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 paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. UMBIOGA Last updated on 02-Jun-2024

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen

COFOUNDER TECH PRIVATE LIMITED

Plot No 72 & 73, BANGALORE SOUTH,
DEVASHISH RAJ
BAGALORE - 560066
N 37/8, RENUSAGAR, DUDHI, SONEBHADRA - 231218 Uttar
Karnataka
Pradesh

PAN of the Employee Reference No. provided by the

PAN of the Deductor TAN of the Deductor Employee/Specified senior Employer/Pension Payment order no. provided
citizen by the Employer (If available)

AALCC0022G BLRC24768C DNEPR9180N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2024-25 01-Dec-2023 31-Mar-2024
Ganganagar, Bangalore - 560032

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 FXCPZYRI 41667.00 0.00 0.00

Q4 FXCTDOVM 125001.00 0.00 0.00
Total (Rs.) 166668.00 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 - 06-01-2024 - F
2 0.00 - 06-02-2024 - F
3 0.00 - 06-03-2024 - F
4 0.00 - 15-04-2024 - F
Total (Rs.) 0.00

Page 1 of 2
 Certificate Number: UMBIOGA TAN of Employer: BLRC24768C PAN of Employee: DNEPR9180N Assessment Year: 2024-25

Verification

I, PRATEEK ANAND, son / daughter of RAM JIWAN SINGH working in the capacity of DIRECTOR (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 BANGALORE

Date 29-Jun-2024 (Signature of person responsible for deduction of Tax)

Designation: DIRECTOR Full Name:PRATEEK ANAND

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 paid to an employee under section 192 or pension/interest income
of specified senior citizen under section 194P

Certificate No. UMBIOGA Last updated on 02-Jun-2024

Name and address of the Employer/Specified Bank Name and address of the Employee/Specified senior citizen

COFOUNDER TECH PRIVATE LIMITED

Plot No 72 & 73, BANGALORE SOUTH,
DEVASHISH RAJ
BAGALORE - 560066
N 37/8, RENUSAGAR, DUDHI, SONEBHADRA - 231218 Uttar
Karnataka
Pradesh

PAN of the Deductor TAN of the Deductor PAN of the Employee/Specified senior citizen

AALCC0022G BLRC24768C DNEPR9180N

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 59, H.M.T. Bhawan, 4th Floor, Bellary Road , 2024-25 01-Dec-2023 31-Mar-2024
Ganganagar, Bangalore - 560032

Annexure - I

Details of Salary Paid and any other income and tax deducted

A Whether opting out of taxation u/s 115BAC(1A)? No

1. Gross Salary Rs. Rs.

(a) Salary as per provisions contained in section 17(1) 166668.00

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 166668.00

(e) Reported total amount of salary received from other employer(s) 110298.00

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) 0.00

(f) Other special allowances under section 10(14) 0.00

Page 1 of 4
Certificate Number: UMBIOGA TAN of Employer: BLRC24768C PAN of Employee: DNEPR9180N Assessment Year: 2024-25

Amount of any other exemption under section 10

(g) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(h) Total amount of any other exemption under section 10 0.00

Total amount of exemption claimed under section 10

(i) 0.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(f)+2(h)]

Total amount of salary received from current employer

3. 166668.00
[1(d)-2(i)]
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) 0.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 50000.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 226966.00

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) 226966.00

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

Deduction in respect of life insurance premia, contributions to

(a) 0.00 0.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) 0.00 0.00
under section 80CCC
Deduction in respect of contribution by taxpayer to pension
(c) 0.00 0.00
scheme under section 80CCD (1)

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 0.00 0.00

Deductions in respect of amount paid/deposited to notified

(e) 0.00 0.00
pension scheme under section 80CCD (1B)
Deduction in respect of contribution by Employer to pension
(f) 0.00 0.00
scheme under section 80CCD (2)
Deduction in respect of health insurance premia under section
(g) 0.00 0.00
80D

Page 2 of 4
 Certificate Number: UMBIOGA TAN of Employer: BLRC24768C PAN of Employee: DNEPR9180N Assessment Year: 2024-25

