FORM NO.

16
[ See rule 31(1) (a) ] " ORIGINAL "

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 designation of the Employee Mr/Ms: Dhiraj Kumar Singh Desig.: Software Engineer Emp #: 40212816 TAN of the Deductor DELH01586E CIT(TDS) Assessment year Address Ayakar Bhawan, Laxmi Nagar From City To
31.03.2012

HCL Technologies Limited

806 Siddharth, 96, Nehru Place

New Delhi 110019

Delhi

PAN of the Deductor AAACH1645P

PAN of the Employee BZNPS7152L Period

Delhi

Pin code

110092

2012- 2013

01.04.2011

Summary of tax deducted at Source

Quarter Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total Receipt Numbers of original statements of TDS under subsection(3) of section 200.
DOWXBLEB

Amount of tax deducted in respect of the employee

817.00

Amount of tax deposited/remitted in respect of the employee

817.00

BUQXBZNB
DLDXEFAA

3195.00
2304.00 2088.00

3195.00
2304.00
2088.00

QTY NOT FILED

8404.00

8404.00

PART B (Refer Note 1)

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED 1. Gross salary a) Salary as per provisions contained in sec.17(1) 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 ) d) Total
330848.42

INR

INR

INR

0.00
0.00

330848.42

2. Less: Allowance to the extent exempt under section 10

Conveyance Exemption 9600.00

54693.70

HRA Exemption
3. Balance(1-2) 4. Deductions: (a) Entertainment allowance (b) Tax on Employment 5. Aggregate of 4(a) and (b) 6. Income chargeable under the head 'salaries'(3-5) 7. Add: Any other Income reported by the employee 8. Gross total income (6+7) 9. Deductions under chapter VI-A A) sections 80C, 80CCC and 80CCD a) section 80C i) Employee Provident Fund
ii) Payment towards Life Insurance Policy

45093.70
276154.72

0.00
1000.00
1000.00

275154.72

0.00

275154.72
Gross Amount Deductible Amount

10819.00
2741.00 13560.00

13560.00

Dhiraj Kumar Singh

(b) section 80CCC (c) section 80CCD Note : 1. Aggregate amount deductible under section 80C shall not exceed one lakh rupees 2. Aggregate amount deductible under the three sections i.e 80C, 80CCC and 80CCD shall not exceed one lakh rupees B) other sections (for e.g. 80E, 80G etc.) under chapter VIA 10. Aggregate of deductible amount under Chapter VIA 11. Total Income(8-10) 12. Tax on total income 13. Education Cess @ 3% (on tax computed at S.No 12) 14. Tax payable (12+13) 15. Less: Relief under sec 89(attach details) 16. Tax Payable (14-15) Gross amount Qualifying amount Deductible amount
0.00
0.00
0.00

0.00

0.00

13560.00

261590.00
8159.00

245.00
8404.00

0.00
8404.00

Verification
I, MR.NAVIN KUMAR son/daughter of LATE MR. HANS RAJ working in the capacity of AVP & GLOBAL HEAD - EHS do hereby certify that a sum of INR 8404.00 [ Rupees EIGHT THOUSAND FOUR HUNDRED FOUR ( 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 book of accounts , documents, TDS statements, TDS deposited and other available records.

Place:NEW DELHI Date:11.05.2012 Designation:AVP & GLOBAL HEAD - EHS

NAVIN KUMAR

Digitally signed by NAVIN KUMAR DN: c=IN, o=mtnlTrustLine Enterprise Subscriber, ou=mtnlTrustLine, cn=NAVIN KUMAR, serialNumber=12C52CAB53C0223CB96AF613DF14CFE0B73E4304686F25EE559E067 1832A80C2, email=navin.kumar@hcl.com Reason: I attest to the accuracy and integrity of this document Date: 2012.05.14 03:55:29 +05'30'

Signature of the person responsible for deduction of tax Full Name: MR.NAVIN KUMAR

ANNEXURE-B
DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The Employer to provide payment wise details of tax deducted and deposited with respect to the employee)
Challan Identification number (CIN) S. No Tax Deposited in respect of the employee (INR) BSR Code of the Bank Branch Date on which tax deposited (dd/mm/yyyy) Challan Serial Number

