WEALTH STATEMENT UNDER SECTION 116 OF THE INCOME

TAX ORDINANCE, 2001

Tax Year 2008 W

(Please mark ü in the relevant box/Use additional sheets where necessary) LTU/RTO/MTU/Zone Code

Circle Code

NTN

CNIC
(For Individuals only)

Particulars/Description of assets and liabilities Code Amount (Rs.)

1. Business Capital (indicate name of business)

821311
(a)

821321
(b)

2. Non-Agricultural Property (indicate location & identification)

711111
(a)

711121
(b)

711131
(c)

711141
(d)

3. Agricultural Property - Land (indicate location & identification)

711211
(a)

711221
(b)

711231
(c)

4. Agricultural Property (Specify equipment, live stock, seeds, seedlings, fertilizer, etc.)

712111
(a)

712121
(b)

5. Investments (Specify stocks, shares, debentures, Unit certificates, other certificates,

deposits and certificates of National Saving Schemes, mortgages, loans, advances, etc.)

712611
(a)

712621
(b)
 712631
(c)

6. Loans and Advances, etc.

712641
(a)

712651
(b)

7. Motor vehicles (Indicate make, model and registration number)

712211
(a)

712221
(b)

8. Jewellery (Indicate description and weight)

712411

9. Furniture and Fittings - Residence

712311

10. Cash & Bank Balances

712811
(a) Non-business cash in hand

(b) Non-business bank balances, etc. in current/ deposit/ savings accounts or any other deposit)

Name of bank, etc. Branch and address Account Number, etc.

712711
(i)

712721
(ii)

712731
(iii)

712741
(iv)

11. Any Other Assets

712661
(a) Accumulated balance of life insurance premium actually paid

712671
(b) Accumulated balance of employees contribution to a Provident fund or any other fund

712681
(c)

712691
(d)

12. Assets, if any, standing in the name of spouse, minor children & other dependents*

713111
(a)
 713121
(b)

713131
(c)

719999
13. Total Assets [ Sum(1 to 12) ]

For Assistance - Call Help line Center at Tele: 0800-00-227, 051-111-227-227 and E-mail at helpline@cbr.gov.pk
 Tax Year 2008 W

LTU/RTO/MTU/Zone Code

Circle Code

NTN

CNIC
(For Individuals Only)

Particulars/Description of assets and liabilities Code Amount (Rs.)

14. Liabilities

(a) Business Capital - Overdrawn (indicate name of business)

821331
(i)

821341
(ii)

(b) Others (including mortgages, loans, overdrafts, advances, borrowings,

amounts due under hire purchase agreement or any other debt)

721111
(i)

721211
(ii)

729999
15. Total Liabilities [ sum( 14(a) to 14(b) ]

799999
16. Net Wealth of the current year [13 minus 15]

749999
17. Annual personal expenses.

740000
18. Number of family members and dependents Adults Minors

19. Assets, if any, transferred to any person

714111
(a)

714121
(b)

714131
(c)

Verification
I, , holder of CNIC No. in my
capacity as Self / Representative* of Taxpayer named above, do hereby solemnly declare that to the best of my knowl
information given in this statement of the assets and liabilities of myself, my spouse or spouses, minor children and other
___________________ and of my personal expenditure for the year ended _____________________ are correct and complete
the provisions of the Income Tax Ordinance, 2001 and Income Tax Rules, 2002.
(The alternative in the verification, which is not applicable, should be scored out.)
* As defined in section 172 of the Income Tax Ordinance, 2001
the provisions of the Income Tax Ordinance, 2001 and Income Tax Rules, 2002.
(The alternative in the verification, which is not applicable, should be scored out.)
* As defined in section 172 of the Income Tax Ordinance, 2001

Date (dd/mm/yyyy) Signature

(Notes on reverse)

Notes

1. If the space provided in the form is found to be inadequate, additional sheet or sheets may be used.

2. All assets should be valued at cost.

3. If any exact figure cannot be inserted, an estimate should be made, mark it clearly "ESTIMATE".

4. (a) If balance sheet in respect of any business has bee n submitted to the Department, the entry of "Business Ca pital" should
balance on capital, current and loan accounts as shown in those Balance Sheets on the specified date, if such net amount
balance.

(b) Where no Balance Sheet has been submitted, the assessed should list, on a separate sheet of paper attached to this form
liabilities of the business on the specified date. Th e excess of assets listed, should be entered as "Business Capital".

(c) If the net balance at (a) above is a debit balance, it should be included in liabilities.

5. Agricultural equipment, such as irrigation pumps and tube-wells etc., should be detailed at cost with description.

6. Give details of stocks, shares and debentures, e.g., number, face value, name of the company and type.

7. Give details of assets of the spouse, minor children and other dependents and state whether such asset was transferred directly
spouse or minor children or other dependents or was acquired by them with funds provided by you.

8. In the case of assets acquired under a Hire Purchase agreement, the total price should be shown under the appropriate head in
the balance amount due should be shown under the liabilities.

9. Where the statement is being field for the first time or covers more than one tax year, separate re-conciliation of the increase/(de
and of the sources and applications should be provided for each year.

For Assistance - Call Help line Center at Tele: 0800-00-227, 051-111-227-227 and E-mail at helpline@cbr.gov.pk
 W1/1

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e best of my knowledge and belief the

children and other dependents as on
rrect and complete in accordance with
ss Capital" should consist of the net
if such net amount is a credit

tached to this form, the assets and

ness Capital".

s transferred directly or indirectly to the

appropriate head in the assets and

n of the increase/(decrease) in wealth

gov.pk