FORM BA
	
RETURN OF NET WEALTH

WEALTH-TAX ACT, 1957		[For individuals/Hindu undivided   families/companies]		Receipt No
Date.	

[SEE RULE 3(1)(b)]					

ORIGINAL/REVISED U/S 16(4)(I)/17	ASSESSMENT YEAR	
		
			19			-				
		
	VALUATION DATE	
		
		3	1	-		3	19			

DATE OF FILING OF ORIGINAL RETURN	PAN/GIR.NO./WARD/ CIRCLA/RANGE	
		
												-			19														

STATUS																									

RECIDENTIAL STATUS																							

																										
																										
NAME (SURNAME FIRST IN THE CASE OF INDIVIDUAL/ KARTA ONLY)
(IN BLOCK LETTERS)

																										
																										
RESIDENTIAL ADDRESS/REGISTERED OFFICE IN THE CASE OF COMPANY (IN BLOCK LETTERS)

																										
TELEPHON								PIN																	

OFFICE ADDRESS (IN BLOCK LETTERS)											

																										
TELEPHON								PIN																	
																										
Please indicate :
		
	(a)		In the case of individual/karta, are you a citizen of India? 	Yes/No	
	(b)		Is this your first wealth –tax assessment?	Yes/No	
	(c)		Are you assessed to income tax?	Yes/No	
	(d)		Have you filed return of income/gift for the same assessment year?
(i)	Return of income 
(ii)	Return of gift(s)
If answer to(d) is yes, on what date(s) and with which Ward/Circle/Range
(i)	Return of income

(ii)	Return of gift(s)

Yes/No
Yes/No	
	(e)		Is this return being filed as a legal representative? 	Yes/No	
	(f)		In the case of Hindu undivided family :-
(i)	Does the HUF have at least one member whose net wealth is assessable for this assessment year?
(ii)	Has a partition taken place after 31st December, 1978 among the member of the HUF?	
Yes/No

Yes/No	
	(g)		Have any assets, as in section (2)(ea) of the W. T. Act, 1957, which were shown in the return of the net wealth for the immediately preceding assessment year been excluded from this return? If answer to (g) is Yes, attach to the Return particulars regarding the date and manner of their disposal and the consideration therefor itemwise, if any?	Yes/No	
	(h)		Have you claimed any Double Taxation Relief?
(a)	Under agreement with foreign countries
(b)	In respect of country with which no agreement exists?
NAME OF THE COUNTRY
	
Yes/No
Yes/No	

PART I
COMPUTAION OF NET WEALTH INCLUDING NET WEALTH OF OHTER PERSONS INCLUDIBLE IN ASSESSEE’S NET WEALTH ON VALUATION DATE

A.	IMMOVABLE PROPERTY

1.	Description and situation 	Value as per Schedule III	Debts owned and incurred in relation to the asset	Net amount
[(b) –(c)]	
(a)		(a)		(a)		(a)		
		Rs.		Rs.		Rs.	
		Rs.		Rs.		Rs.	
		Rs.		Rs.		Rs.	
		Rs.		Rs.		Rs.	
		Rs.		Rs.		Rs.	
							
2.	Aggregate value of immovable property [i.e. total of 1(d) above ]  		
		
B.	IMMOVABLE PROPERTY

3.	Description and situation 	Value as per Schedule III	Debts owned and incurred in relation to the asset	Net amount
[(b) –(c)]	
(a)		(a)		(a)		(a)		
(i)	Motor cars (other than those used by the assessee in the business of running them on hire or as stock-in-trade).									
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs.	
								Total		Rs.	
(ii)	
Precious metals		Weight							
(iii)			Gross	Net							
(1) Gold						Rs.		Rs.		Rs.	
(2) Silver						Rs.		Rs.		Rs.	
(3) Platinum						Rs.		Rs.		Rs.	
(4) Others						Rs.		Rs.		Rs.	
								Total		Rs.	
(iii)	
Jewellery											
(1) Gold											
Ornaments						Rs.		Rs.		Rs.	
(2) Silver Ornaments						
Rs.		
Rs.		
Rs.	
(3) Ornament made by platinum or any other precious metal or nay alloy thereof						

Rs.		

