Retail Location Details Excel Sheet

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Retail Location Details Excel Sheet Powered By Docstoc
					                                                       RETURN OF TOTAL INCOME/STATEMENT OF FINAL TAXATION
                                                         UNDER THE INCOME TAX ORDINANCE, 2001 (FOR INDIVIDUAL / AOP)                 N°
                                                                                                                                                Control Centre
                       CNIC   (for Individual)                                                                         NTN
                       Taxpayer's Name                                                                                 Gender               Male             Female

                                                                                                                                                       30.06.2010
Registration (*)




                       Business Name                                                                                   Year Ending
                       Business Address                                                                                Tax Year                             2010
                       Res. Address                                                                                    Person             IND                    AOP
                       E-Mail Address                                                             Phone                Res. Status        Non-Res.                  Resident    
                       Principal Activity                                                         Code                 Birth Date
                       Employer                  NTN                          Name                                     Filing Section
                       Representative            NTN                          Name                                     RTO/LTU
                       Authorized Rep.           NTN                          Name                                     Authorized Rep. applicable                              
                   Sr. Page/Annex                Description                                              Status                        Error Message/ Remarks
                   1   Page 1 of 2               Accounts, Adjustments, Income, Tax and Refund             NIL         Income=Nil, No Payable, No Refundable
                   2   Page 2 of 2               Fixed and Final Tax                                       NIL         -
Control Centre




                   3   Annexure-A                Depreciation, Initial Allowance & Amortization            NIL         Depriciation = 0, Initial Allowance = 0 & Amortization = 0

                   4   Annexure-B                Tax Already Paid                                          NIL         -
                   5   Annexure-C                Breakup of Sales in case of multiple business             NIL         -
                   6   WS 1 of 2                 Wealth Statement                                          NIL         -
                   7   WS 2 of 2                 Wealth Reconciliation Statement                           NIL         -

                              Wealth Statement Filled

                                        Verify
                                        Verify                  Submit
                                                                Submit                    Print
                                                                                          Print
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                                                                                       RETURN OF TOTAL INCOME/STATEMENT OF FINAL TAXATION                                              IT-2 (Page 1 of 2)
                                                                                           UNDER THE INCOME TAX ORDINANCE, 2001 (FOR INDIVIDUAL / AOP)                        N°
                                                   CNIC   (for Individual)   0                                                                                  NTN                                0
                                                   Taxpayer's Name           0                                                                                  Gender              Male            Female

                                                   Business Name             0                                                                                  Year Ending                   30.06.2010
         Registration (*)




                                                   Business Address          0                                                                                  Tax Year                        2010
                                                   Res. Address              0                                                                                  Person             IND                AOP
                                                   E-Mail Address            0                                                                Phone   0         Res. Status        Non-Res.            Resident   
                                                   Principal Activity        0                                                                Code          0   Birth Date                         0
                                                   Employer                      NTN   0                      Name   0                                          Filing Section                     0
                                                   Representative                NTN   0                      Name   0                                          RTO/LTU                            0
                                                   Authorized Rep.               NTN   0                      Name   0                                          Authorized Rep. applicable           
                                                           NTN               Proprietor/Member/Partners' Name                                                    % in Capital            Capital Amount
         Ownership




                                                   Others
                                                   Total                                                                                                            100%                                          -
                                                   Items                                                                                                            Code                          Total
Manufacturing/ Trading, Profit & Loss
Account ( including Final/Fixed Tax)




                                                   Net Sales (excluding Sales Tax/ Federal Excise Duty & Net of Commission/ Brokerage)
                                              1                                                                                                                     3103
                                                                                                                          (To be reconciled with Annex-C)
                                              2    Cost of Sales [3 + 4 + 5 - 6]                      (To be reconciled with Annex-C)                              3116                                           -
                                              3       Opening Stock                                                                                                3117                                           -
                                              4       Net Purchases (excluding Sales Tax/ Federal Excise Duty & Net of Commission/ Brokerage)                      3106
                                              5       Manufacturing/ Trading Expenses                                                                              3111
                                              6    Closing Stock                                                                                                   3118
                                              7    Gross Profit/ (Loss) [1-2]                          (To be reconciled with Annex-C)                             3119                                           -
                                              8    Other Revenues/ Fee/ Charges for Professional and Other Services/ Commission                                    3131
                                              9    Profit & Loss Expenses                                                                                          3189
                                              10   Net Profit/ (Loss) [(7 + 8) - 9]                                                                                3190                                           -
           Adjustments




