FORM NO. C.A.-1

[Refer Rule 3 of the Customs (Appeal) Rules, 1982]

Form of Appeal to the Commissioner (Appeals) under Section 128 of the Customs Act, 1962

(1) No ....................... of. ............... 19..................

(2) Name and address of the appellant.

(3) Designation and address of the officer passing the decision or order appealed against and the date of the decision or order.

(4) Date of communication of the decision or order appealed against to the appellant.

(5) Address to which notices may be sent to the appellant.

(6) Whether duty or penalty or both is deposited : If not, whether any application for dispensing with such deposit has been made. (A copy of the Challan under which is deposit is made shall be furnished).

(6A) Whether the appellant wishes to be heard in person.

(7) Reliefs claimed in appeal.

Statement of facts Grounds of appeal

(i)

(ii)

(iii) etc.

Verification

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

Verified today, the............................... day of. .....................19 ...................

Place ..........................

Date .............................

Notes : (1) The grounds of appeal and the form of verification shall be signed by the appellant in accordance with the provisions of Rule 3 of the Customs (Appeals) Rules, 1982.

(2) The form of appeal, including the statement of facts and the grounds of appeal shall be filed in duplicate and shall be accompanied by a copy of the decision or order appealed against.