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191. Wealth statement under section 58.- The Statement to be furnished under section 58 shall be in the following form and shall be verified in the manner indicated therein, namely:-
WEALTH STATEMENT UNDER SECTION 58
OF THE INCOME TAX
ORDINANCE 1979, AS ON------------
(See Notes 1, 2, and 3)
Name:
National Tax No:
Residential Address:
Business Address:
1. BUSINESS CAPITAL (See Note 4):
Names(s) of Business________________________________________________________________
Capital amount (s)___________________________________________________________________
Total for Part I_______________________
2. NON-AGRICULTURAL PROPERTY:
Serial No. (1) |
Location and Identification |
Cost including legal Charges, if any (3) |
Total for Part 2____________________________________
3. AGRICULTURAL PROPERTY:
(a) Land
Serial No. (1) |
Location and identification No. of Land (2) |
Main Crop (3) |
Cost including legal Charges, if any (4) |
Total Cost________________________
(b) Other Property:
| (i) Agricultural Equipment (See Note 5) | ________________________________ |
| (ii) Live stock | ________________________________ |
| (iii) Description | ________________________________ |
| (iv) Number | ________________________________ |
| (v) Seeds/Seedings | ________________________________ |
| (vi) Fertilizer | ________________________________ |
| (vii) Any Other | ________________________________ |
| Total for Part 3 | ________________________________ |
4. INVESTMENTS (at cost including brokerage)
| (a) Stocks and shares (see Note 6) | _____________________________ |
| (b) Debentures (See Note 6) | _____________________________ |
| (c) National Investment (Unit) Trust/ICP Certificates etc. | _____________________________ |
| (d) National Savings Schemes Certificates or deposits. | _____________________________ |
| (e) Mortgages | ____________________________ |
| (f) Unsecured loans granted. | _____________________________ |
| (g) Any other | _____________________________ |
| Total for part 4 | _____________________________ |
5. MOTOR VEHICLES (at cost)
| Make and types ______ Reg. No._________ | _________________________________ |
6. JEWELLERY (at cost)
| Description | _________________________________ |
| Weight | _________________________________ |
7. FURNITURE AND FITTINGS (RESIDENCE)
8. CASH OUTSIDE BUSINESS.
| (a) Notes and Coins. | _________________________________ |
| (b) Current Accounts | _________________________________ |
| (c) Deposited Accounts. | _________________________________ |
| (d) Savings Accounts. | _________________________________ |
| (e) Post Office Accounts | _________________________________ |
| (f) Life Insurance Premia actually paid | _________________________________ |
| (g) Deposit receipts or cash certificates | _________________________________ |
| (h) Employers Contribution to Provident Fund | _________________________________ |
| (i) Other deposits | _________________________________ |
| Total for Part 8 | _________________________________ |
9. ANY OTHER ASSETS , IF ANY, STANDING IN THE
NAME OF SPOUSE, MINOR CHILDREN OR DEPENDENTS
(See Note 7).
| Total
assets _______________________________ |
10. BUSINESS LIABILITIES (See Note 4)
| Name(s) of business | ________________ |
| Capital Amount(s) | ________________ |
11. LIABILITIES OUTSIDE THE ACCOUNT BOOKS:
A. Personal Liabilities:
| (a) Mortgages secured on property or land | _________________________________ |
| (b) Unsecured loans owing | _________________________________ |
| (c) Bank Overdraft/loan | _________________________________ |
| (d) Amounts due under Hire Purchase | _________________________________ |
| Agreements. (See Note 8) | _________________________________ |
| (e) Other debts due. | _________________________________ |
B. Liabilities of the spouse, minor children and dependents.
| Total | _________________________________ |
| Liabilities | _________________________________ |
| Total net worth | _________________________________ |
12. PERSONAL EXPENDITURE (See Note 9)
| Number of family members | (a) Adults___________________ |
| (b) Children__________________ |
Personal and other expenses incurred |
Details |
Amounts |
Remarks |
(a) Expenses in the books of accounts.
(b) Expenses outside the books of accounts.
13. ASSETS IF ANY, TRANSFERRED TO ANY PERSON (See Note 9).
I hereby declare that, to the best of my knowledge and belief, the above statement of
the assets and liabilities of myself, my wife or wives, my minor children and dependents
as on-------and of my personal expenditure for the year ended on----------are complete and
correct.
| Notes | Signed________________ |
Form |
Charge |
|
(i) IT-11 |
Form of return of total income. | Rupees Five each. |
(ii) IT-10 |
Form of Wealth statement under section 58 of the Income Tax Ordinance, 1979. | Rupees Five each. |
| National Tax No: | Income Tax Office |
| Date____________________ |
| Date 19------------ | Deputy Commissioner of Income Tax, |
| Place | Circle----------------------------------- |
DETAILS OF TAX
(Rs.)
| Income Tax | -- |
-- |
-- |
-- |
-- |
| Super tax | -- |
-- |
-- |
-- |
-- |
| Surcharge | -- |
-- |
-- |
-- |
-- |
| Surcharge (Jewellers) | -- |
-- |
-- |
-- |
-- |
| Additional tax | -- |
-- |
-- |
-- |
-- |
| Total | _______ |
______ |
|||
NOTICE OF DEMAND UNDER SECTION 85 OF THE INCOME
TAX ORDINANCE, 1979
(PENALTY)
| National Tax No: | Income Tax Office |
| Date . | |
| Assessment Year .. |
| Date 19.......... | Deputy commissioner of Income Tax, |
| Place | Circle |
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