                                              11   Inadmissible Deductions (including Accounting Depreciation)                                                     3191
                                              12   Admissible Deductions (excluding tax depreciation/ including proportionate PTR income                           3192
                                              13   Unadjusted Loss from business for previous year(s) [Transfer from Sr. 24 of Annex-A]                            3902                                           -
                                              14   Un-absorbed Tax Depreciation for previous/ current year(s) (Annex-A)                                            3988                                           -
                                              15   Total Income [Sum of 16 to 21]                                                                                  9099                                           -
                                              16      Salary Income including Arrears Excluding Bonus                                                              1999
                                              17      Bonus                                                                                                       19991
                                              18      Business Income/ (Loss) [ (10 + 11) - 12 - 13 - 14 ]                                                         3999                                           -
         Total / Taxable Income Computation




                                              19      Share from AOP [Income/(Loss)]                                                                              312021
                                              20      Capital Gains/(Loss)                                                                                         4999
                                              21      Other Sources Income/ (Loss)                                                                                 5999
                                              22      Foreign Income/ (Loss)                                                                                       6399
                                              23   Deductible Allowances [24 + 25 + 26]                                                                            9139                                           -
                                              24      Zakat                                                                                                        9121
                                              25      Workers Welfare Fund                                                                                         9122
                                              26      Charitable donations admissible as straight deduction                                                        9124
                                              27   Exempt Income/ (Loss) [Sum of 28 to 32]                                                                         6199                                           -
                                              28      Salary Income                                                                                                6101
                                              29      Property Income/ (Loss)                                                                                      6102
                                              30      Business Income/ (Loss)                                                                                      6103
                                              31      Capital Gains/(Loss)                                                                                         6104
                                              32      Other Sources Income/ (Loss)                                                                                 6105
                                              33   Agriculture Income                                                                                              6106
                                              34   Taxable Income/ (Loss) [if 16 < 1000000,15 - 23 else 15-23-17 ]                                                 9199                                           -
                                              35   Tax chargeable on Taxable Income                                                 @    #DIV/0!                   9201                                           -
                                              36   Tax Reductions/Credits/Averaging (including rebate on Bahbood Certificates, etc.)                               9249
           Tax Computation




                                              37 Minimum Tax Chargeable [a+b+c+d+e];                    a) U/s 113                   b) U/s 148(8)
                                                                                                                                                                    9303                                          -
                                                   c) U/s 153(1)(b)                                d) U/s 233A(2)                    e) U/s 235(4)

                                              38 Total Tax Chargeable (if 35 > 36 then 35-36+37 + 81 else 37 + 81)                                                  9299                                          -
                                              39 Total Tax Payments (Transfer from 24 of Annex-B)                                                                   9499                                          -
                                              40 Tax Payable/ Refundable [38 - 39 + WWF Payable from Sr. 25 of Annex-B                                              9999                                          -
                                              41 Refund Adjustments (not exceeding current year's tax payable)                                                      9998
                                                 Net Tax Refundable, may be credited to my bank account as under:
           Refund




                                                        A/C No.

