Form No. 24Q. 1 ( a ) Tax Deduction Account No ( d ) Assessment year

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Form No. 24Q (See section 192 and rule 31A) Quarterly statement of deduction of tax under sub section ( 3 ) of section 200 of the Income tax Act, 1961 in respect of Salary for the quarter ended June / September / December / March (tick which ever appicable).. (year) 1 ( a ) Tax Deduction Account No ( d ) Assessment year ( b ) Permanent Account No. ( e ) Has any statement been filed earlier for this quarter (Yes / no) ( c ) Financial year ( f ) If answer to (e) is Yes, then Provisional Receipt no. of original statement 2 Particulars of the deductor (employer) (a) Name (b) Type of deductor 1 (c) Branch / division (if any) (d) Address Flat No. Name of the premises / building Road / street / lane Area / location Town / City / District State Pin code Telephone No. E-mail 3 Particulars of the person responsible for deduction of tax (a) Name (b) Address Flat No. Name of the premises / building Road / street / lane Area / location Town / City / District State Pin code Telephone No. E-mail

4 Details of tax deducted and paid to the credit of Central Government : Sr. No. TDS Surcharge Education Interest Others Total tax Cheque/ BSR code Date on Transfer Whether Rs. Rs. Cess Rs. Rs. deposited DD No. which tax voucher / TDS Rs. Rs. (if any) Deposited Challan deposited (302+303 serial No. 2 by book +304+305 entry? +306) Yes/No 3 (301) (302) (303) (304) (305) (306) (307) (308) (309) (310) (311) (312) 1 2 3 4 5 5 Details of salary paid and tax deducted thereon from the employees (Enclose annexures I,II and III) VERIFICATION I,, hereby certify that all the particulars furnished above are correct and complete. Place : Date : Signature of person responsible for deducting tax at source Name and designation of person responsible for deducting tax at source Note :- (1) Indicate the type of deductor Government / Others (2) Government deductors to give particulars of transfer vouchers; other deductors to give particulars of challan no. regarding deposit into bank. (3) Column is relevant only for Government deductors. (4) Salary includes wages, annuity, pension, gratuity, fees, commission, bonus, repayment of amount deposited under the Additional Emoluments (Compulsory Deposit) Act, 1974, or profits in lieu of or in addition to salary or wages, including payments made at or in connection with termination of employment advance of salary or any other sums chargeable to income-tax under the head Salaries. (5) Where an employer deducts from the emoluments paid to an employee or pays on his behalf any contributions of that employee to any approved superannuation fund, all such deductions or payments should be included in the statements. (6) Please record on every page the totals of each of the columns.

Annexure I - Deductee wise break-up of TDS (Please use separate Annexure for each line - item in the table at S.No. 04 of main Form 24Q) Details of salary paid and tax deducted thereon from the employees BSR code of the branch where tax is deposited Date on which tax deposited (dd-mm-yyyy) Challan Serial No. Section under which payment made Total TDS to be allocated among deductees as in the vertical total of col. 323 Interest Others Total of the above Name of Employer TAN Sr. No. Employee PAN of the Name of Date of Taxable TDS Surcharge Educational Total Tax Total Tax Date of Date of Reason for reference employee the payment / amount on Rs. Rs. Cess Deducted deposited deduction Deposit non-deduction no. employee credit which tax Rs. (319+320+ Rs. / lower provided deducted 321) deduction* by Rs. Rs. employer (313) (314) (315) (316) (317) (318) (319) (320) (321) (322) (323) (324) (325) (326) 1 2 3 4 5 Total VERIFICATION I,, hereby certify that all the particulars furnished above are correct and complete. Place : Signature of person responsible for deducting tax at source Date : Name and designation of person responsible for deducting tax at source Note : * Write A if lower deduction or Write B if no deduction is on account of a certificate under section 197.

Serial Number Permanent Account Number(PAN) of the employee Name of the employee (330) (327) (328) (329) Date (331) (332) (333) (334) (335) (336) (337) (338) (339) (340) (341) (342) (343) (344) (345) (346) From Date To Date from which employed with current employer Total amount of salary, excluding amount required to be shown in columns 332 and 333 (See note 4) Total amount of house rent allowance and other allowances to the extent chargeable to tax [see section 10(13A] read with rule 2A and section 10(14)] Value of perquistes and amount of accretion to Employee's Provident Fund Account-as per Annexure Amount of allowances and perquisites claimed as exempt and not included in columns 332 and 333. Total of columns 331, 332 and 333. Total deductions under section 16(i), 16(ii) and 16(iii) (specify each deduction separately) Income chargeable under the head "Salaries" (Column 335 minus 336) Income (including loss from house property) under any head other than Income under the head "Salaries" offered for TDS [Section 192(2B)] Gross total income (Total of columns 337 and 338) Amount deductible under section 80G in respect of donations to certain funds, charitable institutions. Amount deductible under section 80GG in respect of rents paid Amount deductible under any other provision of Chapter VI-A (indicate relevant section and amount deducted) Total amount deductible under Chapter VI-A (Total of columns 340, 341 and 342) Total taxable income (Column 339 minus column 343) Income-tax on total income Income tax rebate under section 88 on life insurance premium, contribution to provident fund etc. (See note 5) Income Tax Rebate under section 88B Income Tax Rebate under section 88C ANNEXURE II (347) (348) (349) Income Tax Rebate under section 88D (350) (351) (352) Total Income-tax payable (column 345 minus total of columns 346, 347, 348&349) and surcharge there on Income tax relief under section 89, when salary etc. is paid in arrear or in advance Net tax payable (column 350 minus column 351)

Name of Employee (353) (354) (355) (356) (357) (358) (359) (360) (361) (362) (363) (364) (365) (366) (367) (368) Employee's Serial No. in Coloumn 327 of annexure II of Form No. 24Q. Value of perquisite (Column 355 minus Column 360 or Column 359 minus Column 360, as may be applicable) Where any conveyance has been provided by the employer free or at a concessional rate or where the employee is allowed the use of one or more motor-cars owned or hired by the employer or where the employer incurs the running expenses of a motor car owned by employees estimated value of perquisite(give details) Remuneration paid by the employer for domestic and personal services provided to the employee (give details) Value of free or concessional passages on home leave and other travelling to the extent chargeable to tax(give details) Estimated value of any other benefit or amenity provided by the employer free of cost or at concessional rate not included in the preceding columns(give details) Employer's contribution to recognised provident fund in excess of 12% of the employee's salary Interest credited to the asessee's account in recognised provident fund in excess of the rate fixed by Central Government Total of columns 361 to 367 carried to column 333 of Annexure-II of Form No. 24Q. ANNEXURE III Particulars of value of perquisites and amount of accretion to Employee's Provident Fund Account for the year ending 31st March... Value of rent-free accomodation or value of any concession in rent for the acommodation provided by the employer (give basis of computation) Where accommodation is furnished Place:... Date :...... Name and signature of employer/person responsible for paying salary Designation... Where accommodation is unfurnished Value as if accommodation is unfurnished Cost of furniture (including TV sets, radio sets, refrigerators, other household appliances and air-conditioning plant or equipment) Perquisite value of furniture (10% of Column 357) Total of Columns 356 and 358 Rent, if any, paid by the employee