FORM NO. 16A [See rule 31(1)(b)] Certificate of deduction of tax at source under section 203 of the Income-tax Act, 1961 For interest on securities; dividends; interest other than "interest on securities"; winnings from lottery or crossword puzzle ; winnings from horse race; payments to contractors and sub-contractors; insurance commission; payments to non-resident sportsmen/sports associations; payments in respect of deposits under National Savings Scheme; payments on account of repurchase of units by Mutual Fund or Unit Trust of India; commission, remuneration or prize on sale of lottery tickets; commission or brokerage; rent; fees for professional or technical services; royalty and any sum under section 28(va); income in respect of units; payment of compensation on acquisition of certain immovable property; other sums under section 195; income in respect of units of non-residents referred to in section 196A; income from units referred to in section 196B; income from foreign currency bonds or shares of an Indian company referred to in section 196C; income of Foreign Institutional Investors from securities referred to in section 196D Name and address of the person deducting tax Acknowledgement Nos. of all Quarterly Statements of TDS under sub-section (3) of section 200 as provided by TIN Facilitation Centre or NSDL web-site Name and address of the person to whom payment made or in whose account it is credited Quarter Acknowledgement No. TAX DEDUCTION A/C NO. OF THE DEDUCTOR NATURE OF PAYMENT PAN NO. OF THE PAYEE PAN NO. OF THE DEDUCTOR FOR THE PERIOD __________ TO ___________. DETAILS OF PAYMENT, TAX DEDUCTION AND DEPOSIT OF TAX INTO CENTRAL GOVERNMENT ACCOUNT (The Deductor is to provide transaction-wise details of tax deducted and deposited) S. No. Amount paid/ credited Date of payment/ credit TDS Rs. Surcharge Rs. Education Cess Rs. Total tax deposited Rs. Cheque/DD No. (if any) BSR Code of Bank branch Date on which tax deposited (dd/mm/yy) Transfer voucher/ Challan Identification No. 1. 2. 3. 4. Certified that a sum of Rs. (in words) __________________________ has been deducted at source and paid to the credit of the Central Government as per details given above. Place _________________ ___________________________________ Date _______________ Signature of person responsible for deduction of tax Full Name._______________________ Designation ___________________________
