FORM NO.

16
PART B
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source on salary paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. UJMPJYD Last updated on 01-Jun-2023

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen

RELIANCE SMSL LIMITED

3RD FLOOR, COURT HOUSE, DHOBI TALAO,
RANJEET KUMAR SAHOO
LOKMANYA TILAK MARG, MUMBAI - 400002
JAGATSINGHPUR KHERAS, JAGATSINGHAPUR,
Maharashtra
JAGATSINGHAPUR - 754103 Odisha
+(91)22-44740760

PAN of the Deductor TAN of the Deductor PAN of the Employee/Specified senior citizen

AALCS0575Q MUMS56878D NFPPS7153H

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2023-24 13-Feb-2023 31-Mar-2023
Building, Charni Road , Mumbai - 400002

Annexure - I

Details of Salary Paid and any other income and tax deducted

Whether opting for taxation u/s 115BAC No

1. Gross Salary Rs. Rs.

(a) Salary as per provisions contained in section 17(1) 58742.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 0.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 58742.00

(e) Reported total amount of salary received from other employer(s) 0.00

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

(a) Travel concession or assistance under section 10(5) 0.00

(b) Death-cum-retirement gratuity under section 10(10) 0.00

(c) Commuted value of pension under section 10(10A) 0.00

Cash equivalent of leave salary encashment under section 10

(d) 0.00
(10AA)

(e) House rent allowance under section 10(13A) 0.00

Page 1 of 4
Certificate Number: UJMPJYD TAN of Employer: MUMS56878D PAN of Employee: NFPPS7153H Assessment Year: 2023-24

Amount of any other exemption under section 10

(f) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(g) Total amount of any other exemption under section 10 0.00

Total amount of exemption claimed under section 10

(h) 0.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 58742.00
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) 50000.00

(b) Entertainment allowance under section 16(ii) 0.00

(c) Tax on employment under section 16(iii) 500.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 50500.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 8242.00

7. Add: Any other income reported by the employee under as per section 192 (2B)

Income (or admissible loss) from house property reported by

(a) 0.00
employee offered for TDS

(b) Income under the head Other Sources offered for TDS 0.00

Total amount of other income reported by the employee

8. 0.00
[7(a)+7(b)]
9. Gross total income (6+8) 8242.00

10. Deductions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life insurance premia, contributions to

(a) 2829.00 2829.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 2829.00 2829.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 0.00 0.00

Page 2 of 4
 Certificate Number: UJMPJYD TAN of Employer: MUMS56878D PAN of Employee: NFPPS7153H Assessment Year: 2023-24

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 0.00 0.00

Deduction in respect of health insurance premia under section

(g) 0.00 0.00
80D

Deduction in respect of interest on loan taken for higher

(h) education under section 80E 0.00 0.00

Gross Qualifying Deductible

Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(i) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(j) 0.00 0.00 0.00
under section 80TTA

Amount Deductible under any other provision (s) of Chapter VI-A

(k) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

Total of amount deductible under any other provision(s) of

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 2829.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 5413.00

13. Tax on total income 0.00

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 0.00

17. Tax payable (13+15+16-14) 0.00

18. Less: Relief under section 89 (attach details) 0.00

19. Net tax payable (17-18) 0.00

Verification
I, UPENDRA LILADHAR VEDPATHAK, son/daughter of .Working in the capacity of AUTHORISED SIGNATORY
(Designation) do hereby certify that the information given above is true, complete and correct and is based on the books of account,
documents, TDS statements, and other available records.

Place MUMBAI (Signature of person responsible for deduction of tax)

Full
Date 06-Jun-2023 UPENDRA LILADHAR VEDPATHAK
Name:

Page 3 of 4
Signature Not Verified
Digitally signed by UPENDRA LILADHAR
VEDPATHAK
Date: Jun 09, 2023 17:29:17 IST
Reason: Form 16
 Certificate Number: UJMPJYD TAN of Employer: MUMS56878D PAN of Employee: NFPPS7153H Assessment Year: 2023-24

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Particular's of Amount for any other
Sl. exemption under section 10 Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2..
3.
4.
5.
6.

