Form A
Form A
Form A
19 -
VALUATION DATE
3 1 - 3 19
- 19
STATUS
TELEPHON PIN
Please indicate :
y
o
u
a
s
s
e
s
s
e
d
t
o
i
n
c
o
m
e
t
a
x
?
( H
d a
) v Yes/No
e Yes/No
y
o
u
f
i
l
e
d
r
e
t
u
r
n
o
f
i
n
c
o
m
e
/
g
i
f
t
f
o
r
t
h
e
s
a
m
e
a
s
s
e
s
s
m
e
n
t
y
e
a
r
?
(
R
(
i
i
)
R
I
f
a
n
s
w
e
r
t
o
(
d
)
i
s
Y
e
s
,
o
n
w
h
a
t
d
a
t
e
(
s
)
a
n
d
w
i
t
h
w
h
i
c
h
W
a
r
d
/
C
i
r
c
l
e
/
R
a
n
g
e
(
i
)
R
(
i
i
)
R
( I Yes/No
e s
)
t
h
i
s
r
e
t
u
r
n
b
e
i
n
g
f
i
l
e
d
a
s
l
e
g
a
l
r
e
p
r
e
s
e
n
t
a
t
i
v
e
?
( I
f n Yes/No
)
t Yes/No
h
e
c
a
s
e
o
f
H
i
n
d
u
u
n
d
i
v
i
d
e
d
f
a
m
i
l
y
:
-
(
i
)
D
(
i
i
)
H
( H Yes/No
g a
) v
e
a
n
y
a
s
s
e
t
s
,
w
h
i
c
h
w
e
r
e
s
h
o
w
n
i
n
t
h
e
r
e
t
u
r
n
o
f
t
h
e
n
e
t
w
e
a
l
t
h
f
o
r
t
h
e
i
m
m
e
d
i
a
t
e
l
y
p
r
e
c
e
d
i
n
g
a
s
s
e
s
s
m
e
n
t
y
e
a
r
b
e
e
n
e
x
c
l
u
d
e
d
f
r
o
m
t
h
i
s
r
e
t
u
r
n
?
I
f
a
n
s
w
e
r
t
o
(
g
)
i
s
Y
e
s
,
a
t
t
a
c
h
t
o
t
h
e
R
e
t
u
r
n
p
a
r
t
i
c
u
l
a
r
s
r
e
g
a
r
d
i
n
g
t
h
e
d
a
t
e
a
n
d
m
a
n
n
e
r
o
f
t
h
e
i
r
d
i
s
p
o
s
a
l
a
n
d
t
h
e
c
o
n
s
i
d
e
r
a
t
i
o
n
t
h
e
r
e
f
o
r
i
t
e
m
w
i
s
e
,
i
f
a
n
y
?
( Have you claimed any Double Taxation Relief?
h (a) Under agreement with foreign countries Yes/No
) (b) In respect of country with which no agreement exists? Yes/No
NAME OF THE COUNTRY
PART I
COMPUTAION OF NET WEALTH INCLUDING NET WEALTH OF OHTER PERSONS INCLUDIBLE IN
ASSESSEE’S NET WEALTH ON VALUATION DATE
A. IMMOVABLE PROPERTY
Rs.
Rs.
Rs.
Rs.
3. Less : Exemption
Description Amount
Rs.
Rs.
Rs.
Rs.
4. Total of 3 above Rs.
5. Aggregate value of immovable property held as
assets other than in business or profession (2-4) Rs.
Held as asset of a business or profession
6. Description and situation Value as per Schedule
III
(a) (a)
Rs.
Rs.
Rs.
Rs.
7. Total of amount at 6(b) above
8. Less : Exemption
Description Amount
Rs.
Rs.
Rs.
12.
B. MOVABLE PROPERTY
Held as assets other than in business or profession
1. Description Amount as on valuation date
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs. Total Rs.
(v) Jewellery
(a) Gold
Ornaments Rs.
(b) Silver
Ornaments Rs.
(c) Ornament
made by
platinum or
any other
precious
metal or
nay alloy
thereof Rs.
(d) Precious or
semi-
precious
stones Rs. Total Rs.
Grand total of totals of item s (i) to (v) Rs. Rs.
