CONVERGYS INDIA SERVICES PVT LTD

Form 16 Digitally Signed

Employee Name : NEERAJ M R

Employee PAN : AKUPN3550E

Employee Personnel Number : 101680583

Employee Designation: Sr. Representative, Operations

Form16 Control Number: 101680583/AKUPN3550E

Assessment Year : 2021-22

Certificate Number:

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Signature Details:
This form has been signed and certified using a Digital Signature Certificate as the specified under section 119 of the
Income-tax Act, 1961. The Digital Signature of the Signatory has been affixed below. To see the details and validate the
signature, click on the digital signature below.

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

NEERAJ M R - 101680583
CONVERGYS INDIA SERVICES PVT LTD
 FORM NO. 16
[See rule 31(1)(a)]

PART A
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. ABDMYMA Last updated on 18-Jun-2021

Name and address of the Employer Name and address of the Employee

CONVERGYS INDIA SERVICES PRIVATE LIMITED

Hindustan Times House, Level 10, K G Marg, MOOTHEDATH RAVINDRAN NEERAJ
Connaught Place, NEW DELHI - 110001 410 TWINS HOUSE 5TH CROSS, 5TH MAIN JAGADISH NAGAR,
Delhi PO NEW TIPPASANDRA, NEAR BEML HOSPITAL, BANGALORE -
+(91)124-98914218 560075 Karnataka
atul.jain@concentrix.com

Employee Reference No.

PAN of the Employee
PAN of the Deductor TAN of the Deductor provided by the Employer
(If available)

AABCC5056G DELC04901B AKUPN3550E

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2021-22 01-Apr-2020 31-Mar-2021
4 , Luxmi Nagar, Delhi - 110092

Summary of amount paid/credited and tax deducted at source thereon in respect of the employee

Receipt Numbers of original

Amount of tax deposited / remitted
quarterly statements of TDS Amount of tax deducted
Quarter(s) Amount paid/credited (Rs.)
under sub-section (3) of (Rs.)
Section 200

Q3 FXIRFFEY 61530.00 0.00 0.00

Q4 QUJVFGRD 71036.00 0.00 0.00
Total (Rs.) 132566.00 0.00 0.00
I. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH BOOK ADJUSTMENT
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Book Identification Number (BIN)

Tax Deposited in respect of the
Sl. No. deductee Date of transfer voucher Status of matching
Receipt Numbers of Form DDO serial number in Form no.
(Rs.) (dd/mm/yyyy) with Form no. 24G
No. 24G 24G

Total (Rs.)
II. DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN
(The deductor to provide payment wise details of tax deducted and deposited with respect to the deductee)

Challan Identification Number (CIN)

Tax Deposited in respect of the
Sl. No. deductee
(Rs.) BSR Code of the Bank Date on which Tax deposited Challan Serial Number Status of matching with
Branch (dd/mm/yyyy) OLTAS*

1 0.00 - 04-12-2020 - F
2 0.00 - 06-01-2021 - F
3 0.00 - 05-02-2021 - F
4 0.00 - 05-03-2021 - F
5 0.00 - 23-04-2021 - F
Total (Rs.) 0.00

Page 1 of 2
 Certificate Number: ABDMYMA TAN of Employer: DELC04901B PAN of Employee: AKUPN3550E Assessment Year: 2021-22

Verification

I, ATUL KUMAR JAIN, son / daughter of SATYENDRA KUMAR JAIN working in the capacity of DIRECTOR PAYROLL (designation) do hereby certify that a sum of
Rs. 0.00 [Rs. Zero Only (in words)] has been deducted and a sum of Rs. 0.00 [Rs. Zero Only] has been 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 books of account, documents, TDS statements, TDS deposited and other
available records.

Place NEW DELHI

Date 10-Jul-2021 (Signature of person responsible for deduction of Tax)

Designation: DIRECTOR PAYROLL Full Name:ATUL KUMAR JAIN

Notes:
1. Part B (Annexure) of the certificate in Form No.16 shall be issued by the employer.
2. If an assessee is employed under one employer during the year, Part 'A' of the certificate in Form No.16 issued for the quarter ending on 31st March of the financial year shall contain the details
of tax deducted and deposited for all the quarters of the financial year.
3. If an assessee is employed under more than one employer during the year, each of the employers shall issue Part A of the certificate in Form No.16 pertaining to the period for which such
assessee was employed with each of the employers. Part B (Annexure) of the certificate in Form No. 16 may be issued by each of the employers or the last employer at the option of the assessee.
4. To update PAN details in Income Tax Department database, apply for 'PAN change request' through NSDL or UTITSL.