Deduction in respect of interest on loan taken for higher

(h) 0.00 0.00
education under section 80E
Deduction in respect of contribution by the employee to Agnipath
(i) 0.00 0.00
Scheme under section 80CCH
Deduction in respect of contribution by the Central Government
(j) 0.00 0.00
to Agnipath Scheme under section 80CCH
Gross Qualifying Deductible
Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(k) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(l) 0.00 0.00 0.00
under section 80TTA

Amount Deductible under any other provision (s) of Chapter VI-A

(m) [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

(n) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 0.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(k)+10(l)+10(n)]

12. Total taxable income (9-11) 226966.00

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, PRATEEK ANAND, son/daughter of RAM JIWAN SINGH .Working in the capacity of DIRECTOR (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 BANGALORE (Signature of person responsible for deduction of tax)

Full
Date 29-Jun-2024 PRATEEK ANAND
Name:

Page 3 of 4
 Certificate Number: UMBIOGA TAN of Employer: BLRC24768C PAN of Employee: DNEPR9180N Assessment Year: 2024-25

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.

BANGALORE (Signature of person responsible for deduction of

Place
tax)
Full
Date 29-Jun-2024 PRATEEK ANAND
Name:

Page 4 of 4
 Annexure B
Employee Name PAN No. of the Employee
Devashish Raj - CFT-007 DNEPR9180N

2. (f) Break up for 'Amount of any other exemption under section 10' to be filled in the table below
Amount of any other
Sl.
exemption under section 10 Gross Amount Qualifying Amount Deductible Amount
No.
Rs. Rs. Rs. Rs.

10(k). Break up for 'Amount deductible under any other provision(s) of Chapter VIA' to be filled in the table below
Amount deductible under any
Sl. other provision(s) of Chapter
No. VIA Gross Amount Qualifying Amount Deductible Amount
Rs. Rs. Rs. Rs.

Signature Not Verified

Place:
Date:
Banglore
31-May-2024
.
Digitally signed by PRATEEK ANAND
Date: 2024.06.29 18:20:02 IST
Reason:
Location: Banglore
(Signature of the person responsible for deduction of tax)
Full Name: Prateek Anand
 PART B Verification Form
Employee Name PAN No. of the Employee
Devashish Raj - CFT-007 DNEPR9180N
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. 166,668.00

(b) Value of perquisites under section 17(2) (as per Form No.12BA, Rs. 0.00
wherever applicable)
(c) Profits in lieu of salary under section 17(3) (as per Form No.12BA, Rs. 0.00
wherever applicable)
(d) Total Rs. 166,668.00
(e) Reported total amount of salary received from other employer(s) Rs. 110,298.00
2. Less : Allowance to the extent exempt under section 10
(g) Total amount of any other exemption under section 10 Rs. 0.00
(h) Total amount of exemption claimed under section 10 Rs. 0.00
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]
3. Total amount of salary received from current employer [1(d)-2(h)] Rs. 166,668.00
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) Rs. 50,000.00
(b) Entertainment allowance under section 16(ii) Rs. 0.00
(c) Tax on employment under section 16(iii) Rs. 0.00
5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] Rs. 50,000.00
6. Income chargeable under the head "Salaries" [(3+1(e)-5] Rs. 226,966.00
7. Add: Any other income reported by the employee under as per section 192 (2B)
(a) Income (or admissible loss) from house property reported by Rs. 0.00
employee offered for TDS
(b) Income under the head Other Sources offered for TDS Rs. 0.00