                                                        Bank                                                    Branch Name & Code                                                   Signature
                                            RETURN OF TOTAL INCOME/STATEMENT OF FINAL TAXATION                                                      IT-2 (Page 2 of 2)
                                                UNDER THE INCOME TAX ORDINANCE, 2001 (FOR INDIVIDUAL / AOP)                                   N°
                CNIC     (for Individual)   0                                                                                             NTN                0
                Taxpayer's Name             0                                                                                            Tax Year        2010
                Business Name 0                                                                                                          RTO/LTU             0
                                                                                                                       Rate
                        Source                                              Code        Receipts/Value                 (%)                Code      Tax Chargeable
                 42 Imports upto 30.06.2009                                 64013                                         4               92013                      -
                 43                                                         64011                                         2               92011                      -
                 44                                                         64012                                         1               92012                      -
                 45                                                         64015                                                         92015                      -
                 46 Dividend                                                64032                                      10                 92032                      -
                 47                                                         64033                                      7.5                92033                      -
                 48 Profit on Debt                                          64041                                      10                 92041                      -
                 49 Royalties/Fees (Non-Resident)                           640511                                     15                 920511                     -
                 50                                                         640512                                                        920512                     -
                 51 Contracts (Non-Resident)                                640521                                        6               920521                     -
                 52 Insurance Premium (Non-Resident)                        640524                                        5               920524                     -
                 53 Advertisement Services (Non-Resident)                   640525                                     10                 920525                     -
                 54 Supply of Goods                                         640611                                     3.5                920611                     -
                 55                                                         640612                                     1.5                920612                     -
 Final Tax




                 56                                                         640613                                                        920613                     -
                 57 Payments to Ginners                                     640614                                        1               920614                     -
                 58 Services rendered upto 30.06.2009                       640621                                        6               920621                     -
                 59     Transport Services rendered upto 30.06.2009         640622                                        2               920622                     -
                 60                                                         640623                                                        920623                     -
                 61 Contracts (Resident)                                    640631                                        6               920631                     -
                 62 Exports/related Commission/Service                      640641                                     0.5                920641                     -
                 63                                                         64072                                         1               92072                      -
                 64 Foreign Indenting Commission                            64075                                         5               92075                      -
                 65 Property Income subject to WHT                          64081                                                         92081                      -
                 66 Prizes                                                  64091                                      10                 92091                      -
                 67 Winnings                                                64092                                      20                 92092                      -
                 68 Petroleum Commission                                    64101                                      10                 92101                      -
                 69 Brokerage/Commission                                    64121                                      10                 92121                      -
                 70 Advertising Commission                                  64122                                         5               92122                      -
                 71 Goods Transport Vehicles                                                                                              92141

                 72 Gas consumption by CNG Station                          64142                                       4                 92142                      -
                 73 Distribution of cigaratte and pharmaceutical products   64143                                       1                 92143                      -
                 74 Retail Turnover upto 5 million                          310102                                     0.5                920202                     -
                 75 Retail Turnover above 5 million                         310103                                                        920203                     -
 Fixed Tax




                 76 Property Income not subject to WHT                      210101                                                        920235                     -
                 77 Purchase of locally produced edible oil                 310431                                        2               920208                     -
                 78 Flying Allowance                                        112001                                     2.5                920234                     -
                 79 Services rendered / contracts                           63311                                         1               920236                     -
                    executed outside Pakistan
                 80 Employment Termination Benefits                         118301                                                        920211                     -
                 81 Final/Fixed Tax Chargeable (42 to 80)                                                                                 9202                       -
                I,
                                                                                                                       Acknowledgement




                holder of CNIC No.                                                       , in my capacity as
 Verification




                Self/ Partner or Member of Association of Persons/ Representative (as defined in section 172 of the
                Income Tax Ordinance, 2001) of Taxpayer named above, do solemnly declare that to the best of
                my knowledge and belief the information given in this Return/Statement u/s 115(4) and the attached
                Annex(es), Statement(s), Document(s) or Detail(s) is/are correct and complete in accordance with 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).
                                                                                                                                               Signatures & Stamp
                     Date :                                                    Signatures                                                 of Receiving Officer with Date

Note-1 : Grey blank fields are for official use
                                                                                                                                                                                                                                               Rate                                     Extent
                                                                                                                                            Description                    Code        WDV (BF)          Additions            Deletions        (%)      Initial Allowance Rate (%)       (%)     Depreciation   WDV (CF)




Annex-A


                                                                       2010
                                                                                                                1    Building (all types)                                   3202                                                                50%                    -       10%                          -               -
                                                                                                                2    Machinery and plant (not otherwise specified)         320301                                                               50%                    -       15%                          -               -
                                                                                                                3    Computer hardware (including allied items)            320302                                                               50%                    -       30%                          -               -
                                                                                                                4    Furniture (including fittings)                        320303                                                               0%                     -       15%                          -               -



