Ref No.

199

Form 16A
[See rule 31(1)(b)]

Certificate under section 203 of the Income-tax Act, 1961 for Tax deducted at source
Name and address of the Deductor SHAREKHAN LIMITED. A-206 PHOENIX HOUSE S.B.MARG LOWER PAREL, MUMBAI MAHARASHTRA INDIA 400013 Name and address of the Deductee Balaji Suraneni 15-18,Prabhu Nagar,Poranki-Vijaywada-521137 0 0 PAN of the Deductor AAECS5096H CIT (TDS) OFFICE OF TH DY.C.I.T.(TDS)-3(2) K.G.MITTAL AYURVEDIC HOSPITAL BLDG CHARNI ROAD MUMBAI 400002 TAN of the Deductor MUMS30398E Assessment Year 2011-2012 From 01/04/2010
Summary of payment

PAN of the Deductee AUCPS2656Q Period To 30/06/2010

Amount paid / credited 393.37 260.32 173.70 5.40

Nature of Payment Commission/Brokerage (s.194H) Commission/Brokerage (s.194H) Commission/Brokerage (s.194H) Commission/Brokerage (s.194H)

Date of payment/ credit 30/04/2010 31/05/2010 30/06/2010 30/06/2010

Summary of tax deducted at source in respect of deductee

Quarter Receipt Numbers of original quarterly statements of TDS under sub-section (3) of section 200 JPDRJPWG Amount of tax deducted in respect of the deductee 83.00 Amount of tax deposited/remitted in respect of the deductee 83.00

Q1

I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT

(The Deductor is to provide payment-wise details of tax deducted and deposited with respect to the Deductee) S.No Tax Deposited in respect of the deductee (Rs.) Book Identification Number (BIN) Receipt Numbers of Form No 24G DDO Sequence Number in the Book Adjustment Mini Statement Date on which tax deposited (dd/mm/yyyy)

Total :

II. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN

(The Deductor is to provide payment wise details of tax deducted and deposited with respect to the deductee) S.No Tax Deposited in respect of the deductee (Rs.) 39.00 26.00 17.00 1.00
83.00

Challan Identification number (CIN). BSR Code of Bank Branch Date on which tax deposited (dd/mm/yyyy) 07/05/2010 07/06/2010 07/07/2010 07/07/2010 Challan Serial Number 02905 02653 03552 03552

1 2 3 4 Total

0510308 0510308 0510308 0510308

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Ref No. 199

Verification

I, MANGESH G BAGWE son of GANPAT working in the capacity of AUTHORISED SIGNATORY (designation) do here by certify that a sum of Rs 83 [ Rs. (in words) Eighty Three 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. Place : Date : Signature of the person responsible for deduction of tax MUMBAI

Designation :

AUTHORISED SIGNATORY

Full Name :

MANGESH G BAGWE

Signature Not Verified

Digitally signed by MANGESH GANPAT BAGWE Date: 2010.07.16 17:22:23 +05:30 Reason: FORM 16A Location: MUMBAI

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