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 : DCB BANK LTD

9th Floor, Tower A, Peninsula Business Park,

Senapati Bapat Marg, Lower Parel,
Mumbai - 400013

2. TAN : MUMD04526E

3. TDS Assessment Range of the employer : As per CIT TDS

4. Name, designation and Permanent Account Number MURALI PAGADALA

or Aadhaar Number of employee : SENIOR PORTFOLIO MANAGER

ALUPM4805C

5. Is the employee a director or a person with NO

substantial interest in the company (where the
employer is a company):
6. Income under the head “Salaries” of the employee 1,451,820.00
(other than from perquisites) :

7. Financial year 2023-2024

8. Valuation of Perquisites 41,968

Sr. Nature of perquisite Value of perquisite Amount, if any, Amount of taxable

No. (See Rule 3) as per rules recovered from the perquisite
(Rs.) employee (Rs.) (Rs.)

1 Accommodation 0 0 0

2 Cars/Other automotive 0 0 0

3 Sweeper gardener watchman or personal attendant 0 0 0

4 Gas,Electricity,Water 0 0 0

5 Interest Free or Concessional Loans 41968 0 41968

6 Holiday Expenses 0 0 0

7 Free And Concessional travel 0 0 0

8 Free Meals 0 0 0

9 Free Education 0 0 0

10 Gifts,Vouchers etc. 0 0 0

11 Credit card expense 0 0 0

12 Club Expenses 0 0 0

13 Use of movable assets by employees 0 0 0

14 Transfer of assets to employees 0 0 0

15 Value of any other benefit/amenity/service/privilege 0 0 0

16 Stock options allotted or transferred by employer being an eligible 0 0 0

start-up referred to in section
17 Stock options (non-qualified options) other than ESOP in col 16 0 0 0
above
18 Contribution by employer to fund and scheme taxable under section 0 0 0
17(2)(vii)
19 Annual accretion by way of interest dividend etc to the balance at 0 0 0
the credit of fund and scheme ref
20 Other benefits or amenities 0 0 0

22 Tax paid by employer 0 0 0

 Total value of perquisites 41,968.00 0.00 41,968.00
Total value of profits in lieu of salary as per section 17(3)

(9) Details of Tax,--

(a) Tax deducted from salary of the employee under section 192(1) 144,308.00
(b) Tax paid by employer on behalf of the employee under section 192(1A) 0.00
(c) Total tax paid 144,308.00
(d) Date of payment into Government treasury As per Form No. 16

DECLARATION BY EMPLOYER

I ASHU RAJIV SAWHNEY Son/ daughter of GOBIND RAM SAWHNEY working as SENIOR VICE PRESIDENT HR do hereby declare on
behalf of DCB BANK 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 value of each perquisite are in accordance with section 17 and rules framed there under and
that such information is true and correct.

Place : Mumbai Full Name : ASHU RAJIV SAWHNEY

Date : 13-JUN-2024 Designation : SENIOR VICE PRESIDENT HR
DCB BANK LTD
9th Floor, Tower A, Peninsula Business Park,
Senapati Bapat Marg, Lower Parel,
Name MURALI PAGADALA
Desg. SENIOR PORTFOLIO MANAGER
Particulars of Income
ANNEXURE : GROSS SALARY DETAILS
Sr. No. Description Gross Amount Non - Taxable Total Amount
1=(A+B) Portion U/s10 3=(1-2)
(2)
1 BALANCE CONSOLIDATED ALL 509484 0 509484
2 BASIC SALARY 380100 0 380100
3 COLLECTION PERF PAYOUT II 133240 0 133240
4 COLLECTION PERF PAYOUT III 109305 0 109305
5 EDUCATION ALLOWANCE 2400 0 2400
6 HOUSE RENT ALLOW 190056 0 190056
7 LEAVE ENCASHMENT III 6160 0 6160
8 LEAVE TRAVEL CONCESSION ANN 31675 0 31675
9 MEAL VOUCHER TAXABLE 30000 0 30000
10 STATUTORY BONUS 50400 0 50400
11 TELEPHONE ALLOWANCE 9000 0 9000
12 Total Income From Salary 1451820 0 1451820
13 House Perq. 0 0 0
14 Car Perquisite 0 0 0
15 Loan Perq. 0 0 0
16 Other Perq. 41968 0 41968
17 Other Claims 0 0 0
18 Retirement Fund Perquisite 0 0 0
19 Taxable Income From (FORM 12B) 0 0 0
20 Total 1493788 0 1493788

Note :- For Employee Reference only

Signature Not Verified

Digitally signed by Ashu Rajiv Sawhney
Date: 2024.06.15 15:34:45 IST
Reason:
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