FORM NO.

16 - PART B
[See Rule (31)(1) (a)]
Certificate under section 203 of the Income-tax, 1961 for tax deducted at source from
income chargeable under the head 'Salaries'

Name and address of the Employer Name and designation of the Employee
Home Interior Designs E-commerce Pvt. Ltd. Umair Hussain Baig

401, Prestige Obelisk Building, 4th Level, Kasturba Road, Bangalore - 560 Project Manager
001,Bangalore-560001,Karnataka ,India

PAN No. of the Deductor TAN No. of the Deductor PAN No. of the Employee
AADCH4222R BLRH06891D BLMPB2218K

Period Financial Year Assessment Year

From To 2018-2019 2019-2020

01 April 2018 31 March 2019

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED

1) GROSS SALARY

(a) Salary as per provisions contained U/s 830,904

17(1)

(b) Value of perquisite U/s 17(2) (as per 0

Form No.12 BA,wherever applicable)

(c) Profit in lieu of salary U/s 17(3) (as per 0.00

Form No.12 BA,wherever applicable)

(d) Less: Standard Deduction 40,000

(e)Total 790,904

2) Less : Allowance to the extent exempt

under section 10

HRA 136,402

LTA 28,416

Internet OR Data Card 0

Telephone OR Mobile 0

Fuel Allowance 0

Meal Allowance 0

Total 164,818

3) Balance ( 1- 2 ) 626,086 626,086

4) Deductions

Professional Tax 0

5) Aggregate of (4) 0

6) Income chargeable under the Head 626,086

Salaries (3-5)

7) Add: Any other income reported by the 0.0

employee

8) Gross total income (6+7) 626,086

9) Deduction under Chapter VIA

PF(80C) 21,600

Mutual Fund(80C) 37,000

Total 58,600 150000 58600

 Housing Loan Interest Amount u/s 0
24(Housing Loan Interest)

Total 0 200000 0

Medical Treatment(80DD - Medical 0

treatment for handicapped dependent)

Total 0 125000 0

Depandant Handicapped Treatment(80DDB 0

Med Exp incurred on treatment of
employees or his dependent)

Total 0 80000 0

Income of Blind OR Physically 0

Handicapped person(80U - Income of Blind
OR Physically Handicapped person)

Total 0 125000 0

Interest Education Loan(80 E- Interest paid 0

on Higher Education Loan)

Total 0 0 0

Rajiv Gandhi Equity Scheme(80 CCG- Rajiv 0

Gandhi Equity Scheme)

Total 0 25000 0

Additional Home Loan Interest Deduction 0

(U/Sec 80EE)(80 EE - Additional Home
Loan Interest Deduction)

Total 0 100000 0

Health Insurance self(Section 80D - Medical 0

Insurance Self)

Total 0 25000 0

National Pension Scheme (NPS) u/s 0

80CCD(National Pension Scheme (NPS)
u/s 80CCD)

Total 0 50000 0

Profit on Housing Loan Interest u/s 24 (Let 0

out property)(Let out property Housing Loan
Interest u/s 24 )

Total 0 200000 0

Loss on Housing Loan Interest u/s 24 (Let 0

out property)(Let out property Housing Loan
Interest u/s 24 )

Total 0 200000 0

80 G - Donation(80 G - Donation) 0

Total 0 0 0

Depandant Handicapped Treatment 0

senior(80DDB Med Exp incurred on
treatment of employees or his dependent if
senior citizen)

Total 0 100000 0

Depandant Handicapped Treatment 0

senior(80DDB Med Exp incurred on
treatment of employees or his dependent if
senior citizen)

Total 0 100000 0

Health Insurance parents(Section 80D - 0

Medical Insurance Parents Senior Citizen)

Total 0 30000 0

10) Aggregate of deductible amount under 58,600

Chapter VI-A

11) Total Taxable income (8-10) 572,486

12) Tax on total Taxable income 26,997

13) Rebate v/s 87 A 0

 14) Tax After Rebate v/s 87 A 26,997

15) Surcharge (on tax computed at 0

S.No.12)

16) Educational Cess @ 3 % (on tax at 1,080

S.No.12 and surcharge at S.No.13)

17) Tax Payable(14+15+16) 28,077

18) Less : (a) Tax deducted at source U/S 37,654

192(1) b) Tax Paid by the employer on
behalf of the employee U/s 192(1A) on
perquisites U/S 17(2)

19) Tax payable/refundable (15-16) (-) 9,577

Verification
I RAMAKANT SHARMA son / daughter of LAKHAN LAL SHARMA working in the capacity of DIRECTOR do hereby certify that the information given above is true, complete and
correct and is based on the books of accounts, documents, TDS statements, TDS deposited and other available records.

