The Central Sales Tax (Orissa) Forms
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FORM XIV

Form of appeal under rule 3 (4) (a) of the Central Sales Tax

(Orissa) Rules, 1957

The Assistant Commissioner of Sales Tax/Additional Commissioner of Sales Tax/ Special Additional Commissioner of Sales Tax
1	Name(s) of the appellant(s)
2	Assessment year
3	Authority passing the original order in dispute
4	Date on which the order was communicated
5	Address to which notice may be sent to the appellant(s)
6	Relief claimed in appeal.
7	Grounds of appeal, etc.

(Signed)

Appellants(s)

(Signed)

Authorised representative, if any,

Verification

I/We ............................................. the appellant(s) named in the above appeal do hereby declare that what is stated herein is true to the best of my/our knowledge and belief.

Verified today ............................................... day of ................................ 19 ................................

(Signed)

Appellant(s)

(Signed)

Authorised representative, if any.

Strike off whichever is not applicable