COLLABERA SOLUTIONS PRIVATE LIMITED

Digitally Signed

Form 16
Form16 Details:

Employee Name: ASHISH KULKARNI

Employee PAN: AURPA7835L

Employee Serial Number: 3853

Employee Designation: Engineer

Form16 Control Number: 3853/AURPA7835L

Assessment Year: 2012 - 2013

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 :LAKSHMI NARAYANAN N

Digitally Signature Certificate issued by :mtnlTrustLine Class 2 Individual Subscriber Sub
CA G1
Serial Number of DSC Signed by: NATARAJAN LAKSHMI
Number of Pages : 5 (including this page) NARAYANAN
Date: 2012.06.02 19:43:04 +0530

ASHISH KULKARNI-3853 1
 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 Salaries
Name and address of the Employer Name and Designation of the Employee
COLLABERA SOLUTIONS PRIVATE LIMITED ASHISH KULKARNI
Tower D, 6th Floor, Subramanya Arcade, #12, Bannerghatta Engineer
Road, Bangalore - 560076

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

AABCP2354A BLRP01490G AURPA7835L
CIT(TDS) Assessment Year Period
Address:Room No. 59, H.M.T. Bhawan, 4th Floor 2012 - 2013 From To
Bellary Road, Ganganagar 01/04/2011 06/01/2012
City:Bangalore Pincode:560032
Summary of tax deducted at source
Quarter Receipt Numbers of original statements of TDS Amount of tax deducted in respect of the Amount of tax
under sub-section (3) of section 200 employee deposited/remitted in
respect of the
employee
Quarter1 GPZXXJWE 6041.00 6041.00
Quarter2 GPZXBHPB 5752.00 5752.00
Quarter3 MDFXXDDC 6253.00 6253.00
Quarter4 MDFXXGHC 0.00 0.00
Total 18046.00 18046.00
PART B (Refer Note 1)
Details of Salary paid and any other income and tax deducted
Particulars Rs. Rs. Rs.
1. GROSS SALARY
(a) Salary as per provisions contained in section 17(1) 367723.00
(b) Value of perquisites under section 17(2) 0.00
(as per Form No:12BA,wherever applicable)
(c) Profits in lieu of salary under section 17(3) 0.00
(as per Form No: 12BA,wherever applicable)

Total 367723.00
2. Less : Allowance to the extent exempt u/s 10
Sl No. Allowance Rs.
1 House Rent Allowance Exemption 58287.00
2 Transport Exemption 7355.00
3 Gratuity Exemption 0.00
4 Children Education Allowance 0.00
5 Leave Encashment 0.00
6 LTA exemption 0.00
Total 65642.00
3. Balance (1-2) 302081.00
4. DEDUCTIONS :
(a) Entertainment Allowance 0.00
(b) Tax on Employment 2000.00
5. Aggregate of 4 (a) and (b) 2000.00
6. Income chargeable under the head 'salaries'( 3-5 ) 300081.00
7. Add : Any other income reported by the employee
Income Rs
Income / Loss from House Property 0.00
Income from Other Sources 0.00
Other_Source_Income2 0.00
Other_Source_Income3 0.00 0.00
8. Gross total income( 6+7 ) 300081.00

ASHISH KULKARNI-3853 2
 9. DEDUCTIONS UNDER CHAPTER VI-A
(A) Sections 80C, 80CCC & 80CCD
(a) Section 80C Gross Amount Deductible Amount
(i) Life Insurance Premium 0.00 0.00
(ii) Public Provident Fund 0.00 0.00
(iii) National Saving Certificates 0.00 0.00
(iv) Children Tuition Fees 0.00 0.00
(v) Mutual Funds / ULIP 0.00 0.00
(vi) Housing Loan Principal Repayment 0.00 0.00
(vii) Employee Provident Fund 18387.00 18387.00
(viii) Infrastructure Bonds 0.00 0.00
(ix) Others / (Fixed Deposit (5 Years) , NSS, SCSC,etc ) 0.00 0.00
(x) NSC Interest / Approved Superannuation 0.00 0.00
(xi) Voluntary Provident Fund 0.00 0.00
(b) Section 80CCC 0.00 0.00
(c) Section 80CCD 0.00 0.00
(d) section 80CCF ( Long Term Infrastructure Bonds ) 0.00 0.00
Total of (a)+(b)+(c)+(d) 18387.00
Note: 1. Aggregate amount deductible under section 80C shall not exceed one lakh rupees.
2. Aggregate amount deductible under the these sections, i.e., 80C,80CCC,80CCD and 80CCF shall not exceed Rs. one lakh twenty thousand.
(B) Other Sections(e.g. 80E,80G etc.) Under Chapter VI-A
Gross Amount Qualifying Amount Deductible Amount
(a) 80 D Medical Insurance Premium 0.00 0.00 0.00
(b) 80 DD Handicapped Dependents 0.00 0.00 0.00
(c) 80 DDB Medical Expenses, Chronic Diseases 0.00 0.00 0.00
(d) 80 E Interest on Loan taken for Higher Education 0.00 0.00 0.00
(e) 80 U Permanent Physical disability 0.00 0.00 0.00
(f) 80 G Donation 0.00 0.00 0.00
Total 0.00
10. Aggregate of deductible amounts under chapter VIA 18387.00