(vi) Debentures
Name of Face value per unit Total units held Value as per Schedule III
the
company
Quoted Rs. Rs..
Rs. Rs.
Unquoted Rs. Rs.
Rs. Rs. TotalRs.
(vii)Preference shares
Quoted Rs. Rs.
Rs. Rs.
Unquoted Rs. Rs.
Rs. Rs. TotalRs.
(b) A
O
P
Rs.
Rs.
Rs.
Total Rs.
E. STATEMENT OF NOTIFIED ASSETS ON WHICH TH-TAX IS NOT PAYABLE BUT WHICH ARE TO BE
INCLUDED IN NET WEALTH UNDER SECTION 5(2) AND HAVE BEEN SO INCLUDED IN THE ASSETS
SHOWN IN SUB-PARTS B & C ABOVE
1. Description of assets No. and date of Central Government Value
notification granting exemption from
tax
Dep Rs.
osits
with
Cen
tral
Gov
ern
men
t
Deposits with State Governments Rs.
Sec Rs.
uriti
es
of
Cen
tral
Gov
ern
men
t
Sec Rs.
uriti
es
of
Stat
e
Gov
ern
men
ts
Sec Rs.
uriti
es
of
loca
l
auth
oriti
es
2. Total of 1 above Rs.
3. Interest held as a partner or member in the value of assets of the above nature included Rs.
in the net wealth of a firm or AOP
4. Total (2+3) Rs.
F. STATEMENTS OF NET WEALTH LOCATED OUTSIDE INDIA AND INCLUDED IN THE NET WEALTH I.E.
IN THE ASSETS SHOWN IN SUB-PARTS A, B, & C AND IN THE DEBTS SHOWN IN SUB-PART D ABOVE
1. Total value of immovable property by
held as assets other than in business or
profession Rs.
2. Total value of immovable property held
as assets of business or profession Rs.
3. Total value (1+2) Rs.
4. Less: Total value of exemptions Rs.
5. Aggregate value of immovable property
(3-4) Rs.
6. Total value of movable property held as
assets other than in business or profession
Rs.
7. Total value of movable property held as
assets of business or profession Rs.
8. Total value (6+7) Rs.
9. Less: Total value of exemptions Rs.
10. Aggregate value of movable property (8- Rs.
9)
11. Total value of interest held in a firm or
AOP as a partner or member thereof Rs.
12. Less: Total value of of exemptions
13. Agg
rega
te Rs.
valu
e of
inter
est
held
in a
firm
or
AO
P as
a
part
ner
or
me
mbe
r
ther
eof
(11-
12)
14. Aggregate value of assets located outside
India (5+10+13) Rs.
15. Less Rs.
:
Deb
ts
loca
ted
outs
ide
Indi
a
16. Total value of net wealth located outside
India (14-15) Rs.
G. STATEMENT OF NET WEALTH
1. A. Aggregate value of immovable property [Item No. A.II] Rs.
B. Aggregate value of immovable property [Item No. B.2] Rs.
C. Aggregate value of interest held in a firm or AOP as partner or
member there of (Item C.5) Rs.
2. Aggregate value of assets (A+B+C) Rs.
3. Less: Aggregate value of debts (Item D.5) Rs.
4. Net wealth (2-3) Rs.
5. Net wealth (as rounded off to the nearest multiple of hundred rupees)
(in words) Rs.
6. Amount of net wealth included in 2 above being net wealth of any other person Rs.
7. Name and relationship of such
person
PART II
STATEMENT OF TAXES
1. Tax on net wealth Rs.
2. Add Rs.
:
Inte
rest
on
late
filli
ng
of
retu
rn
3. Total tax and interest payable (i.e. 1+2) Rs.
4. Less : Tax and interest, if any, paid on self- Tax Rs. Interest Rs. Total Rs.
assessment [Attach challan(s)]
Date of payment
- 19
Name of the Bank/Branch
PART III
INFORMATION WHERE ASSESSEE IS A PARTNER OR MEMBER OF A FIRM/AOP
PART IV
LIST OF DOUMENTS/STATEMENTS ATTACHED
(a) (d)
(b) (e)
(c) (f)
Verification
I, Son/Daughter/Wife of Shri
[Name in block letters] [Name of father/husband]*
Solemnly declare that to the best of my knowledge and belief, the information given in this return and the annexures
and statements accompanying it is correct and complete, that the amount of net wealth and other particulars shown
are truly stated and related to the valuation date relevant to the assessment year commencing on 1 st April, 19
I further solemnly declare that
*I
the person for and on whose behalf this return is furnished the person in respect of whose net wealth I am
*me either in * my
assessable had no other asset belonging to the said person the said person’s in computing *
my net wealth on the said valuation date.