                                                      0


                                                                                  Depreciable Assets
                                                                                                                5    Technical and professional books                      320304                                                               50%                    -       15%                          -               -


                                                                       Tax Year
                                                                                                                6    Below ground installations of mineral oil concerns    320306                                                               50%                    -       100%                         -               -
                                                                                                                7    Off shore installations of mineral oil concerns       320307                                                               50%                    -       20%                          -               -
                                                                                                                8                                                         320308
                                                                                                                     Machinery and equipment used in manufacture of IT products                                                                 50%                    -       30%                          -               -
                                                                                                                9    Motor vehicles (not plying for hire)                  32041                                                                0%                     -       15%                          -               -
                                                                                                                10 Motor vehicles (plying for hire)                        32042                                                                50%                    -       15%                          -               -
 Depreciation, Initial Allowance and Amortization




                                                                                                                11 Ships                                                   32043                                                                50%                    -       15%                          -               -
                                                    Reg/Inc/CNIC No.




                                                                                                                12 Air crafts and aero engines                             32044                                                                50%                    -       30%                          -               -
                                                                                                                13 Total                                                                          -                  -                  -                              -                                    -               -
                                                                                                                                                                                                                                                                                        Extent
                                                                                                                                            Description                    Code     Acquisition Date Useful Life(Years)     Original Cost                        .                       (%)     Amortization
                                                                                  Intangibles




                                                                                                                14 Intangibles                                              3205
                                                                                                                15 Expenditure providing long term advantage/benefit        3207
                                                                                                                16 Total                                                                                                               -                                                                    -
                                                                                                                                                                                                                              Original
                                                                                                                                            Description                    Code                                             Expenditure                          .           Rate (%)            Amortization
                                                                                                                17 Pre commencement expenditure                             3206                                                                                               20%
                                                                                                                                            Description                    Code         Amount            Tax Year                                Description                           Code       Amount       Tax Year

                                                                                                                     Unadjusted Business loss for previous year adjusted                                                   Unabsorbed Amortization of intangibles / expenditure
                                                                                                                     against Business income for current year                                                             providing long term advantage/benefit for previous year(s)
                                                                                                                18                                                          3902                            2004          adjusted against Total Income for current year                3987                    upto 2009
                                                                                  Brought Forward Adjustments




                                                                                                                     Unadjusted Business loss for previous year adjusted                                                   Amortization of intangibles / expenditure providing long
                                                                                                                     against Business income for current year                                                             term advantage/benefit for current year adjusted against
                                                                                                                19                                                          3902                            2005          Total Income for current year                                 3987                      2010
                                                                                                                                                                                                                           Unabsorbed tax depreciation/initial allowance of fixed
                                                                                                                     Unadjusted Business loss for previous year adjusted
                                                                                                                                                                                                                          assets for previous year(s) adjusted against Total Income
                                                                                                                     against Business income for current year
                                                                                                                20                                                          3902                            2006          for current year                                              3988                    upto 2009
                                                                                                                     Unadjusted Business loss for previous year adjusted
                                                    0




                                                                                                                                                                                                                           Depreciation/initial allowance of fixed assets for current
                                                                                                                     against Business income for current year
                                                                                                                21                                                          3902                            2007          year adjusted against Total Income for current year           3988                      2010
                                                                                                                   Unadjusted Business loss for previous year adjusted
                                                                                                                22 against Business income for current year                 3902                            2008
                                                                                                                   Unadjusted Business loss for previous year adjusted
                                                                                                                23 against Business income for current year                 3902                            2009
                                                      NTN