Place: BANGALORE
Date : 2019-06-26
(Signature of the person responsible for deduction of tax)
Designation : DIRECTOR
 Home Interior Designs E-commerce Pvt. Ltd.
ANNEXTURE - GROSS SALARY DETAIL
Employee Name Umair Hussain Baig
Designation Project Manager
Employee PAN BLMPB2218K
Financial Year 2018-2019
Address 401, Prestige Obelisk Building, 4th Level, Kasturba Road, Bangalore - 560 001,Bangalore-560001,Karnataka ,India

Sr.No Description Goss Amount 1=(A+B) Non - Taxable Portion U/s10 Total Amount
(2) 3=(1-2)
1 Basic 341,004 0 341,004

2 HRA 136,404 136,402 2

3 Conveyance 19,200 0 19,200

4 Medical 15,000 0 15,000

5 Lta 28,416 28,416 0

6 Internet or data card 18,000 0 18,000

7 Telephone or mobile 18,000 0 18,000

8 Fuel allowance 60,000 0 60,000

9 Meal allowance 26,400 0 26,400

10 Special allowance 168,480 0 168,480

11 Bonus 0 0 0

12 Total Income Salary 830,904 164,818 666,086

13 Total Perquisite 0 0.0 0

14 Taxable Income From (FORM 12B) 0 0 0

15 Total 830,904 164,818 666,086

Note :- For Employee Reference only

 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 : Home Interior Designs E-commerce Pvt. Ltd.
401, Prestige Obelisk Building, 4th Level, Kasturba Road, Bangalore - 560
001,Bangalore-560001,Karnataka ,India
2. TAN : BLRH06891D
3. TDS Assessment Range of the Employer :
4. Name Designation and PAN of Employee : Umair Hussain Baig
Project Manager
BLMPB2218K
5. Is the Employee a director or a person with Substantial interest in the : No
company
6. Income under the head Salaries of the Employee:(other than from : 790,904
perquisites)
7. Assessment Year : 2019-2020
8. Valuation of Perquisites :

S. No Name of perquisites (See rule 3) Value of perquisite as per Amount, if any, recovered Amount of perquisite
rules(Rs.) from the employee (Rs.) chargeable to tax
[Col(3)-Col(4)](Rs.)

1 2 3 4 5

1 Residential accommodation provided by the employer 0 00.00 0

2 Hotel Accommodation 0 00.00 0

3 Use of Motor Car 0 00.00 0

4 Services of a sweeper, a gardener, a watchman or a personal attendant 0 00.00 0

5 Supply of Gas, Electric Energy or Water 0 00.00 0

6 Free / Concessional Educational Facility 0 00.00 0

7 Transport facilities provided by the employer engaged in carriage of 0 00.00 0

passenger or goods (except Airlines or Railways)

8 Amount payable by the employer to effect an insurance on life of 0 00.00 0

employee or to effect a contract for an annuity

9 ESOP/ Sweat Equity Shares 0 00.00 0

10 Employer's contribution towards superannuation fund 0 00.00 0

11 Interest free or Concessional Loan Facility 0 00.00 0

12 Travelling, Touring Accommodation etc 0 00.00 0

13 Free Food and Non-alcoholic beverages 0 00.00 0

14 Any Gift or Voucher or Token 0 00.00 0

15 Membership Fees, Annual Fees for Credit Card 0 00.00 0

16 Membership of Clubs 0 00.00 0

17 Use of Movable Assets 0 00.00 0

18 Transfer of Movable Assets 0 00.00 0

19 Any Other Benefit or Amenity, Service, Right or Privilege 0 00.00 0

20 Medical facilities in India 0 00.00 0

21 Medical facilities outside India 0 00.00 0

9. Details of tax ...

(a) Tax deducted from salary of the employee under sec. 192(1) : 37,654

(b) Tax paid by employer on behalf of the employee under section 192(1A) : 0.00

(c) Total tax paid : 37,654

(d) Date of payment into Government treasury :

DECLARATION BY EMPLOYER
 I RAMAKANT SHARMA son / daughter of LAKHAN LAL SHARMA working in the capacity of DIRECTOR do hereby declare on behalf of Home Interior Designs E-commerce 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 there under and that such information is true and correct.
Place: BANGALORE

Date : 2019-06-26

(Signature of the person responsible for deduction of tax)

Designation : DIRECTOR

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