The said person’s
I further declare that I am competent to make this return and verify it.
Date
Place: Signature
Important:
Before signing the verification, the signatory should satisfy himself that this return is correct and complete in every
respect. Any person making a false statement in this return shall be liable to prosecution under section 35D of the
Wealth-tax Act, 1957 and on conviction be punishable:-
(i) In a case where the tax sought to be evaded exceeds one lakh rupees, with rigorous imprisonment
for term which shall not be less than six months but which may extend to seven years and with
fine:
(ii) In any other case, with rigorous imprisonment for a term which shall not be less than three months
but which may extend to three years and with fine.
Strike out whichever is not applicable.
5 The Permanent Account Number (PAN) given to the taxpayer under the
Income -tax Act, 1961 and Ward/Circle/Range are to be quoted here. If
PAN is not allotted/ obtained, indicate the GIR number, if any. If
neither is given, write NOT ALLOT-TED in the first row of boxes and
mention Wealth-tax Ward/Circle/Range where assessed or assessable in the
lower row of boxes after ascertaining the same from the Public Relation
Officer or the Income-tax Officer or at the Receipt Counter.
6 For indicating the status, please use following codes
Individual 01
Hindu undivided family 02
Example:If it is the case of an individual, the correct code will be 01.
7 Please use one of the following codes to indicate the residential
status:
Resident 01
Non-resident 02
Resident but not ordinarily resident 03
Relevant provisions are in section 6 of the Income-tax Act, 1961,
8 Write the name using block letters. Surname should be given first. Leave
one box blank after each limb.
Example: Gupta Gauri Shankar.
G U P T A G A U A R I S H A N K A R
5 & Give complete residential and office addresses along with Telephone
Number, if
6 any and Pin Code.
7 Strike out whichever is not applicable. If answer to (a) is in
affirmative, give relevant information in the space provided thereunder.
PARTI
Page 2.44
A.Immovable property.
I Furnish in the given columns the details of all immovable
properties held by the assessee, including agricultural land,
whether located in or outside India, and whether assessable or
exempt under section 5.
II Details of similar assets belonging to any other person but
includible in net wealth of the assessee should be given here.
Such assets are:
i Assets transferred to certain relatives or to other persons
for the benefit of those relatives or assets transferred
under revocable transfer [section 4(1)(a)].
ii Interest of a minor child admitted to the benefits of
partnership in a firm [section 4(1)(b)].
iii Individual property of assessee converted into the property
of Hindu undivided- family after 31-12-1969 [section 4(1A)].
(iv) Moneys gifted by means of book entries [section 4(5A)]
I If the assessee is a member of a co-operative housing society, the
value of any building or flat allotted or leased should also be
included in this sub-part of the Return.
II Each item of immovable property should be listed separately one
below the other. If immovable property consists of any right in
land or building, the nature of the right and the extent thereof
should he clearly stated.
III Value of immovable property should be declared as per rules 1 to
8, 20 and 21 of Schedule III Where the assets are held as assets
of business for which accounts are maintained regularly the
valuation should be done as per rule 14 of this Schedule.
As indicated earlier, where the assets are held as assets of business for
which accounts are maintained regularly, rule 14 of Schedule III will apply
for purposes of valuation. However, details and value of assets falling under
rule 14(2)(a)(iii) of this Schedule in respect of which wealth-tax is not
payable under this Act, should first be shown here and then claimed as exempt
at item No. 8 of this sub-Part.
1 Indicate here the aggregate sum of amounts mentioned at 6(b).
2 Give here the description of immovable properties shown at item No. 6
but excluded under section 2(e) and exempt under sections 5(1) and 6.
The exemptions available are the same as mentioned at item 3 above.
IMPORTANT NOTE.