                                                                                                                   Total (Not exceeding the amount of Business Income available                                           Total (Not exceeding the amount of Total Income available for
                                                                                                                24 for adjustment) (transfer to Sr. 13 of Main Return)                            -                       adjustment) (transfer to Sr. 14 of Main Return)                                   -
                                                                                                                                      Annex-B                                                       2010
                                                                                                                                 Tax Already Paid                                                     B
                                                         NTN                           0                                                         Reg/Inc/CNIC No.                            0
                                                                                                                                                                                                 Amount of Tax
                                                                                                                    Particulars                                                     Code
                                                                                                                                                                                                 deducted (Rs.)
                                                         1    On import of goods (other than tax deduction treated as final tax)                                                    94019
                                                         2    On withdrawal from pension fund                                                                                       94028
                                                         3    From salary U/S 149                                                                                                   94029
                                                         4    On dividend Income (other than tax deduction treated as final tax)                                                    94039
                                                         5    On Government securities                                                                                              94043
                                                         6    On profit on debt (other than tax deduction treated as final tax)
                                                                                                                                                                                    94049
                                                                 Certificate/Account No. etc.                Bank                             Branch                       Share%                           -
Tax Collected/Deducted at Source (Adjustable Tax only)




                                                          7   On payments received by non-resident (other than tax deduction treated as final tax)                                  940539
                                                          8   On payments for goods (other than tax deduction treated as final tax)                                                 940619
                                                          9   On payments for services (other than tax deduction treated as final tax)                                              940629
                                                         10   On payments for execution of contracts (other than tax deduction treated as final tax)                                940639
                                                         11   On cash withdrawal from bank
                                                                                                                                                                                    94119
                                                                 Certificate/Account No. etc.                Bank                             Branch                       Share%                           -




                                                         12   On sale/purchase of shares through a Member of Stock Exchange                                                         94131
                                                         13   On trading of shares through a Member of Stock Exchange                                                               94138
                                                         14   On financing of carry over trade                                                                                      94139
                                                         15   With motor vehicle token tax (Other than goods transport vehicles)
                                                                                                                                                                                    94149
                                                                   Registration No.                Engine / Seating Capacity              Owner's Name                     Share%                           -




                                                         16 With bill for electricity consumption
                                                                                                                                                                                    94159
                                                                     Consumer No.                     Subscriber's CNIC                 Subscriber's Name                  Share%                          -




                                                         17 With telephone bills, mobile phone and pre-paid cards
                                                                                                                                                                                    94169
                                                                         Number                       Subscriber's CNIC                 Subscriber's Name                  Share%                              -




                                                         18 With Motor Vehicle Registration Fee
                                                                                                                                                                                    94179
                                                                Registration No.            Engine / Seating Capacity          Owner's Name              Manufacturer Particulars                               -




                                                         19 On Sale by Auction u/s 236A                                                                                             94180
                                                         20 Total Tax Deductions at source (Adjustable Tax) [Sum of 1 to 18]                                                        94599                   -
                                                         21 Total Tax Deductions at source (Final Tax)                                                                              94591
                                                         22 Advance Tax U/S 147(1) [ a + b + c + d]                                                                                 9461                   -
                                                            a. First installment    CPR No.
Tax Payments




                                                            b. Second installment   CPR No.
                                                            c. Third installment    CPR No.
                                                            d. Fourth installment   CPR No.
                                                         23 Admitted Tax U/S 137(1) Liability Paid [ Sum of a and b]                                                                9471                   -
                                                            a. U/S 137 (1)          CPR No.
                                                            b. U/S 137 (1)          CPR No.
                                                         24 Total Tax Payments [20 + 21 + 22 + 23] (Transfer to Sr. 39 of Main Return)                                                                     -
                                                              WWF Payable with Return (WWF payable will be
                                                         25   adjusted against the excess payments made during the                                                                  9308
                                                              current year)
Note-1 : Grey blank fields are for official use
                                                                                               Annex C                                                      2010
                                                                          Breakup of Sales in case of Multipe Business                                          C
                                   Reg./Inc. No.       0                                                                                 NTN                    0
                                   Taxpayer Name       0                                                                                 Tax Year            2010
                                   Business Name       0                                                                                 RTO/LTU                0

                                                                   Business Name & Business Activity                     Sales       Cost of Sales      Gross Profit/Loss
                                    Sr.
                                                                                    (1)                                   (2)             (3)             (4) = (2) - (3)

                                          Business Name
                                    1                                                                                                                                       -
  BUSINESS WISE BREAKUP OF SALES




                                          Business Acitivity

                                          Business Name
                                    2                                                                                                                                       -
                                          Business Acitivity

                                          Business Name
                                    3                                                                                                                                       -
                                          Business Acitivity

