DETAILS REQUIRED FOR FORM 12BA & FORM 16

MONTH

2016

TDS
Rs.

Surcharge
Rs.

Education
Cess
Rs.

Total Tax
Deposited
Cheque No.
Rs. of Tax Payment

Transfer
Voucher /
BSR Code of Date on Which Tax
Challan ID No.
Bank Branch
Deposited

Bank Name & Branch

Where Tax Paid

dd / mmm / yyyy

APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER

2017
JANUARY

FEBRUARY
MARCH

Totals Rs.

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Company's Name:
Company's Address:

Your Company's T.A.Number

(NEW 10 DIGIT Alpha Numeric Number)

Your Company's P.A.Number

(10 Alpha Numeric Number)

Your Company's TDS Assessment Range

Name of Authorised Signatory For Form 12BA, Form16, Form 24 & eTDS
Designation of Authorised Signatory for Form 16
Full Name of Authorised Signatory's Father for Form 16

Further:
Please also mention those employees who are - "Director or person with substantial interest in the company"
- Required for Form 12BA, if any, below:
1

10

11

12

13

14

15

16

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C:\CYRUS DATA\FORMS\F16 & F12BA_DETAILS_YE_2017.xls F16 & F12BA Details

Please refer to the Quarterly eTDS Provisional Receipt that you have
Relavant Quarter

15 Digit Receipt Number (From the Top Left side of the Provisional
Receipt) + 8 Alphabetic code at the (Right Side)

Quarter 1
Quarter 2
Quarter 3
Quarter 4

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C:\CYRUS DATA\FORMS\F16 & F12BA_DETAILS_YE_2017.xls F16 & F12BA Details