10(k). Break up for ‘Amount deductible under any other provision(s) of Chapter VIA ‘to be filled in the table below
Particular's of Amount deductible under
Sl. any other provision(s) of Chapter VIA Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

MUMBAI (Signature of person responsible for deduction of

Place
tax)
Full
Date 06-Jun-2023 UPENDRA LILADHAR VEDPATHAK
Name:

Page 4 of 4
Signature Not Verified
Digitally signed by UPENDRA LILADHAR
VEDPATHAK
Date: Jun 09, 2023 17:29:17 IST
Reason: Form 16
 Annexure to Part B Form No.16

Name of the employer :Reliance SMSL Limited

TAN:MUMS56878D
Assessment Year :2023-2024
Name: Mr. Ranjeet Kumar Sahoo Emp No.: 67702170 PAN:NFPPS7153H

Part B Annexure Amount(Rs.)

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Details of Sr.2(f)-Other Exemptions u/s 10.

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- -------

Total Exemption 0

--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Details of Srno.10(K) Amount(Rs.)

Chapter VI-A Deduction(Other Provisions)
--------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- --

Date: 01.06.2023 Full Name: UPENDRA VEDPATHAK

Place: MUMBAI Designation: AUTHORISED SIGNATORY
Signature Not Verified
Annexure to Digitally Signed Certificate.
Digitally signed by UPENDRA LILADHAR
VEDPATHAK
Date: Jun 09, 2023 17:29:17 IST
Reason: Form 16
 FORM No.12BA
See Rule 26A(2)(b)
Statement showing particulars of perquisites , other fringe benefitsor amenities and profits in lieu of salary with value thereof
1) Name and address of employer :
Reliance SMSL Limited , 3rd Floor Court House, Lokmanya Til Mumbai - 400002 , Maharashtra
2) TAN: MUMS56878D
3) TDS Assessment Range of the employer :
CIT(TDS), 9thFlr, Smt.KGM Ayurvedic Hosp.Bldg, Charni Road, Mumbai, 400002, Maharashtra
4) Name, designation and PAN of employee :
Mr. Ranjeet Kumar Sahoo , Desig.: , Emp #: 67702170 , PAN: NFPPS7153H
5) Is the employee a director or a person with substantial interest in the company (where the employer is a company):No
6) Income under the head "Salaries" of the employee : 8242 (other than from perquisites)
7) Financial year : 2022-2023
8) Valuation of Perquisites: 0

S.No Nature of perquisites Value of perquisites Amount, if any recovered Amount of perquisites
(see rule 3) as per rules(Rs.) from the employee(Rs.) chargeable to tax(Rs.)
(1) (2) (3) (4) (5) Col(3)-Col(4)

1 Accommodation 0 0 0
2 Cars/Other automotive 0 0 0
3 Sweeper , gardener , watchman or 0 0 0
personal attendant
4 Gas , electricity , water 0 0 0
5 Interest free or concessional loans 0 0 0
6 Holiday expenses 0 0 0
7 Free or concessional travel 0 0 0
8 Free meals
9 Free Education
10 Gifts,vouchers etc.
11 Credit card expenses
12 Club expenses 0 0 0
13 Use of movable assets by employees 0 0 0
14 Transfer of assets to employees 0 0 0
15 Value of any other benefit
/amenity/service/privilege
16 Stock options alloted 80-IAC
17 Stock options ( non-qualified options ) 0 0 0

18 Contribution by employer Sec 17(2)(vii) 0 0 0

19 Annual accretion 17(2)(vii) Tax 17(2)(viia) 0 0 0

20 Other benefits or amenities 0 0 0

21 Total value of perquisites 0 0 0

22 Total value of Profits in lieu of salary

as per 17 (3) 0 0 0

9. Details of tax, - (a) Tax deducted from salary of the employee u/s192(1) 0
(b) Tax paid by employer on behalf of the employee u/s 192(1A) 0
(bb) Tax paid by previous employer/or on other income 0
(c) Total tax paid 0
(d) Date of payment into Government treasury *
* Refer PART A of form No 16 under Details of tax deducted and deposited in the Central Government Account.

DECLARATION BY EMPLOYER
I UPENDRA VEDPATHAK son/daughter LILADHAR VEDPATHAK working as AUTHORISED SIGNATORY ( designation ) do hereby declare
on behalf of Reliance SMSL 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.
Signature Not Verified Signature of the person responsible
Digitally signed by UPENDRA LILADHAR for deduction of tax
Place: MUMBAI VEDPATHAK Full Name : UPENDRA VEDPATHAK
Date: Apr 30, 2023 17:29:17 IST
Date : 30.04.2023 Reason: Form 16 Designation : AUTHORISED SIGNATORY