Employer (deductor) details

Employer / company name *

Employer address *

Employer TAN *

Employer PAN *

CIN (if company)

Employee details

Employee full name *

Employee PAN *

Employee designation

Employee ID

Date of joining (if mid-year)

Date of leaving (if mid-year)

Financial year *

Assessment year *

Salary components (₹ per annum)

Basic salary *

HRA received

HRA exempt (s.10(13A))

LTA received

LTA exempt (s.10(5))

Special allowance

Other taxable allowances

Bonus / incentive (taxable)

Perquisites / non-cash benefits (s.17(2))

Gross salary (pre-deduction, from payroll) *

Tax regime and deductions

Tax regime opted by employee *

Standard deduction (s.16(ia)) — auto ₹75,000 (FY 24-25)

Professional tax paid (s.16(iii))

80C (PF, ELSS, LIC, PPF, home loan principal, tuition)

80D (medical insurance premium)

80CCD(1B) (NPS additional contribution)

80G (donations to eligible funds)

Other Chapter VI-A deductions (describe)

Other Chapter VI-A deductions total (₹)

Sec 24(b) — Home loan interest (old regime only)

TDS Part A — Deducted and deposited

TDS Q1 (Apr–Jun) deducted (₹)

TDS Q2 (Jul–Sep) deducted (₹)

TDS Q3 (Oct–Dec) deducted (₹)

TDS Q4 (Jan–Mar) deducted (₹)

Certificate serial / unique no. (from TRACES)

Date of Form 16 issue *

Authorised signatory name & designation *

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FORM 16 TDS CERTIFICATE FOR SALARY INCOME

PART A — TDS DEDUCTED AND DEPOSITED (As per TRACES / Form 26AS)

Certificate No.
Financial Year
Assessment Year
Date of Issue: [ISSUE_DATE]
Employer Name
Employer Address
Employer TAN
Employer PAN
Employee Name
Employee PAN
Designation
Employee ID
Period of Employment (FY): 1 April to 31 March

Quarter-wise TDS Deducted and Deposited

Quarter	Period	TDS Deducted (₹)	TDS Deposited (₹)	BSR Code / Challan
Q1	Apr–Jun __GAP[f16_fy\|2024	₹0	₹0	[From TRACES]
Q2	Jul–Sep __GAP[f16_fy\|2024	₹0	₹0	[From TRACES]
Q3	Oct–Dec __GAP[f16_fy\|2024	₹0	₹0	[From TRACES]
Q4	Jan–Mar 2025]__	₹0	₹0	[From TRACES]
Total		₹0	₹0

Note: Part A of Form 16 must be downloaded from TRACES (www.tdscpc.gov.in) and bears a digital signature. The above is the working/working reference for Part A. The employer must provide the TRACES-generated Part A to the employee.

PART B — COMPUTATION OF INCOME AND TAX (Annexure to Form 16)

Tax regime opted: New Tax Regime — s.115BAC (default)

A. Income from Salary

Particulars	Amount
Gross Salary (per payroll)	₹0
(-) HRA received	Nil
(-) HRA exempt u/s 10(13A)	Nil
(-) LTA received	Nil
(-) LTA exempt u/s 10(5)	Nil
Income chargeable under 'Salaries'	₹0
(-) Standard deduction u/s 16(ia)	(₹75,000)
(-) Professional tax u/s 16(iii)	Nil
Net income from salary	₹0

B. Chapter VI-A deductions: Not applicable under New Tax Regime (most deductions not available except employer NPS contribution u/s 80CCD(2)).

C. Tax Computation

Particulars	Amount
Net Taxable Income	₹0
Income Tax (as per applicable slab)	₹[TAX_ON_INCOME]
Rebate u/s 87A	(Nil if taxable income > ₹7L)
Surcharge (if applicable)	₹[SURCHARGE]
Health & Education Cess @ 4%	₹[CESS]
Total Tax Payable	₹[TOTAL_TAX]
(-) TDS deducted by employer (Part A)	(₹0)
Balance tax payable / (refundable)	₹[BALANCE — file ITR to pay/claim]

CERTIFICATION: I, , authorised signatory of (TAN: ), certify that the information furnished above is correct and complete to the best of my knowledge. The tax deducted at source has been / will be paid to the credit of the Central Government in accordance with s.192 read with Rule 26A of the Income Tax Rules 1962. Important Notes: 1. This document is a working reference. The official Form 16 (Part A) must be downloaded from TRACES and bears a valid digital signature. 2. Employees must cross-check Form 26AS / Annual Information Statement (AIS) with this working before filing ITR. 3. If PAN is not furnished, TDS is deductible at 20% under s.206AA. 4. This Form 16 covers only salary income. Other income (interest, capital gains, etc.) must be declared separately in the ITR.

Authorised Signatory __GAP[f16_signatory|Priya Sharma, HR Manager]__ __GAP[f16_emp_name|Acme Technologies Private Limited]__ TAN: __GAP[f16_emp_tan|MUMB12345A]__