Please ensure that the claim of exemption in respect of a house mentioned at
SI. No.(iv) of item 3 above is made in respect of one house only, either at
item 3 above or here. Also, the exemption claimed in respect of one house in
this sub-Part, along with claim of exemption in respect of certain movable
assets mentioned in section 5(I A), which are enumerated at SL Nos. (t) to
(xvit) of the second category of exempted movable assets mentioned in item 6
of sub-Part B (refer pages 2.S8-2.60 of these notes), should not exceed rupees
five lakhs. However, this is subject to a few exceptions in certain cases, as
mentioned at pages 2.58-2.60 of these notes. Further, this overall ceiling of
rupees five lakhs imposed by section 5(1 A) would also apply to the
proportionate share of a partner's or member's interest in the movable or
immovable assets of the above nature which are owned by the firm or the AOP
(refer discussion at item 3 of sub-Part C at page 2.63 of these notes).
3 The sum total of exemptions claimed at item No. 8 above should be
indicated here.
4 Indicate here the balance (ie., 7-9).
5 The aggregate value of immovable property (ie., 5 + 10) is to be
indicated here.
Page 2.45
B.Movable property:
I Furnish in the given columns the details of all movable properties
held by the assessee, including those mentioned in section 2(e)
which are not assets for purposes of the Wealth-tax Act, whether
located in India or outside India, whether assessable or exempt
under section 5 and whether wealth-tax is payable on them or not
under section 5(2).
II Details of similar assets belonging to any other person but
includible in the net wealth of the assessee under section 4
should also be given here. Nature of such assets is the same as
mentioned at SI. No. II of sub-Part A of these notes.
III Value of movable property should be declared as per rules 1, 2, 9
to 13 and 17 to 21 of Schedule III. Where the assets are held as
assets of business, for which accounts are maintained regularly,
the valuation should be done as per rule 14 of this Schedule.
Held as assets other than in business or profession
1. (i) Indicate here amount of cash in hand.
ii Use the space provided here in specifying each loan or advance of
Rs. 50,000 and above owing to the assessee. Others below Rs.
50,000 may be shown together The amount of loan or advance should
include the interest accrued thereon up to the valuation date,
which has not been received and is outstanding on that date.
Furnish and attach with the return the following information in respect
of each loan or advance of Rs. 50,000 and above owing to the assessee. -
Sl Amount Name of Whether Date of Mode of Rate of Type of Remarks
No. (Rs.) the loan or loan or loan interes securit , if
person advance advance advance t y if any
owning any
the
amount
1 2 3 4 5 6 7 8 9
ii Indicate in the columns given here name of the bank and its
branch, account number, nature of account, i e., whether it is a
savings bank account or a current account, recurring deposit
account, fixed deposit account, etc., and the amount in each
account.
iii Indicate here the form of gold, silver, platinum or other precious
metal, its gross and net weight in grams and its value as per rule
20 of Schedule Ill. 'Gold' means gold, including its alloy,
whether virgin, melted, remitted, wrought or unwrought, in any
shape or form of a purity of not less than nine carats and
includes any gold coin (whether legal tender or not), any gold
ornament and other articles of gold (rule 2 of Schedule Ill).
However, details of gold ornaments should be given against item
(v) below. Gold of purity of less than nine carats should be
shown under 'others' at item (iv)(d).
iv ltemwise details of jewellery should be given using columns (a) to
(a). Thus, gold ornaments at (a) would include ornaments of gold
with diamonds or other precious or semi-precious stones studded in
them. Similarly, diamond jewellery in silver will be shown at,
(b) while diamondjewellerv in platinum will be shown at (c).
Precious or semi-precious stones which are not part of any gold or
silver ornaments or ornaments of any other precious metal, but are
kept separate or are set in any furniture, utensils or other
articles or sewn into any apparel, should be shown at (a).
Valuation of jewellery is to be done as per rules 18 and 19 of
Schedule III. In support of the valuation of jewellery, the
prescribed form to be attached with the return is:
a where the value of the jewellery on the valuation date is up
to Rs. 5 lak s, a statement in Form No. O-8A, as prescribed
by rule 13(c), signed by the assessee, or
(b) where the value of the jewellery on the valuation date exceeds
Rs. 5 lakhs, a report of Registered Valuer in Form No. 0-8, as
prescribed by rule 8D.
Note :The definition of the term 'jewellery' is given in rule 2 of Schedule
III.
