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. AGPYIJA Last updated on 04-Jul-2020

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

UNIVERSITY OF PETROLEUM AND ENERGY STUDIES

3RD FLOOR, PHD HOUSE AUGUST, KRANTI MARG 4/2 SIRI, PANKAJ KUMAR MISHRA
INSTITUTIONAL AREA, New Delhi - 110020 QR.NO.21,, VYOMPRASTHA COLNY PHASE 1, GENERAL
Delhi MAHADEV SINGH ROA, NEAR EPF OFFICE, DEHRADUN - 248001
+(91)11-1141730151 Uttarakhand
sgupta@upes.ac.in

Employee Reference No.

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

AAAJU0111A DELU02012D ANNPM2039F

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2020-21 01-Apr-2019 31-Mar-2020
4 , Luxmi Nagar, Delhi - 110092

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 QTQMUULC 356922.00 27668.00 27668.00

Q2 QTTSTKBE 361172.00 18720.00 18720.00
Q3 QTVYBCZD 489448.00 58462.00 58462.00
Q4 QTZEJRUF 399069.00 15096.00 15096.00
Total (Rs.) 1606611.00 119946.00 119946.00
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 15985.00 6910333 07-05-2019 30066 F

2 5841.00 6910333 07-06-2019 33883 F
3 5842.00 6910333 05-07-2019 20286 F
4 7037.00 6910333 06-08-2019 29047 F

Page 1 of 2
 Certificate Number: AGPYIJA TAN of Employer: DELU02012D PAN of Employee: ANNPM2039F Assessment Year: 2020-21

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 5842.00 6910333 06-09-2019 31327 F

6 5841.00 6910333 05-10-2019 31660 F
7 5842.00 6910333 06-11-2019 22870 F
8 47576.00 6910333 06-12-2019 32648 F
9 5044.00 6910333 07-01-2020 30028 F
10 5720.00 6910333 06-02-2020 34639 F
11 0.00 - 07-03-2020 - F
12 9376.00 6910333 20-03-2020 11698 F
Total (Rs.) 119946.00

Verification

I, NAVNEET MEHTA, son / daughter of ARUN KUMAR MEHTA working in the capacity of FINANCE OFFICER (designation) do hereby certify that a sum of
Rs. 119946.00 [Rs. One Lakh Nineteen Thousand Nine Hundred and Fourty Six Only (in words)] has been deducted and a sum of Rs. 119946.00 [Rs. One Lakh
Nineteen Thousand Nine Hundred and Fourty Six 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 NEW DELHI

Date 08-Jul-2020 (Signature of person responsible for deduction of Tax)

Designation: FINANCE OFFICER Full Name:NAVNEET MEHTA

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 navneet
mehta
Date: 2020.07.16 14:11:04
IST

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. AGPYIJA Last updated on 04-Jul-2020

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

UNIVERSITY OF PETROLEUM AND ENERGY STUDIES

3RD FLOOR, PHD HOUSE AUGUST, KRANTI MARG 4/2 SIRI, PANKAJ KUMAR MISHRA
INSTITUTIONAL AREA, New Delhi - 110020 QR.NO.21,, VYOMPRASTHA COLNY PHASE 1, GENERAL
Delhi MAHADEV SINGH ROA, NEAR EPF OFFICE, DEHRADUN - 248001
+(91)11-1141730151 Uttarakhand
sgupta@upes.ac.in

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

AAAJU0111A DELU02012D ANNPM2039F

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2020-21 01-Apr-2019 31-Mar-2020
4 , Luxmi Nagar, Delhi - 110092

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) 1539748.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 66863.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 1606611.00

(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) 0.00

Page 1 of 4
Certificate Number: AGPYIJA TAN of Employer: DELU02012D PAN of Employee: ANNPM2039F Assessment Year: 2020-21

Amount of any other exemption under section 10

(f) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(g) Total amount of any other exemption under section 10 51320.00

Total amount of exemption claimed under section 10

(h) 51320.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 1555291.00
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) 50000.00

(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)] 50000.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 1505291.00

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) -200000.00
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

8. -200000.00
[7(a)+7(b)]
9. Gross total income (6+8) 1305291.00

10. Deductions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life insurance premia, contributions to

(a) 150000.00 150000.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

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

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 150000.00 150000.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 33336.00 33336.00

Page 2 of 4
 Certificate Number: AGPYIJA TAN of Employer: DELU02012D PAN of Employee: ANNPM2039F Assessment Year: 2020-21

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 87518.00 87518.00

Deduction in respect of health insurance premia under section

(g) 25000.00 25000.00
80D

Deduction in respect of interest on loan taken for higher

(h) education under section 80E 0.00 0.00

Gross Qualifying Deductible

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

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

(k) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

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

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 295854.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 1009437.00

13. Tax on total income 115331.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 4613.00

17. Tax payable (13+15+16-14) 119944.00

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

19. Net tax payable (17-18) 119944.00

Signature Not Verified
Verification Digitally signed by navneet
mehta
I, NAVNEET MEHTA, son/daughter of ARUN KUMAR MEHTA .Working in the capacity of FINANCE14:11:04
Date: 2020.07.16 OFFICER (Designation)
do hereby certify that the information given above is true, complete and correct and is based
IST on the books of account, documents, TDS
statements, and other available records.