8. Total amount of other income reported by the employee Rs. 0.00

[7(a)+7(b)]
9. Gross total income (6 + 8) Rs. 226,966.00
10. Deductions under Chapter VI-A
Gross Amount Deductible Amount
(a) Deduction in respect of life insurance premia, contributions to Rs. 0.00 Rs. 0.00
provident fund etc. under section 80C
(b) Deduction in respect of contribution to certain pension funds under Rs. 0.00 Rs. 0.00
section 80CCC
(c) Deduction in respect of contribution by taxpayer to pension scheme Rs. 0.00 Rs. 0.00
under section 80CCD (1)
(d) Total deduction under section 80C, 80CCC and 80CCD(1) Rs. 0.00 Rs. 0.00
(e) Deductions in respect of amount paid/deposited to notified pension Rs. 0.00 Rs. 0.00
scheme under section 80CCD (1B)
(f) Deduction in respect of contribution by Employer to pension scheme Rs. 0.00 Rs. 0.00
under section 80CCD (2)
(g) Deduction in respect of health insurance premia under section 80D Rs. 0.00 Rs. 0.00
(h) Deduction in respect of interest on loan taken for higher education under Rs. 0.00 Rs. 0.00
section 80E
Gross Amount Qualifying Amount Deductible Amount
(i) Total Deduction in respect of donations to certain funds, charitable Rs. 0.00 Rs. 0.00 Rs. 0.00
institutions, etc. under section 80G
(j) Deduction in respect of interest on deposits in savings account under Rs. 0.00 Rs. 0.00 Rs. 0.00
section 80TTA
(k) Amount deductible under any other provision(s) of Chapter VI-A
(l) Total of amount deductible under any other provision(s) of Chapter VI-A Rs. Rs. Rs.
11. Aggregate of deductible amount under Chapter VI-A Rs. 0.00
[10(a)+10(b)+10(c)+10(d)+10(e)+10(f)+10(g)+10(h)+10(i)
10(j)+10(l)]
12. Total taxable income (9 - 11) Rs. 226,966.00
13. Tax on total income Rs. 0.00
14. Rebate under section 87A, if applicable Rs. 0.00
15. Surcharge, wherever applicable Rs. 0.00
16. Health and education cess Rs. 0.00
17. Tax payable (13+15+16-14) Rs. 0.00
18. Less: Relief under section 89 (attach details) Rs. 0.00
19. Net Tax payable (17-18) Rs. 0.00

Verification
I, Prateek Anand , son/daughter of Ram Jawan Singh working in the capacity of Director (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.

Signature Not Verified

Place:
Date:
Banglore
31-May-2024
.
Digitally signed by PRATEEK ANAND
Date: 2024.06.29 18:20:02 IST
Reason:
Location: Banglore
(Signature of the person responsible for deduction of tax)
Full Name: Prateek Anand
 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 : CoFounder Tech Private Limited

Goodwork Coworks, 3rd floor, Akshay Tech park, Plot No 72 & 73 EPIP
Zone, Whitefield Bangalore, EPIP, Bangalore-560066, Karnataka
2) TAN : BLRC24768C
3) TDS assessment range of the employer : Bengalore
4) Name, designation and PAN of employee : Devashish Raj - CFT-007
Product Operation Associate
DNEPR9180N
5) Is the employee a director or a person with substantial interest in the company : No
(where the employer is a company)
6) Income under the head "SALARIES" of the employee (other than from perquisites) : 166,668.00
7) Financial year : 2023 - 2024
8) Valuation of perquisites

Sl Nature of perquisite Value of Amount, if any Amount of perquisite

No (see rule 3) perquisite as per recovered from chargeable to tax
rules (Rs.) the employee (Rs.) (3) - (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 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 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 allotted /transferred by employer being an eligible start-up referred to 0.00 0.00 0.00
in section 80-IAC.
17 Stock options (non-qualified options) other than ESOP in col 16 above. 0.00 0.00 0.00
18 Contribution by the employer to fund and scheme taxable under section 17(2)(vii). 0.00 0.00 0.00
19 Annual accretion by way of interest, dividend, etc. to the balance at the credit of 0.00 0.00 0.00
fund and scheme referred to in section 17(2)(vii) and taxable under section 17(2)
(viia).
20 Other benefits or amenities 0.00 0.00 0.00
21 Total value of perquisites 0.00 0.00 0.00
22 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) : 0.00

(b) Tax paid by employer on behalf of the employee u/s 192(1A) : 0.00
(c) Total tax paid : 0.00
(d) Date of payment into Government treasury :
DECLARATION BY EMPLOYER
I, Prateek Anand , son/daughter of Ram Jawan Singh working in the capacity of Director do hereby declare on behalf of CoFounder Tech 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 Not Verified

.
Digitally signed by PRATEEK ANAND
Date: 2024.06.29 18:20:02 IST
Reason:
Location: Banglore
Signature of the person responsible for deduction of tax

Place: Banglore Full Name: Prateek Anand

Date: 31-May-2024 Designation: Director