WS 1/5

WEALTH STATEMENT UNDER SECTION 116

OF THE INCOME TAX ORDINANCE, 2001

Taxpayer's Name

NTN

CNIC
Address

Tax Year
RTO/LTU
Particulars/Description of assets and liabilities (Please read WS Notes for guidance)

A. IMMOVABLE ASSETS
1. Business Capital (indicate name of business)

2013

Code

821311

###

Code
82131101
82131102

Amount (Rs.)

3
4

82131103
82131104

5
6

82131105
82131106

7
8

82131107
82131108

9
10

82131109
82131110

Sr.
1
2

2.
Sr.

Name of Business

Non-Agricultural Property (indicate location, Size/Area & identification)

Status

Size

Land Unit

Covered Area

Unit

District

711111
Location

###

Code

Amount (Rs.)

71111101

2
3

71111102
71111103

4
5
6

71111104
71111105
71111106

7
8

71111107
71111108

9
10

71111109
71111110

3.

Type

Agricultural Property (indicate location, Size/Area & identification

711211

###

Code
71121101

Amount (Rs.)

2
3

71121102
71121103

4
5
6

71121104
71121105
71121106

7
8

71121107
71121108

9
10

71121109
71121110

Sr.
1

Size

Land Unit

Province

District

Location

B. MOVEABLE ASSETS

4.

Business Capital (Except immovable portion)

Sr.

Name of Business

821312
Code

###

Amount (Rs.)

1
2

82131201
82131202

3
4

82131203
82131204

5
6

82131205
82131206

7
8
9

82131207
82131208
82131209

10

82131210

5.

Agricultural Moveable Property (Tractor, Trolley, Loader, Planter,

Harvester, Thrasher, Driller & other Agricultural Equipments etc. & Live Stock)

712111

###

Code
71211101

Amount (Rs.)

2
3

71211102
71211103

4
5
6

71211104
71211105
71211106

7
8

71211107
71211108

71211109

Sr.
1

Property Name

Quantity

Description

10

71211110

WS 2/5

WEALTH STATEMENT UNDER SECTION 116

OF THE INCOME TAX ORDINANCE, 2001

Taxpayer's Name

NTN

CNIC
Address

Tax Year
RTO/LTU
Particulars/Description of assets and liabilities (Please read WS Notes for guidance)

6.
Sr.

Investments (Specify stocks, shares, debentures, unit certificates, other certificates, deposits
and certificates of National Saving Schemes,mortgages, loans, advances, etc.)

2013

Code
712611

###
-

Code

Amount (Rs.)

1
2

71261101
71261102

3
4

71261103
71261104

5
6

71261105
71261106

7
8

71261107
71261108

9
10

71261109
71261110

Description

Invesments

7.

Loans and Advances, etc.

Sr.
1

Debtor Name

712641

###

Code
71264101

Amount (Rs.)

2
3
4

71264102
71264103
71264104

5
6

71264105
71264106

7
8

71264107
71264108

9
10

71264109
71264110

8.

Motor vehicles (Indicate make, model and registration number)

Sr.
1

Registration No.Make

712211

###

Code
71221101

Amount (Rs.)

2
3
4

71221102
71221103
71221104

5
6

71221105
71221106

7
8

71221107
71221108

9
10

71221109
71221110

Model with Year

9.

Jewellery (Indicate description weight and value)

Sr.
1

Description and weight with unit of measure (e.g 10 Tolas)

Engine Capacity (CC)

712411

###

Code
71241101

Amount (Rs.)

2
3

71241102
71241103

4
5
6

71241104
71241105
71241106

7
8

71241107
71241108

9
10

71241109
71241110

10. Furniture and Fittings - Residence

712311

###

Code
71231101

Amount (Rs.)

2
3

71231102
71231103

4
5
6

71231104
71231105
71231106

7
8

71231107
71231108

9
10

71231109
71231110

Sr.
1

Description

WS 3/5

WEALTH STATEMENT UNDER SECTION 116

OF THE INCOME TAX ORDINANCE, 2001

Taxpayer's Name

NTN

CNIC
Address

Tax Year
RTO/LTU
Particulars/Description of assets and liabilities (Please read WS Notes for guidance)

11.

Sr.
1

Cash & Bank Balances

Non-business cash in hand

(b)

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

Account No. Country

Bank Name

###

712811

City Name Br. Code

Branch Name

2
3

712711

Code

Amount (Rs.)