Page 2.45
(vi) Companywise details of debentures, quoted/unquoted, should be
indicated in the respective columns given here.
The value of a quoted debenture is determined as per. rule 9 and
the value of an unquoted debenture is determined as per rule 20 of
Schedule III
Page 2.48
F. STATEMENT OF NET WEALTH LOCATED OUTSIDE INDIA AND INCLUDED IN THENETWEALTH,
I.E,IN THE ASSETS SHOWN IN SUB-PARTS A, B & C AND IN THE DEBTS SHOWN IN SUB-
PART D
1 Indicate here the total value of immovable properties located
outside India and already included in item A.1 at page 2.44 of the
return.
2 Indicate here the total value of immovable properties located
outside India and already ncluded in item A.6 at page 2.44 of the
return.
3 Indicate here the sum total of 1 and 2.
4 Indicate here the total amount of exemptions relating to immovable
properties shown at items 1 and 2 above and already included in
items A.3 and A.8 at page 2.44 of the return.
5 Aggregate value of movable properties located outside India (ie.,
3-4) is to be indicated here.
6 Indicate here the total value of movable properties located
outside India and already included in items B.1(i) to (x) at pages
2.45-2.46 of the return.
7 Indicate here the total value of movable properties located
outside India and already included in item B.3 at page 2.46 of the
return.
8 Indicate here the sum total of 6 and 7.
9 Indicate here the total amount of exemptions relating to movable
properties shown at items 6 and 7 above and already included in
item B.6 at page 2.46 of the return.
10 Aggregate value of movable properties located outside India (i.e.,
8-9) is to be indicated here.
11 Indicate here the total value of interest held in a firm or AOP as
a partner or member thereof, which is located outside India and is
already included in item C.1 at page 2.47 of the return.
12 Indicate here the total value of exemptions relating to the value
of the interest of a partner or member shown at item No. 11 above
and already included in item C.3 at page 2.47 of the return.
13 Aggregate value of the interest held in a firm or AOP as a partner
or member thereof, which is located outside India (i.e., 11- 12)
is to be indicated here.
14 Aggregate value of wealth located outside India (i e., 5+10+13) is
to be indicated here.
15 Indicate here the total value of debts referable to assets shown
in this sub-Part, which have already been in items D. 1 and D.3 at
page 2.47 of the return.
16 Indicate here the total value of net wealth located outside India
(i.e., 14-15).
Note : An individual who is not a citizen of India or an individual or a Hindu
undivided family not resident in India or resident but not ordinarily resident
in India need not fill this sub-Part or in his case assets and debts located
outside India would already have been excluded from his assets and debts shown
in sub-Parts A, B, C & D.
PART II
STATEMENT OF TAXES
Page 2.49
1. Wealth-tax payable on the net wealth arrived at G.5 of Part I is
to be indicated here. The tax should be calculated according to
the rates specified in Part I of Schedule I. Further, rules 1, 3
and 4 of the said Schedule I provide for the method of determining
the wealth-tax payable in the following types of cases:
1 Where the net wealth of an assessee includes the value of
any asset on which wealth-tax is not payable under section
5(2) [rule 1 of Schedule I].
2 Where the assessee is an individual who is not a citizen of
India and who is not a resident in India [rule 3 of Schedule
I.
3 Where the net wealth of a resident assessee, being an
individual who is a citizen of India or a Hindu undivided
family, includes any assets located outside India [rule 4 of
Schedule I].
4 Give here interest chargeable for late filing of return. The
manner of computation of interest is laid down in section 17B.
5 The total amount of tax and interest payable (1 + 2 is to be
indicated here).
6 Give details of the tax and interest, if any, paid on self -
assessment (ie., before filing the return) and also attach
challan(s) in support of the amounts so paid.
7 The net tax/interest payable or refund due, as the case may be, is
to be indicated here. For indicating refund, precede it by a
minus (-) symbol.
PART III
INFORMATION WHERE ASSESSEE IS A PARTNER OR MEMBER OF A FIRM/AOP
PART IV
LIST OF DOCUMENTS/STATEMENTS ATTACHED
Verification
Read the instructions below the verification carefully before signing it.Fill
all the relevant columns in the verification. [Give the place and date as
indicated.]