FORM BA
RETURN OF NET WEALTH
[See rule 3(1)(B) of Wealth-tax Rules, 1957]

For individuals/Hindu undivided families/companies
Please follow enclosed instructions For Office use only
PAN must be quoted.
Use block letters only.
ACKNOWLEDGEMENT
Receipt No. Date

1. PERMANENT ACCOUNT NUMBER(PAN)
(If not applied for or not allotted, enclose Form 49A)
2. NAME (LAST NAME/SURNAME, FIRST NAME, MIDDLE NAME IN THAT ORDER)
Seal and Signature of Receiving
Official
3. ADDRESS FOR COMMUNICATION (A. RESIDENCE Or B. OFFICE ) 8. WARD/CIRCLE/SPECIAL RANGE
(Flat No./Door/House No., Premises, Road, Locality/Village, Town/ District,
State/Union Territory in that Order) 9. IF THERE IS CHANGE IN JURISDICTION, STATE OLD
WARD/CIRCLE/SPECIAL RANGE
10. VALUATION DATE - -
11. ASSESSMENT YEAR 12. RESIDENTIAL STATUS
-
PIN TELEPHONE 13. WHETHER ORIGINAL or Revised Return ?
FAX, IF ANY 4. Sex (M/F) u/s 14/15/17
,5. DATE OF BIRTH - - 6. STATUS 14. If revised, Receipt No. and
(DD-MM-YYYY) date of filing original Return
7. IS THERE ANY CHANGE IN ADDRESS ? Yes No 15. IS THIS YOUR FIRST RETURN ? Yes No
If yes, whether A. Residence or B. Office 16. ARE YOU ASSESSED TO INCOME-TAX ? Yes No
STATEMENT OF NET WEALTH AND TAX (IN RS.)
Statement of net wealth
17. Aggregate value of immovable property (item 28.1e) 112
18. Aggregate value of movable property (item 28.2d) 113
19. Includible net wealth of other persons (item 28.3e) 114
20. Aggregate value of interest in assets held in a Firm/AOP as
partner/member (item 28.4f)
115
21. Net wealth (As rounded off to nearest multiple of hundred rupees)
(17+18+19+20)
116
In words
Statement of tax
22. Tax on net wealth 118
23. Add: interest on late filing of return 119
24. Total tax and interest payable (22+23) 135
25. Less prepaid tax and interest (Attach Challans)
Date Name of Bank and Branch Branch Code Amount (Rs.)
I
II
III
Total 137
26. Balance tax and interest payable (24-25) 149
27. Amount of refund due, if any 151
Fill in code as mentioned in instructions.

COMPUTATION OF NET WEALTH INCLUDING NET WEALTH OF
OTHER PERSON(S) INCLUDIBLE IN ASSESSEE’S NET WEALTH
VALUE OF ASSETS AS DEFINED U/S 2(ea) OF THE WEALTH-TAX ACT
(Attach separate sheet(s) wherever necessary and
mention aggregate figures in relevant columns)
28.1 Immovable property
Description Address Value as per Schedule
III
Debts owed in Relation
to the asset
Net amount
[(c) -(d)]
(a) (b) (c) (d) (e)
Building(s) S. 2(ea)(i)
Urban Land S. 2(ea)(v)
Total 154
28.2 Movable property
Description Value as per Schedule III Debts owed in Relation to the
asset
Net Amount
[(b)-(c)]
(a) (b) (c) (d)
(i) Motor cars S. 2(ea)(ii)
(ii) Jewellery etc. S. 2(ea)(iii)
(iii) Yachts, etc. S. 2(ea)(i v)
(iv) Cash in hand S. 2(ea)(vi)
Total 1 5 5
28.3 Includible net wealth of other persons
Name of other person Relationship Aggregate value of
all assets
Debts owed in relation to
such assets
Net amount [(c)-
(d)]
(a) (b) (c) (d) (e)
Total 156
28.4 Interest held in the assets of a firm or association of persons (AOP) as a partner or member thereof:
Name(s) and
Address(es) of
Firm(s)/AOP(s)
Name(s) of other
Partners/ Members
Assessee’s
Profit Sharing
Ratio (%)
Value of the Assessee’s
interest in the assets of
firm/ AOP as per
Schedule III
Debts owed in
Relation to such
Interest
Net Amount [(d)-(e)]
(a) (b) (c) (d) (e) (f)
Total 157
29. Assets claimed exempt:
Description of Asset Value Debt owed in relation to
the Asset
Reasons for the claim
30. List of documents/statements attached
Description In Figures In words
Verification
I (Name in full and in Block Letters)
son/daughter of 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, and that the net wealth and other particulars shown therein are truly stated and in accordance
with the provisions of the Wealth-tax Act, 1957, in respect of net wealth as on the valuation date chargeable
to wealth-tax for the assessment year .
I further declare that I am making this return in my capacity as (designation in case
of Company/Hindu undivided family) and that I am competent to make this return and verify it.
Date :
Place : Signature
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 lakhs rupees, with rigorous imprisonment for a 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.