FORM 16

Certificate No.: 57

[See Rule 31(1) (a)]

PART A
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source on Salary
Name and address of the Employer

Name and address of the Employee

Arezzo Sky India Pvt. Ltd

Patil, Nilkanth

Business Bay, 6th Floor,

Tower A, Wing 1,
Off Airport Road Pune 411006
PAN of the Deductor

TAN of the Deductor

PAN of the Employee

Employee Reference No.

AALCA8367N

PNEA19149E

BPGPP0760L

1964

CIT (TDS)

Assessment year

Period with the Employer

Address

From

To

01-Apr-2014

11-Nov-2014

2015-2016

Summary of amount paid/credited and tax deducted at source thereon in respect of the employee
Quarter

Receipt Numbers of original quarterly

statements of TDS under sub-section (3) of
section 200.

Amount of tax
deducted ( Rs. )

Amount of tax
deposited/remitted
(Rs. )

1
2

QQSXRFEB

9,966

9,966

QQVLUGJB

7,684

7,684

13,188

13,188

QQZYANYG

QRCVOOVA

Amount
paid/credited

557,648

Total

557,648

30,838

30,838

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 deductree)
Challan indentification number ( CIN )
SI. No.

Tax deposited in respect

of the deductee (Rs.)

BSR Code of Bank

Branch

Date on which tax deposited

(dd/mm/yyyy)

Challan Serial
Number

Status of
matching with
OLTAS

3,322

6910333

07/05/2014

60883

3,322

6910333

06/06/2014

53942

3,322

6910333

07/07/2014

56056

2,554

6910333

07/08/2014

51747

2,554

6910333

05/09/2014

55640

2,576

6910333

07/10/2014

56766

2,895

6910333

07/11/2014

53447

10,293

6910333

05/12/2014

55002

Totals

30,838

Verification
I Sheetal Raut, daughter of Hemant Manjrekar working in the capacity of Director do hereby certify that a sum of Rs.30,838 [Rupees THIRTY
THOUSAND EIGHT HUNDRED THIRTY-EIGHT ONLY] has been deducted and 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.

Digitally Signed By SHEETAL RAUT

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

Pune
31-May-2015

aigitally signed by SebbTAi RAUT

aate: 201R.0S.22 1T:04:30 H0RD30D

Full Name: Sheetal Raut

Designation: Director

Arezzo Sky India Pvt. Ltd

A.Y.: 2015-2016

Patil, Nilkanth

PART B

Certificate No.: 57

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1. Gross Salary

(Rs.)

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

(Rs.)

(Rs.)

(Rs.)

557,648

b. Value of perquisites under section 17(2) (as per Form No.

12BA, wherever applicable)

c. Profits in lieu of salary under section 17(3) (as per Form

No.12BA, wherever applicable)

0
557,648

d. Total
2. Less: Allowance to the extent exempt under section 10
a. House Rent Allowance

b. Conveyance

5,773

c. Medical Reimbursement

8,078

d. LTA

e. Leave Encashment

f.

Children Education Allowance

g. Gratuity

i.

0
13,851

Total [a to g]

3. Balance (1 - 2)

543,797

4. Deductions
a. Entertainment allowance
b. Tax on Employment

0
1,600

5. Aggregate of 4 (a) and (b)

1,600

6. Income chargeable under the head 'salaries' (3 - 5)

542,197

7. Add: Any other income reported by the employee

a. Income under the head 'Income from House Property'

b. Income under the head 'Income from Other Sources'

c. Total of (a+b) above

8. Gross total income (6 + 7)

542,197
Gross Amount

Deductible Amount

17,492

17,492

(b) section 80 CCC

(c) section 80 CCD

9. Deductions under Chapter VI-A

(A) sections 80C, 80CCC and 80CCD
(a) section 80C
(i)

PF

(ii)

LIC/ULIP/NSS/PPF

17,492
0

(iii) Pension Plan of LIC / 80CCC

(vi) NSC/Interest Accrued on NSC

(v)

Equity Linked Savings Scheme

(vi) Tution Fees/ Fixed Deposit

(vii) Mutual Fund

(viii) Principal on Housing Loan

Arezzo Sky India Pvt. Ltd

A.Y.: 2015-2016

(B) other sections ( e.g., 80E, 80G, 80TTA etc.) under

Chapter VI-A

Patil, Nilkanth
Certificate No.: 57

Gross Amount

Qualifying Amount

Deductible Amount

a.

b. Section 80 CCG ( RGESS )

c. Section 80 D(Limit Rs.15,000)

d. Section 80 DD(Limit Rs.50,000)

e. Section 80 DDB/80U

f.

g.

h.

Section 80 E

10. Aggregate of deductible amount under Chapter VI-A

17,492

11. Total Income (8 - 10)

524,700

12. Tax on total income

29,940

13. Education cess @3.00% (on tax computed at S.No.12)

898

14. Tax payable (12+13)

30,838

15. Less: Relief under section 89 (attach details)

16. Tax payable (14-15)

30,838

Verification
I, Sheetal Raut, daughter of Hemant Manjrekar 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 account, documents, TDS statements, and other available records.

Digitally Signed By SHEETAL RAUT

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

Pune
31-May-2015

Full Name: Sheetal Raut

Designation: Director

Patil, Nilkanth

Annexure to Form No. 16

Gross Salary

Certificate No.: 57
Total (Rs.)

Basic
House Rent Allowance
Medical Reimbursements
Transport Allowance
Executive Allowance
Special Allowance
Performance Bonus
LTA -Taxable
Other Allowance
Arrears-Performance Bonus

145,770
58,307
9,021
5,773
111,407
17,492
22,553
15,035
166,163
6,126
Gross Salary

557,648

Certificate No.: 57

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 :

Arezzo Sky India Pvt. Ltd

Business Bay, 6th Floor,
Tower A, Wing 1,
Off Airport Road Pune 411006
PNEA19149E

2. TAN
3. TDS Assessment Range of employer:
4. Name,designation and
PAN of employee:
5. Is the employee a director or a person with substantial interest
in the company (where the employer is a company):
6. Income under the head 'Salaries' of the employee:
(other than from perquisites)
7. Financial Year

Patil, Nilkanth - Systems Administrator, Production

BPGPP0760L
NO
557,648
2014-2015

8. Valuation of Perquisites
S.No.
Nature of perquisites (see rule 3)

Value of perquisite
as per rules
(Rs.)

1. Accommodation
2. Perquisites-Cars/Other automotive
3. Sweeper,gardner,watchman,P.A.
4. Gas,electricity,water
5. Int.free/concessional loans
6. Holiday expenses
7. Free or concessional travel
8. Free meals
9. Free education
10. Gifts, vouchers, etc.
11. Credit card expenses
12. Club expenses
13. Use of movable assets by employees
14. Transfer of assets to employees
15. Stock options (non-qualified options)
16. Other benefits or amenities
17. Profits in lieu of salary
18. Total value of perquisites
19. Total value of profits in lieu of salary as per section 17(3)
9. Details of tax:
(a) Tax deducted from salary of the employee under section 192(1)
(b) Tax paid by employer on behalf of the employee under section 192(1A)
(c) Total tax paid

Amount, if any, Amount of perquisite

recovered from the
chargeable to tax
employee
(Rs.)
(Rs.)

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

(d) Date of payment into Government treasury

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30,838
0
30,838
as per Form-16

DECLARATION BY EMPLOYER
I, Sheetal Raut, daughter of Hemant Manjrekar working as Director do hereby declare on behalf of Arezzo Sky 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 SHEETAL RAUT

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

Pune
31-May-2015

Full Name: Sheetal Raut

Designation: Director