 0 8,000 11,092 5,782 11,092
Totals: 253,149 96,000 126,579 70,689 126,570
HRA Yearly Exemption : Least of (A,B,C)= 70,689
 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 : INTEGREON MANAGED SOLUTIONS (INDIA) PVT. LTD.
Unit No.602,6th Floor,Bld
No-3,NESCO lT park,NESCO
Complex,Western Exp Highw Goregaon (E) , Mumbai 400063
2. TAN MUMI03901C
3. TDS Assessment Range of employer: ITO (TDS) WARD 2(1), MUMBAI[NEW]

4. Name,designation and VISHAL SHARMA - ASSISTANT TEAM LEAD

PAN of employee: DCOPS8922N
5. Is the employee a director or a person with substantial interest NO
in the company (where the employer is a company):
6. Income under the head 'Salaries' of the employee: 499,846
(other than from perquisites)
7. Financial Year 2018-19
8. Valuation of Perquisites
Amount, if any,
Value of perquisite Amount of perquisite
S.No. Nature of perquisites (see rule 3) recovered from the
as per rules chargeable to tax
employee
(Rs.) (Rs.) (Rs.)
1 Total value of perquisites 0 0 0
2 Total value of profits in lieu of salary as per section 17(3) 0 0 0

9. Details of tax:
(a) Tax deducted from salary of the employee under section 192(1) 7,881
(b) Tax paid by employer on behalf of the employee under section 192(1A) 0
(c) Total tax paid 7,881
(d) Date of payment into Government treasury as per Form-16
DECLARATION BY EMPLOYER
I, RAHUL MALHOTRA, son of SUBASH MALHOTRA working as DIRECTOR do hereby declare on behalf of INTEGREON MANAGED
SOLUTIONS (INDIA) PVT. LTD. 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.

Digitally Signed By RAHUL MALHOTRA

Signature of the person responsible for deduction of tax
Place: MUMBAI Full Name: RAHUL MALHOTRA
Date: 28-Jun-2019 Designation: DIRECTOR

Signature Not Verified

Digitally signed by: RAHUL MALHOTRA
Date: 2019.06.28 16.31.13
Reason:
Location: MUMBAI