FORM No.

12BA
Employee Code AE701 [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 employer Arctern Consulting Private Limited
#34, 4th B Cross, 5th Block,
Koramangala Industrial Layout,
Bangalore 560095
2. TAN BLRA06532B
3. TDS Assessment Range of the employer SALARY

4. Name, designation and PAN of the employee SAVAN GURUDAS ANVEKAR

DEVELOPMENT MANAGER
AAOPA9108A
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 Rs. 564828.00
(other than from perquisites)
7. Financial year 2009-2010
8. Valuation of Perquisites
S.No Nature of perquisites Value of perquisite Amount,if any, recovered Amount of perquisite
(see rule 3) as per rules (Rs.) from the employee (Rs.) chargeable to tax
Col(3)-Col(4) (Rs.)
(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 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 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 Stock options(non-qualified options) 0.00 0.00 0.00
17 a) Other benefits or amenities 0.00 0.00 0.00
b) LTA 0.00 0.00 0.00
c) Medical 0.00 0.00 0.00
18 Total value of perquisites 0.00 0.00 0.00
19 Total value of profits in lieu of salary
as per section 17(3) 0.00 0.00 0.00
9. Details of tax -
(a) Tax deducted from salary of the employee u/s 192(1) 72893.00
(b) Tax paid by employer on behalf of the employee u/s 192 (1A) 0.00
(c) Total tax paid 72893.00
(d) Date of payment into Government treasury As per Form16
DECLARATION BY EMPLOYER
I, Suresh Anandham, son of Late. Sivathanu Pillai K, working as Corporate Controller, do hereby declare on behalf of
Arctern Consulting 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.

BANGALORE
Place :........................................................................
Date : .....................................
30/04/2010 ...................................................................................................
Signature of the person responsible for deduction of tax
Full Name : .............................................................................
Suresh Anandham
Designation :.............................................................................
Corporate Controller

E-LOCK EVALUATION SIGNATURE

Signer: SURESH S ANANDHAM 797781

Date: Friday, April 30, 2010 10:02 AM
Location: Bangalore
Reason:
IDF136481002160138
 FORM No. 16 Original
[See rule 31(1)(a)] Sl.No. 1-425
Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source
from income chargeable under the head "Salaries"
Name and address of the Employer Name and designation of the Employee
Arctern Consulting Private Limited AE701
#34, 4th B Cross, 5th Block, Koramangala Industrial Layout, SAVAN GURUDAS ANVEKAR
Bangalore 560095 DEVELOPMENT MANAGER

PAN No. of the Deductor TAN No. of the Deductor PAN No. of Employee
AAECA9113F BLRA06532B AAOPA9108A
Acknowledgement Nos. of all quarterly statements of TDS under sub-section
Period Assessment year
(3) of section 200 as provided by TIN Facilitation Centre or NSDL web-site
Quarter Acknowledgement No. From To
I 071990400031885
II 071990400044220
20/10/2009 31/03/2010 2010-2011
III 071990400050214
IV YET TO FURNISH

DETAILS OF SALARY PAID AND ANY OTHER INCOME AND TAX DEDUCTED
1. Gross Salary
(a) Salary as per provisions contained in section 17(1) Rs. 564828.00
(b) Value of perquisites u/s 17(2)(as per Form No.12BA, wherever applicable) Rs. 0.00
(c) Profits in lieu of salary under section 17(3)
(as per Form No.12BA, wherever applicable) Rs. 0.00
(d) Total Rs. 564828.00
2. Less : Allowance to the extent exempt u/s 10
Allowance Rs.
i Conveyance Exempt U/S 10 4025.00 Rs. 4025.00
3. Balance (1 - 2) Rs. 560803.00
4. Deductions
(a) Entertainment allowance Rs. 0.00
(b) Tax on employment Rs. 1000.00
5. Aggregate of 4 [(a) and (b)] Rs. 1000.00
6. Income chargeable under the head 'Salaries' (3 - 5) Rs. 559803.00
7. Add :Any other income reported by the employee Rs. 0.00

8. Gross total income (6 + 7) Rs. 559803.00

9. Deductions under Chapter VI-A
(A) Section 80C,80CCC and 80CCD Gross Amount Deductible Amount
(a) Section 80 C
i PF Rs. 3900.00
(b) Section 80CCC Rs. 0.00
(c) Section 80CCD Rs. 0.00
Rs. 3900.00 Rs. 3900.00
Note : 1. aggregate amount deductible under section 80C shall not exceed one lakh rupees
2. aggregate amount deductible under the three sections, i.e.,80C, 80CCC and 80CCD, shall not exceed one lakh rupees
(B) other sections (eg., 80E, 80G, etc.) under Chapter VI-A Gross Amount Qualifying Amount Deductible Amount
10. Aggregate of deductible amounts under Chapter VI-A Rs. 3900.00
11. Total Income (8 - 10) Rs. 555900.00
12. Tax on total Income Rs. 70770.00
13. Surcharge(on tax computed at S.NO.12) Rs. 0.00
14. Education Cess @ 3% on (tax at S.NO.12
plus Surcharge at S.NO.13) Rs. 2123.00
15. Tax payable (12+13+14) Rs. 72893.00
16. Relief under section 89 (attach details) Rs. 0.00
17. Tax payable (15 - 16) Rs. 72893.00
18. Less : (a) Tax deducted at source u/s 192(1) Rs. 72893.00
(b) Tax paid by the employer on behalf of the
employee u/s 192(1A) on perquisites u/s 17(2) Rs. 0.00
(c) Tax deducted from previous employment Rs. 0.00 Rs. 72893.00
19. Tax payable / refundable ( 17- 18 ) Rs. 0.00

E-LOCK EVALUATION SIGNATURE

Signer: SURESH S ANANDHAM 797781

Date: Friday, April 30, 2010 10:02 AM
Location: Bangalore
Reason:
IDF136481002160138
AE701 SAVAN GURUDAS ANVEKAR
DETAILS OF TAX DEDUCTED AND DEPOSITED INTO CENTRAL GOVERNMENT ACCOUNT
(The Employer is to provide transaction-wise details of tax deducted and deposited)

S.No. TDS Surcharge Education Total Tax Cheque/DD BSR Code of Date On which Transfer
Cess Deposited No.(If any) Bank Branch Tax Deposited Voucher/Challan
Rs. Rs. Rs.
Rs. (dd/mm/yy) Identification No.
1 37688.00 0.00 1131.00 38819.00 E TDS 0510308 08/03/2010 00184
2 33082.00 0.00 992.00 34074.00 E TDS 0510308 06/04/2010 00200

70770.00 0.00 2123.00 72893.00

I, Suresh Anandham, son of Late. Sivathanu Pillai K, working in the capacity of Corporate Controller, do hereby certify
that a sum of Rs.72893.00 (Rupees Seventy Two Thousand Eight Hundred and Ninety Three 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.

Place :........................................................................
BANGALORE
.....................................................................................................
Signature of the person responsible for deduction of tax
Date : .....................................
30/04/2010
Full Name : ..............................................................................
Suresh Anandham
Designation :..............................................................................
Corporate Controller
Tax Deducted to date 72893.00
Tax Deducted to date by previous employer(s) 0.00
Total: 72893.00

E-LOCK EVALUATION SIGNATURE

Signer: SURESH S ANANDHAM 797781

Date: Friday, April 30, 2010 10:02 AM
Location: Bangalore
Reason:
IDF136481002160138