11. Total Income (8-10 ) 281690.00

12. Tax on total income 10169.00

13. Education Cess @ 3% on (on tax computed at S.No.12) 305.00

14. Tax Payable (12+13) 10474.00

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

16. Tax Payable (14-15 ) 10474.00

17. (a) Tax Deducted at source u/s 192 (1) 18046.00

(b) Tax paid by the employer on behalf of the employee u/s 192 (1A) 0.00

On perquisites u/s 17(2)

18. Tax payable / refundable (16-17 ) -7572.00

Verification

I, LAKSHMI NARAYANAN N son / daughter of NATARAJAN S V working in the capacity of ASSOCIATE VICE PRESIDENT - FINANCE do hereby certify that a sum of
Rs.18046.00 [Rs Eighteen thousand and forty-six only] has been deducted and 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.

Signature of the person responsible for deduction of tax

Place : Bangalore Full Name : LAKSHMI NARAYANAN N
Date : 31/05/2012 Designation : ASSOCIATE VICE PRESIDENT - FINANCE

This Form 16 is signed using Digital Signature. Please see Page1.

ASHISH KULKARNI-3853 3
 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 Road
Bangalore-560076
2. TAN BLRP01490G
3. TDS Assessment Range of the Employer Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road, Ganganagar,
Bangalore-560032
4.Name,Designation and PAN of the employee
a). Name ASHISH KULKARNI
b). Designation Engineer
c). PAN AURPA7835L
5. Is the Employee a Director or a person with substantial No
interest in the company (Where the employer is a company)
6. Income under the Head 'Salaries' of the Employee 300081.00
(Other than from perquisites)
7. Financial Year 2011 - 2012
8. Valuation of Perquisites

Sl No. Nature of perquisite (See Rule 3) Value of perquisite Amount,if any, Amount of
as per rules(Rs.) recovered from perquisite
employee(Rs.) chargeable to tax
Col(3)-Col(4)
(1) (2) (3) (4) (5)
(1) Accommodation 0.00 0.00 0.00
(2) Cars/Other automotive 0.00 0.00 0.00
(3) Sweeper,gardener,watchman or personal attendant 0.00 0.00 0.00
(4) Gas,electricity,water 0.00 0.00 0.00
(5) Interest free or concessional loans 0.00 0.00 0.00
(6) Holiday expenses 0.00 0.00 0.00
(7) Free or concessional travel 0.00 0.00 0.00
(8) Free Meals (Food Coupons Taxable ) 0.00 0.00 0.00
(9) Free Education 0.00 0.00 0.00
(10) Gifts,vouchers,etc. 0.00 0.00 0.00
(11) Credit card expenses 0.00 0.00 0.00
(12) Club expenses 0.00 0.00 0.00
(13) Use of movable assets by employees 0.00 0.00 0.00
(14) Transfer of assets to employees 0.00 0.00 0.00
(15) Value of any other benefit/amenity/service/privilege 0.00 0.00 0.00
(16) ESOP /ESPP/RSU Perquisites 0.00 0.00 0.00
(17) Other Benefits or amenities 0.00 0.00 0.00
(18) Total Value of Perquisites 0.00 0.00 0.00
(19) Value of profits in lieu of salary as per section 17(3) 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) : 18046.00
b) Tax Paid by Employer on behalf of Employee u/s 192(1A) : 0.00
c) Total Tax Paid : 18046.00
d) Date of Payment into Government Treasury : AS PER FORM 16 ATTACHED

DECLARATION BY EMPLOYER
I,LAKSHMI NARAYANAN N son / daughter of NATARAJAN S V 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.

Signature of the person responsible for deduction of tax

Place : Bangalore Full Name : LAKSHMI NARAYANAN N
Date : 31/05/2012 Designation : ASSOCIATE VICE PRESIDENT - FINANCE

This Form 16 is signed using Digital Signature. Please see Page1.

ASHISH KULKARNI-3853 4
 Income Tax deduction details for the Financial year 2011 - 2012
ANNEXURE-B
1. Name and Address of the Employer COLLABERA SOLUTIONS PRIVATE LIMITED
Tower D, 6th Floor, Subramanya Arcade
#12, Bannerghatta Road
Bangalore-560076
2. TAN of the employer BLRP01490G
3. Name of the employee with employee No ASHISH KULKARNI
3853
4. PAN of the employee AURPA7835L

DETAILS OF TAX DEDUCTED AND DEPOSITED IN THE CENTRAL GOVERNMENT ACCOUNT THROUGH CHALLAN

Sl. Tax Deposited in respect Challan identification number (CIN)

No of the employee (Rs.) BSR Code of the Bank Branch Date on which tax deposited Challan Serial Number
(dd/mm/yyyy)
1 1917.00 6360218 07/05/2011 00309
2 1917.00 6360218 07/06/2011 03246
3 2207.00 6360218 07/07/2011 04048
4 1917.00 6360218 05/08/2011 25010
5 1918.00 6360218 07/09/2011 25028
6 1917.00 6360181 07/10/2011 00037
7 1918.00 6360218 04/11/2011 25024
8 2253.00 6360218 07/12/2011 25055
9 2082.00 6360218 06/01/2012 25078
Total 18046.00

ASHISH KULKARNI-3853 5