Collabera Solutions Private Limited

Form 16
Form16 Details: Employee Name: Employee PAN: Employee Serial Number: Employee Designation: Form16 Control Number: Assessment Year: GANESH KUMAR M AUZPG7564L
4082 Engineer 4082/AUZPG7564L 2013 - 14

Digitally Signed

Signature Details: This form has been signed and certified using a Digital Signature Certificate as specified under section 119 of the Income-Tax Act, 1961. (Please refer Circular No.2/2007.dated 21-5-2007). The Digital Signature of the signatory has been affixed in the box provided below. To see the details and validate the signature, you should click on the box
Digitally Signed by Digitally Signature Certificate issued by Serial Number of DSC Number of Pages : NATARAJAN LAKSHMI NARAYANAN : mtnlTrustLine Class 2 Individual Subscriber Sub CA G1 : : 4 (including this page)

Signature Not Verified

Digitally signed by NATARAJAN LAKSHMI NARAYANAN Date: 2013.05.31 19:36:55 +05:30 Reason: I am the Author Location: l

GANESH KUMAR M-4082

FORM NO.16
[See rule 31(1)(a)]
Part B (Annexure) Certificate under section 203 of the Income-Tax Act, 1961 for tax deducted at Source on Salary
Name and address of the Employer Collabera Solutions Private Limited Tower D, 6th Floor, Subramanya Arcade, #12, Bannerghatta Road, Bangalore 560 07 GANESH KUMAR M Name and address of the Employee

PAN of the Deductor AABCP2354A CIT(TDS)

TAN of the Deductor BLRP01490G .

PAN of the Employee AUZPG7564L Assessment Year 2013 - 14

Employee Reference No. Provided by the Employer (If available) 4082 Period From 01/04/2012 To 31/03/2013

Room # 59, H.M.T. Bhawan, 4th Floor, Bellary Road, Ganganagar Bangalore 560032

Details of Salary paid and any other income and tax deducted

Rs. 399756.00 0.00 0.00

Rs.

Rs.

1. GROSS SALARY (a) Salary as per provisions contained in section 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) Total 2. Less : Allowance to the extent exempt u/s 10
Sl No. Allowance 1 2 3 4 5 6 House Rent Allowance Exemption Transport Exemption Gratuity Exemption Children Education Allowance Leave Encashment LTA exemption Rs. 71400.00 9600.00 0.00 0.00 0.00 0.00

399756.00

Total 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
Income Income / Loss from House Property Income from Other Sources Other_Source_Income2 Other_Source_Income3 Rs 0.00 0.00 0.00 0.00

81000.00 318756.00 0.00 2400.00 2400.00 316356.00

0.00 316356.00

8. GROSS TOTAL INCOME( 6 + 7 ) 9. DEDUCTIONS UNDER CHAPTER VI-A (A) Sections 80C, 80CCC & 80CCD (a) Section 80C
(i) LIC (ii) Public Provident Fund (iii) National Saving Certificates (iv) Children Tuition Fees (v) Contribution to ULIP (vi) Housing Loan Principal Repayment (vii) Employee Provident Fund (viii) Infrastructure Bonds (ix) Others / (Fixed Deposit (5 Years) , NSS, SCSC,etc ) (x) NSC Interest / Approved Superannuation (xi) Voluntary Provident Fund (xii) Mutual Fund

Gross Amount

Deductible Amount

0.00 0.00 0.00 0.00 0.00 0.00 21420.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 21420.00 0.00 0.00 0.00 0.00

(b) Section 80CCC (c) Section 80CCD(1)

0.00 0.00 0.00

0.00 0.00 0.00

Total of (a) + (b) + (c)

Note : Aggregate amount deductible under section i.e., 80C and 80CCD(1) shall not exceed one lakh rupees.

21420.00

(B) Other Sections(e.g. 80E, 80G, 80TTA etc.) Under Chapter VI-A

Gross Amount

Qualifying Amount

Deductible Amount

(a) 80 CCG (b) 80 D (c) 80 DD (d) 80 DDB (e) 80 E (f) 80 U (g) 80 G (h) 80 GG (i) 80 TTA

Rajiv Gandhi Equity Scheme Medical Claim Handicapped Dependents Medical Expenses, Chronic Diseases Interest on Loan taken for Higher Education Permanent Physical disability Donation Rent paid (HRA not received) Deduction on Interest on saving Account

0.00 9600.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 9600.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 9600.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9600.00 31020.00 285340.00 8534.00 256.00 8790.00 0.00 8790.00 8790.00 0.00