001 002 003 004 005 006

007

445.00 184.00 188.00 1376.00 331.00 1488.00

657.00

6910333 6910333 6910333 6910333 6910333 6910333

6910333

06.05.2011 06.06.2011 07.07.2011 06.08.2011 07.09.2011 07.10.2011

04.11.2011

15354 14092 21077 17474 19835 21042

16952

008 009 010 011 012

Total

979.00 668.00 675.00 687.00 726.00

8404.00

6910333 6910333 6910333 6910333 6910333

07.12.2011 06.01.2012 07.02.2012 07.03.2012 27.04.2012

23035 19374 20833 20308 12599

FORM No.12BA {See Rule 26A(2)(b)}

Statement showing particulars of perquisities, other fringe benefits or amenities and profits in lieu of salary with value thereof 1) Name and address of employer :
HCL Technologies Limited, 806 Siddharth, 96, Nehru PlaceNew Delhi-110019, Delhi

2) TAN: DELH01586E 3) TDS Assessment Range of the employer :

DEL W 22 (12), Ayakar Bhawan, Laxmi Nagar, Delhi, 110092, Delhi

4) Name, designation and PAN of employee :

Mr/Ms: Dhiraj Kumar Singh, Desig.:Software Engineer, Emp #:40212816, PAN:BZNPS7152L

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 : 8) Valuation of Perquisites 275154.72 2011-2012

S.No (1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Nature of perquisite (see rule 3) (2) Accommodation Cars/Other automotive Sweeper , gardener , watchman or personal attendant Gas , electricity , water Interest free or concessional loans Holiday expenses Free or concessional Travel Free meals Free Education Gifts,vouchers etc. Credit card expenses Club expenses Use of movable assets by employees Transfer of assets to employees Value of any other benefit /amenity/service/privilege Stock options ( non-qualified options ) Other benefits or amenities Total value of perquisites Total value of Profits in lieu of salary as per 17 (3)

Value of perquisite as per rules(INR) (3)

Amount, if any recovered from the employee(INR) (4)

Amount of perquisite chargeable to tax(INR) Col(3)-Col(4) (5)

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00
0.00

0.00
0.00
0.00

0.00
0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00
0.00

0.00 0.00 0.00

0.00

0.00 0.00 0.00

0.00

0.00 0.00 0.00

0.00

16 17 18 19

0.00 0.00 0.00

0.00

0.00 0.00 0.00

0.00

0.00 0.00 0.00

0.00

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 (d) Date of payment into Government treasury
8404.00 0.00 8404.00 *

DECLARATION BY EMPLOYER
I, MR.NAVIN KUMAR Son/daughter of LATE MR. HANS RAJ working as AVP & GLOBAL HEAD - EHS (designation ) do hereby declare on behalf of HCL Technologies Limited ( name of the employer ) 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.

NAVIN KUMAR

Digitally signed by NAVIN KUMAR DN: c=IN, o=mtnlTrustLine Enterprise Subscriber, ou=mtnlTrustLine, cn=NAVIN KUMAR, serialNumber=12C52CAB53C0223CB96AF613DF14CFE0B73E4304686F25EE559E0671 832A80C2, email=navin.kumar@hcl.com Reason: I attest to the accuracy and integrity of this document Date: 2012.05.14 03:55:35 +05'30'

Signature of the person responsible for deduction of tax

Place : NEW DELHI Date : 11.05.2012 Full Name:MR.NAVIN KUMAR Designation:AVP & GLOBAL HEAD - EHS

Annexure to Form No.16

Name: Dhiraj Kumar Singh

Emp No.: 40212816

Particulars Emoluments paid

Basic Salary

Amount(INR)

90187.40

Conveyance Allowance

23600.00

House Rent Allowance Bonus

Other Allowances

58216.00 10145.92
148699.10

Perquisites

Gross emoluments

330848.42

Income from other sources

Total income from other sources

0.00

Exemptions u/s 10
Conveyance Exemption 9600.00

HRA Exemption
Total Exemption

45093.70
54693.70

Date: 11.05.2012 Place: NEW DELHI

Full Name: MR.NAVIN KUMAR Designation: AVP & GLOBAL HEAD - EHS