FORM O-8A

[See rule 18 of schedule III]

Statement of valuation of jewellery

Sl. Description of Gross Net weight Description and Value of each Total value
No. item weight of precious weight of precious precious of semi- of the item
metal or semi-precious precious stone of jewellery
stones and decided value
of such stones
(1) (1) (1) (1) (1) (1) (1)

I hereby declare that the information furnished above is true and correct to the best of my knowledge and belief

Date.:
Place: Signature of the assessee

Notes :
1. If the space provided above is not sufficient, details may be attached on separate sheets.
2. If the item of jewellery have been valued by a registered valuer, a copy of the report of such valuer may be
enclosed.