71271101
71271102

71271103
71271104

4
5

71271105
71271106

6
7

71271107
71271108

8
9
10

71271109
71271110

12. Any Other Assets

Sr.
1

Code
7128

(a)

2013

7126

Description

###

Amount (Rs.)

Code
71267101

2
3

71267102
71267103

4
5

71267104
71267105

6
7

71267106
71267107

8
9
10

71267108
71267109
71267110

13.

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

713111

###

Code
71311101

Amount (Rs.)

2
3

71311102
71311103

4
5

71311104
71311105

6
7

71311106
71311107

8
9

71311108
71311109

10

71311110

Sr.
1

Description

719999 ###

14. Total Assets [ Sum(1 to 13 ]

15. Liabilities (including mortgages, loans, overdrafts, advances, borrowings,
amounts due under hire purchase agreement )

8213

###

Code
72111101

Amount (Rs.)

2
3

72111102
72111103

4
5

72111104
72111105

6
7

72111106
72111107

8
9

72111108
72111109

10

72111110

Sr.
1

Liabilities

Description

16.

Total Liabilities

729999

###

17.

Net Wealth of the current year [14 minus 16]

799999

###

18.

Annual personal expenses ( To be reconciled with Annex D / IT-4)

749999

19.

Number of family members and dependents

740000

Adults

Minors

WS 4/5

WEALTH STATEMENT UNDER SECTION 116

OF THE INCOME TAX ORDINANCE, 2001

Taxpayer's Name

NTN

CNIC
Address

Tax Year
RTO/LTU
Particulars/Description of assets and liabilities (Please read WS Notes for guidance)

20.
Sr.

Assets, if any, transferred to any person

Code
714111
Code

Description

2013

###

Amount (Rs.)

1
2

71411101
71411102

3
4

71411103
71411104

5
6

71411105
71411106

7
8
9

71411107
71411108
71411109

71411110

10

Verification
I, _______________________________________________, holder of CNIC No. ______________________________ in my capacity as Self/
Representative* of the taxpayer named above, do hereby solemnly declare that to the best of my knowledge and belief the information given in
this statement of the assets and liabilities of myself, my spouse or spouses, minor children and other dependents as on _______________ and
of my personal expenditure for the year ended ________ are correct and complete in accordance with the provisions of the Income Tax
Ordinance, 2001, Income Tax Rules, 2002 and Income Support Levy Act, 2013.

Date (dd/mm/yyyy):
* The spouse who has not filed return of income along with wealth statement independently

Signature

WS 1/5
2013

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

WS 2/5
2013

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

WS 3/5
2013

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

unt (Rs.)
-

WS 4/5
2013

unt (Rs.)
-

WS 5/5

WEALTH RECONCILIATION STATEMENT

N
Taxpayer's Name

NTN

CNIC

Tax Year

Address

RTO/LTU

Particulars

Code

2013
Amount (Rs.)

Net assets as on 30-06-2013

Net assets as on 30-06-2012

Increase/Decrease [1 - 2]

Income

a) Income declared for the Tax Year - 2013

b) Exempt income including agriculture income
c) Others

i)
ii)
iii)
iv)
v)
5

Expenditures

a) Personal expenditures
b) Other expenditures

i)
ii)
iii)
iv)
v)
6

Increase/ Decrease in wealth [4 - 5]

Date :

Signature:

"

WEALTH STATEMENT UNDER SECTION 116

OF THE INCOME TAX ORDINANCE, 2001
(Notes on reverse)
Notes
1. If the space provided in the form is found to be inadequate, additional sheet(s) may be used.
2. All assets should be valued at cost.
3. If any exact figure can not be inserted, an estimate should be made, mark it clearly "ESTIMATE".
If balance sheet in respect of any business has been submitted to the Department, the entry of "Business Capital" should
4. (a) consist of the net balance on capital, current and loan accounts as shown in those Balance Sheets on the specified date, if
such net amount is a credit balance.
Where no Balance Sheet has been submitted, the assessed should list, on a separate sheet of paper attached to this form,
(b) the assets and liabilities of the business on the specified date. The 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
or indirectly to the 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 assets and the balance amount due should be shown under the liabilities.
9. Where the statement is being filed for the first time or covers more than one tax year, separate re-conciliation of the increase/
(decrease) in wealth 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@fbr.gov.pk