                                          Business Name
                                    4                                                                                                                                       -
                                          Business Acitivity

                                          Business Name
                                    5                                                                                                                                       -
                                          Business Acitivity


                                   Total (to be reconciled with Sr. 1, 2 & 7 of Main Return)                                     -                  -                       -



                                                                                                                                                           Signature
Note : Grey blank fields are for official use
                                                                       WEALTH STATEMENT UNDER SECTION 116                                                                     WS 1/2
                                                                       OF THE INCOME TAX ORDINANCE, 2001                                                        N°
CNIC                         0                                                                                                                     NTN                            0
Taxpayer's Name              0                                                                                                                     Tax Year                    2010
Address                      0                                                                                                                     RTO/LTU                        0
                             Particulars/Description of assets and liabilities (Please read WS Notes for guidance)                                  Code                        Amount (Rs.)


1.     Business Capital (indicate name of business)                                                                                                 821311                                 -

2.     Non-Agricultural Property (indicate location & identification)                                                                               711111                                 -

3.     Agricultural Property - Land (indicate location & identification)                                                                            711211                                 -

4.     Agricultural Property (Specify equipment, live stock, seeds, seedlings, fertilizer, etc.)                                                    712111                                 -

5.     Investments (Specify stocks, shares, debentures, Unit certificates, other certificates,                                                      712611                                 -
       deposits and certificates of National Saving Schemes,mortgages, loans, advances, etc.)

6.     Loans and Advances, etc.                                                                                                                     712641                                 -

7.     Motor vehicles (Indicate make, model and registration number)                                                                                712211                                 -

8.     Jewellery (Indicate description and weight)                                                                                                  712411                                 -

9.     Furniture and Fittings - Residence                                                                                                           712311                                 -

10. Cash & Bank Balances                                                                                                                             7128                                  -

       (a) Non-business cash in hand                                                                                                                712811                                 -

       (b) Non-business bank balances, etc. in current/ deposit/ savings accounts or any other deposit)                                             712711                                 -

11. Any Other Assets                                                                                                                                 7126                                  -

       (a)    Accumulated balance of life insurance premium actually paid                                                                           712661
       (b)    Accumulated balance of employees contribution to a Provident fund or any other fund                                                   712671                                 -

12. Assets, if any, standing in the name of spouse, minor children & other dependents*                                                              713111                                 -

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

14. Liabilities                                                                                                                                      8213                                  -

       (a)    Business Capital - Overdrawn (indicate name of business)                                                                              821331                                 -

       (b) Others (including mortgages, loans, overdrafts, advances, borrowings, amounts due under hire purchase agreement                          721111                                 -
                         or any other debt)


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

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

17. Annual personal expenses.                                                                                                                       749999                                 -

18. Number of family members and dependents                                                                                                         740000           Adults       Minors


19. Assets, if any, transferred to any person                                                                                                       714111                                 -

                                                                                               Verification
     I,                                                          0                                                            , holder of CNIC No.                     0                   in my
     capacity as Self / Representative* of 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 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
                                                    WEALTH RECONCILIATION STATEMENT                      WS 2/2
                                                                                                  N°
CNIC               0                                                                  NTN                    0
Taxpayer's Name 0                                                                     Tax Year            2010
Address            0                                                                  RTO/LTU                0

                                               Particulars                              Code           Amount (Rs.)

 1     Net assets as on 30-06-2010
 2     Net assets as on 30-06-2009
 3     Increase/Decrease [1 - 2]                                                                                      -

 4     Income                                                                                                         -

       a) Income declared for the Tax Year - 2010
       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".


4. (a)


   (b)

   (c)

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

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.
                               WEALTH STATEMENT UNDER SECTION 116
                                OF THE INCOME TAX ORDINANCE, 2001


                                                   (Notes on reverse)
                                                         Notes

If the space provided in the form is found to be inadequate, additional sheet(s) may be used.

All assets should be valued at cost.

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 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, the assets and liabilities of the business on the specified date. The excess of assets listed, should be
    entered as "Business Capital".
    If the net balance at (a) above is a debit balance, it should be included in liabilities.

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

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

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

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.

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
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