10. Aggregate of deductible amounts under chapter VIA 11. Total Income (8-10 ) 12. Tax on total income 13. Education Cess @ 3% on (on tax computed at S.No.12) 14. Tax Payable (12+13) 15. Less : Relief under section 89 16. Tax Payable (14-15 ) 17. Less : (a) Tax Deducted at source u/s 192 (1) (b) Tax paid by the employer on behalf of the employee u/s 192 (1A) On perquisites u/s 17(2) 18. Tax payable / refundable (16-17 )

0.00

Verification Income tax deducted in case of individual employee forms a part of total amount of monthly deposits I, NATARAJAN LAKSHMI NARAYANAN son / daughter of MR.SERUKUDY VENKATRAMAN NATARAJAN working in the capacity of ASSOCIATE VICE PRESIDENT FINANCE, do hereby certify that a sum of Rs.8790.00 [RUPEES EIGHT THOUSAND SEVEN HUNDRED AND NINETY ONLY)] has been deducted at source and paid to the credit of the Central Government.I further certify that the information given above is true and correct based on the books of account, documents and other available records.

For Collabera Solutions Private Limited Place : Date : Bangalore 31-May-2013

Signature of the person responsible for deduction of tax This Form 16 is signed using Digital Signature. Please see Page1. FULL NAME : NATARAJAN LAKSHMI NARAYANAN Designation : ASSOCIATE VICE PRESIDENT - FINANCE

* Status of matching with OLTAS

F O P U

Final Overbooked Provisional Unmatched

In case of non-goverment deductors, payment details of TDS/TCS deposited in bank by deductor have matched with the payment details mentioned in the TDS/TCS statement filed by the deductors. In case of government deductors, details of TDS/TCS booked in Government account have been verified by Pay & Accounts Officer (PAO) Payment details of TDS/TCS deposited in bank by deductor in bank by deductor have matched in the TDS/TCS statement but the amount is over claimed in the statement. Final(F) credit will be reflected only when deductor reduces claimed amount in the statement or makes new payment for excess amount claimed in the statement Provisional tax credit is effected only for TDS/TCS statements filled by Government deductors. P status will be changed to final (F) on verfication of payment details submitted by Pay and Accounts Officer (PAO) Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be refelected only when payment details in bank match with details of deposit in TDS/TCS statement

FORM NO. 12BA

{See rule 26A(2)(b)} Statement showing particulars of perquisites, other fringe benefits or amenities and profits in lieu of salary with value thereof _____________________________________________________________________________________________________________________ 1. Name and Address of the Employer : Collabera Solutions Private Limited Tower D, 6th Floor, Subramanya Arcade#12, Bannerghatta RoadBangalore - 560 07 : BLRP01490G : Room # 59, H.M.T. Bhawan, 4th Floor, Bellary Road,, Ganganagar, Bangalore-560032 : GANESH KUMAR M : Engineer : AUZPG7564L : No : 316356.00
: 2012 - 13

2. TAN 3. TDS Assessment Range of the Employer 4.Name of Employee Designation PAN 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
Sl No. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Nature of perquisite

Value of perquisite as per rules(Rs.)

Amount,if any, recovered from employee(Rs.)

Amount of Taxable perquisite(Rs.)

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 (Food Coupons Taxable ) 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 (ESOS Perquisites) Other Benefits or amenities (Conveyance Perks) Total Value of Perquisites Value of profits in lieu of salary as per section 17(3)

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 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

* ''Other benefits or amenities'' includes medical reimbursement exceeding Rs. 15,000/-.

9. Details of Tax a) Tax Deducted from Salary of Employee u/s 192(1) b) Tax Paid by Employer on behalf of Employee u/s 192(1A) c) Total Tax Paid d) Date of Payment into Government Treasury

: : : :

8790.00 0.00 8790.00 Refer FORM 16

DECLARATION BY EMPLOYER I,NATARAJAN LAKSHMI NARAYANAN son / daughter of SERUKUDY VENKATRAMAN NATARAJAN working in the capacity of ASSOCIATE VICE PRESIDENT FINANCE do hereby declare on behalf of Collabera Solutions Private Limited 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.

For Collabera Solutions Private Limited Place : Date : Bangalore 31-May-2013

Signature of the person responsible for deduction of tax This Form 16 is signed using Digital Signature. Please see Page1. FULL NAME : NATARAJAN LAKSHMI NARAYANAN Designation : ASSOCIATE VICE PRESIDENT - FINANCE