Form 16 B

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FORM NO.

16B

[See rule 31(1)(b)]

Certificate under Section 203 of the Income Tax Act, 1961 for Tax Deducted at Source

Certificate No.: Last Updated On:

Name and Address of the Deductor (Transferee) Name and Address of the Deductee (Transferor)

PAN of the Deductor (Transferee) PAN of the Deductee (Transferor) Assessment Year

Summary of Transaction(s)

Sr. No. Unique Acknowledgement Number Amount Paid / Credited Date of Payment / Credit (dd/mm/yyyy)

Total (Rs.)

I. DETAILS OF TAX DEDUCTED AND DEPOSITED WITH RESPECT TO THE DEDUCTEE


(Income Tax + Surcharge + Edu. Cess)

Challan Identification number (CIN)


Sr. No. Amount (Rs.)
Date on which Tax Deposited
BSR Code of the Bank Branch Challan Serial Number
(dd/mm/yyyy)

II. DETAILS OF TAX DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(Income Tax + Surcharge + Edu. Cess + Fee + Interest)

Challan Identification number (CIN)


Sr. No. Amount (Rs.)
Date on which Tax Deposited
BSR Code of the Bank Branch Challan Serial Number
(dd/mm/yyyy)

Verification

I, , son / daughter of working in the capacity of (designation) do hereby certify that a sum of Rs. [Rs. (in words)] 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: Signature of person responsible for deduction of tax:

Date: Full Name:

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