Legend used in Form 16

* Status of matching with OLTAS

Legend Description Definition
Deductors have not deposited taxes or have furnished incorrect particulars of tax payment. Final credit will be reflected only when payment
U Unmatched
details in bank match with details of deposit in TDS / TCS statement
Provisional tax credit is effected only for TDS / TCS Statements filed by Government deductors."P" status will be changed to Final (F) on
P Provisional
verification of payment details submitted by Pay and Accounts Officer (PAO)
In case of non-government deductors, payment details of TDS / TCS deposited in bank by deductor have matched with the payment details
F Final 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 have matched with details mentioned in the TDS / TCS statement but the
O Overbooked 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

Page 2 of 2
 FORM NO. 16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. ABDMYMA Last updated on 18-Jun-2021

Name and address of the Employer Name and address of the Employee

CONVERGYS INDIA SERVICES PRIVATE LIMITED

Hindustan Times House, Level 10, K G Marg, MOOTHEDATH RAVINDRAN NEERAJ
Connaught Place, NEW DELHI - 110001 410 TWINS HOUSE 5TH CROSS, 5TH MAIN JAGADISH NAGAR,
Delhi PO NEW TIPPASANDRA, NEAR BEML HOSPITAL, BANGALORE -
+(91)124-98914218 560075 Karnataka
atul.jain@concentrix.com

PAN of the Deductor TAN of the Deductor PAN of the Employee

AABCC5056G DELC04901B AKUPN3550E

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Aayakar Bhawan, District Centre, 6th Floor Room no 610, Hall no. 2021-22 01-Apr-2020 31-Mar-2021
4 , Luxmi Nagar, Delhi - 110092

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) 132566.00

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 132566.00

(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) 20914.00

Page 1 of 4
Certificate Number: ABDMYMA TAN of Employer: DELC04901B PAN of Employee: AKUPN3550E Assessment Year: 2021-22

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) 20914.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 111652.00
[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) 600.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 50600.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 61052.00

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) 61052.00

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

Deduction in respect of life insurance premia, contributions to

(a) 31162.00 31162.00
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) 31162.00 31162.00

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: ABDMYMA TAN of Employer: DELC04901B PAN of Employee: AKUPN3550E Assessment Year: 2021-22

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. 31162.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 29890.00

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, ATUL KUMAR JAIN, son/daughter of SATYENDRA KUMAR JAIN .Working in the capacity of DIRECTOR PAYROLL
(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 NEW DELHI (Signature of person responsible for deduction of tax)

Full
Date 10-Jul-2021 ATUL KUMAR JAIN
Name:

Page 3 of 4
 Certificate Number: ABDMYMA TAN of Employer: DELC04901B PAN of Employee: AKUPN3550E Assessment Year: 2021-22

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.

NEW DELHI (Signature of person responsible for deduction of

Place
tax)
Full
Date 10-Jul-2021 ATUL KUMAR JAIN
Name:

Page 4 of 4
 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 there of

1. Name and Address of the Employer : CONVERGYS INDIA SERVICES PVT LTD
Level 10, Hindustan Times House, K G Marg, NEW DELHI,
DELHI,110001

2. TAN : DELC04901B

3. TDS Assessment Range of the Employer :

4. Name of Employee : NEERAJ M R

Designation : Sr. Representative, Operations
PAN : AKUPN3550E
5. Is the Employee a Director or a with substantial NO
:
interest in the company (Where the employer is a company)
6. Income under the Head "Salaries" of the Employee 61052.00
:
(Other than from perquisites)

7. Financial Year : 2020-21

8. Valuation of perquisites
Sr. Value of perquisite Amount,if any, recovered Amount of Taxable
No. Nature of perquisite
as per rules(Rs.) from employee (Rs.) perquisite(Rs.)
Total Value of Perquisites 0.00 0.00 0.00

9. Details of Tax
a) Tax Deducted from Salary of Employee u/s 192(1) : 0.00
b) Tax Paid by Employer on behalf of Employee u/s 192(1A) : 0.00
c) Total Tax Paid : 0.00
d) Date of Payment into Government Treasury :

DECLARATION BY EMPLOYER

I, Atul Kumar Jain Son / daughter of Satyendra Kumar Jain working as Director Payroll do hereby declare on behalf of CONVERGYS INDIA SERVICES
PVT LTD 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 such perquisite are in accordance with section 17 and rules framed there under and that such information is true and correct.

For CONVERGYS INDIA SERVICES PVT LTD

Signature of person responsible for deduction of tax
This form is signed using Digital Signature. Please see page 1.
Place: NEW DELHI Full Name : Atul Kumar Jain
Date: 1-Jul-21 Designation : Director Payroll

NEERAJ M R - 101680583
CONVERGYS INDIA SERVICES PVT LTD
 ANNEXURE TO FORM NO. 16
Details of Salary Paid and Allowance Exempted u/s 10 and 17(2) of Income-tax Act,1961

1. Name and Address of the Employer : CONVERGYS INDIA SERVICES PVT LTD
Level 10,Hindustan Times House,K G Marg,NEW DELHI,
DELHI,110001

2. Name of Employee : NEERAJ M R

Designation : Sr. Representative, Operations
PAN : AKUPN3550E
Employee Serial No. : 101680583

Salary for the period: 1-Apr-20 to 31-Mar-21

1. Salary as per provisions contained in Sec 17(1)

Basic Salary 52,286.00
HRA 20,914.00
Other Allowances 59,366.00

1,32,566.00
Total Salary (A)
Value of perquisite u/s17(2) 0.00
(as per Form No.12BA wherever applicable)
Profit in lieu of Salary u/s 17(3)
0.00
(as per Form No.12BA wherever applicable)

Total Perquisites (B) 0.00

Gross Salary (A+B) 1,32,566.00
2. Details of Allowance exempted u/s 10
HRA Exemption 20,914.00

Total (C) 20,914.00

3. Balance : (A+B-C) 1,11,652.00

NEERAJ M R - 101680583
CONVERGYS INDIA SERVICES PVT LTD