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Service = Tax=20

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FORM ST =96 5

Form of Appeal to = Appellate Tribunal=20 under section 86 of the Finance Act, 1994 ( 32of 1994 )

In the Customs, Excise = and Gold=20 (Control) Appellate Tribunal Appeal No. ________________ of __________=20 20_____________ _______________________ Appellant

v.

______________________=20 Respondent

1.

The designation and = address of=20 the authority passing the order appealed against.
2.

The number and the = date of the=20 order appealed against.
3.

Date of = communication of a copy=20 of the order appealed against.
4.

State / Union = territory and the=20 Commissionerate in which the order / decision of assessment / = penalty /=20 interest was made.
5.

Designation and = address of the=20 adjudicating authority in cases where the order appealed against = is an=20 order of the Commissioner (Appeals).
6.

Address to which = the notices may=20 be sent to the appellant.
7.

Address to which = the notices may=20 be sent to the respondent.
8.

Whether the = decision or order=20 appealed against involves any question having a relation to the = value of=20 the taxable service for purposes of assessment; if not , = difference in tax=20 or tax involved, or amount of interest or penalty involved, as the = case=20 may be.
8A.

(i)

Period of = dispute

(ii)

Amount of tax if = any, demanded=20 for the period mentioned in item (i)

(iii)

Amount of refund, = if any, claimed=20 for the period mentioned in item (i)

(iv)

Amount of interest=20 involved.

(v)

Amount of penalty=20 imposed.
9.

Whether tax or = penalty / interest=20 is deposited; if not, whether any application for dispensing with = such=20 deposit has been made ( a copy of the challan under which the = deposit is=20 made shall be furnished).
9A.

Whether the = appellant wishes to=20 be heard in person.
10.

Reliefs claimed in=20 appeal.

 

STATEMENT OF = FACTS
Grounds of appeal

(i)
(ii)
(iii)
(iv)

Signature = of the=20 authorised
representative, if any		 Signature = of the=20 appellant

 Verification

I, ______________________ = the=20 appellant, do hereby declare that what is stated above is true to the = best of my=20 information and belief.

Verified today, the=20 ____________________ day of ______20_____

Place:
Date = :

Signature of the=20 authorised
representative, if any 		Signature of the = appellant
or=20 his authorised=20 representative

Note :-

(1)

The appeal = including the=20 statement of facts and the grounds of appeal shall be filed in=20 quadruplicate and shall be accompanied by an equal number of = copies of the=20 order appealed against (one of which at least shall be a certified = copy).

(2)

The form of appeal = shall be in=20 English (or Hindi) and should set forth, concisely and under = distinct=20 heads, the grounds of appeal without any argument or narrative and = such=20 grounds be numbered consecutively.

(3)

The fee of Rs. = 200/- required to=20 be paid under the provisions of the Act shall be paid through a = crossed=20 bank draft in favour of the Assistant Registrar of the Bench of = the=20 Tribunal on a branch of any nationalised bank located at the place = where=20 the Bench is situated and demand draft shall be attached to the = form of=20 = appeal.

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