Place NEW DELHI (Signature of person responsible for deduction of tax)

Full
Date 08-Jul-2020 NAVNEET MEHTA
Name:

Page 3 of 4
 Certificate Number: AGPYIJA TAN of Employer: DELU02012D PAN of Employee: ANNPM2039F Assessment Year: 2020-21

2. (f) Break up for ‘Amount of any other exemption under section 10’ 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
Sl. any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

NEW DELHI (Signature of person responsible for deduction of

Place
tax)
Full
Date 08-Jul-2020 NAVNEET MEHTA
Name:

Signature Not Verified

Digitally signed by navneet
mehta
Date: 2020.07.16 14:11:04
IST

Page 4 of 4
TAN of Employer : DELU02012D PAN of Employee : ANNPM2039F Assessment Year : 2020-21

2. (f) Break up for Amount of any other exemption under section 10 to be filled in table below
Sl. No. Particular s of amount of any other exemption Gross Amount Qualifying Amount Deductible Amount
( under section 10)

Rs. Rs. Rs. Rs.

1 Helper Allowance Exempt 0.00 0.00 0.00

2 Children Education Allowance 0.00 0.00 0.00

3 Academic Allowance Exemp 51320.00 51320.00 51320.00

4 Prev exemp u/s10 0.00 0.00 0.00

10. (k) Break up for Amount of deductible under any other provision(s) of chapter VI-A to be filled in table below
Sl. No. Particular s deductible under any other provision(s) of chapter VI- Gross Amount Qualifying Amount Deductible Amount
( under section 10)

Rs. Rs. Rs. Rs.

80DD - Medical Treatment of Dependent Suffering from

1 0.00 0.00 0.00
Permanent Disability

80DDB - Medical Treatment of Specified Diseases for

2 0.00 0.00 0.00
Self/Dependent

3 80U - Medical Treatment for Personal Permanent Disability 0.00 0.00 0.00

4 80E - Education Loan 0.00 0.00 0.00

5 80EE 0.00 0.00 0.00

Signature Not Verified

Digitally signed by navneet
mehta
Date: 2020.07.16 14:11:04
IST
 FORM No. 12 BA
[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: UNIVERSITY OF PETROLEUM AND ENERGY STUDIES

3RD FLOOR
PHD HOUSE AUGUST, KRANTI MARG 4/2 SIRI
INSTITUTIONAL AREA, New Delhi-110020

2 TAN: DELU02012D
3 TDS Assessment Range of the employer:
4 Name, designation and PAN of employee: PANKAJ KUMAR MISHRA - ANNPM2039F
5 Is the employee a director or a person with
substantial interest in the Company
6 Income under the head “Salaries” of the
15,39,748.00
employee ( other than from perquisites):
7 Financial Year: 2019-20
8 Valuation of Perquisites:
Sl. No. Value of perquisite Amount, if any Amount perquisite
(See rule 3) as per rules recovered from chargeable to tax
the employee Col.(3) – Col.(4)
Rs. Rs. Rs.
1 RFA Perk 0.00 0.00 0.00
2 Cars/Other automotive 25000.00 0.00 25000.00
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 on Loan Perk 6163.00 0.00 6163.00
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 Gift Perk 35700.00 0.00 35700.00
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 ESOP Perk 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) 66863.00 0.00 66863.00

9 Details of tax,-
(a) Tax deducted from salary of the employee under section 192 (1) 1,19,946.00
(b) Tax paid by employer on behalf of the employee under section 192(1A) -
(c) Total tax paid 1,19,946.00
(d) Date of payment into Government treasury As per form 16
Declaration by Employer
I, NAVNEET MEHTA, D/o ARUN KUMAR MEHTA working in the Capacity of FINANCE OFFICER do hereby declare on behalf of UNIVERSITY
OF PETROLEUM AND ENERGY STUDIES that the information given above is based on the books of account, documents and other relevant
Signature Not Verified
records, or information available with us and the details of value of each such perquisite are in accordance with section 17 and rules
framed there under and that such information is true and correct. Digitally signed by navneet
mehta
Place: NEW DELHI Date: 2020.07.16 14:11:04
IST
Date: 08-Jul-20 Signature of person responsible for deduction of tax
Designation: FINANCE OFFICER Full Name: NAVNEET MEHTA