Rs.		

Rs.	
(4) Precious or semi-precious stones						

Rs.		

Rs.		

Rs.	
(5) Furniture, utensils or any other article made of gold, silver, platinum or any other precious metal						

Rs.		

Rs.		

Rs.	
								Total		Rs.	
											
(iv)	Yachts, Boats and Aircrafts (other than those used by the assessee for  commercial purposes) (enumerate each item separately)											
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs.	
				Rs.		Rs.		Rs. 	
						Total		Rs.	
(v)	Cash in hand								Rs.	
AGGREGATE VALUE OF IMMOVABLE PROPERTY [i.e. Grand total of totals of items(i)(d) to (v)(d) above]	
									
B.	INTEREST HELD IN THE ASSETS OF A FIRM OR ASSOCIATION OF PERSONS (AOP) AS A PARTNER OR MEMBER THEREOF :	
1.	Description				Value as per schedule III		Debts owed and incurred in relation to the asset		Net amount 
[(b)-(c)]	
(a)				(b)		(c)		(d)	
	(i)	Firm (Name and address)									
					Rs.		Rs.		Rs.	
					Rs.		Rs.		Rs.	
					Rs.		Rs.		Rs.	
					Rs.		Rs.		Rs. 	
							Total		Rs.	
										
	(ii)	AOP (Name and address)									
					Rs.		Rs.		Rs.	
					Rs.		Rs.		Rs.	
					Rs.		Rs.		Rs.	
 					Rs.		Rs.		Rs. 	
							Total		Rs.	
										
	2.	Aggregate value of interest held in the assets of firm or AOP as a partner or member thereof [i.e. Grand total of totals of items 1(i)(d) and 1(ii)(d) above]				
							Total		Rs.	
D. STATEMENT OF NET WEALTH							
1.		A.	Aggregate value of immovable property [Item No. A.2]		Rs.	
	B.	Aggregate value of immovable property [Item No. B.2]		Rs.	
	C.	Aggregate value of interest in assets held in a firm or AOP as partner or member thereof [Item No. C.2]		
Rs.	
1.		Net wealth (A+B+C)		Rs.	
2.		Net wealth (as rounded  off to the nearest multiple of hundred rupees)(in words)
			
3.		Value of asset included in 2 above being the asset of any other person 		Rs.	
4.		Name and relationship of such person(s)			
	
PART II	
STATEMENT OF TAXES	
	
1.		Tax on net wealth 	Rs.					
2.		Add : Interest on late filling of return	Rs.					
3.		Total tax and interest payable (i.e. 1+2)					Rs.	
							
4.		Less : Tax and interest, if any, paid on self- assessment [Attach challan(s)]		Tax Rs.		Interest Rs.		
							
					Total Rs. 		
	Date of payment									
			-			19										
	Name of the Bank/Branch					
						
5.		Tax/interest payable or refund due (3-4)								
Rs.	

PART III
INFORMATION WHERE ASSESSEE IS A PARTNER OR MEMBER OF A FIRM/AOP

	Sl  No. 	Name(s) of other partners/Members	Share of profit Ratio	Value of interest in the assets of the concern	
	(a)	(b)	(c)	(d)	
Firm AOP					

PART IV
ASSETS CLAIMED EXEMPT

Description of asset	Amount (Rs.)	Reasons for claim	
(a)
(b)
(c)
(d)
(e)

PART V
LIST OF DOUMENTS/STATEMENTS ATTACHED

(a)
(b)
(c)
(d)
(e)
(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, hte 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 1st April, 19 
I further solemnly declare that					*I
					the person for and on whose behalf this return furnished 
the person in respect of whose net wealth I am assessable had no other asset belonging to 
     *me				*my
		either in  			name or in the name of any other person which is 
the said person		the said person’s
							*my
required to be taken into consideration in computing 	the said person	
net wealth on the said valuation date.
It had no other assets belonging to it which is required to be taken into consideration in computing its net wealth as on the said valuation date.
I further declare that I am maing this return in my capacity as 				(designation in the case of company/HUF) of 			and 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.