THE WEST BENGAL VALUE ADDED TAX RULES, 2005 : FORMS
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 68

[See rule 138, rule 144, rule 148, rule 156 and rule 161]

Form of memorandum of appeal under section 84/ application for revision under section 86/ application for revision under section 87/ application for review under section 88 of the West Bengal Value Added Tax Act, 2003

Details of fees paid:-

Amount (Rs.)

Date

Bank

Branch

Challan No.

(a) Nature of petition /application [put (tick) in appropriate box]

Appeal under section 84

Revision under section 86

Revision under section 87

Review under section 88

B. Memorandum / Application submitted before

C. Trade name of the appellant / applicant

D. Certificate of Registration No. under W.B.V.A.T. Act 2003, if any

E. Address of the principal place of business in West Bengal, if any

F. Address for communication, if other than in E above

G. Mobile Telephone No. of appellant / applicant

H. E-mail ID of appellant / applicant

(I) Prayer for stay of realisation of disputed demand and documents attached/submitted along with Form 68 [ Put (tick) if attached / submitted]

a. * I pray for stay of realisation of disputed demand/I do not pray for stay of realisation of disputed demand

b. Receipt of Fees Paid

c. Copy of Notice of Demand

d. Copy of Order against which the application / petition is made

e. Grounds of Appeal / Revision/Review

6. Designation of the officer who passed the order
7. Date of receipt of the relevant notice of demand, if any
8. Date of receipt of order against which the petition / application is made
9. Appeal Case Number, if any (only for revision u/s 87/review u/s 88)

(d) Particulars of provisional assessment or any other assessment relevant for memorandum of appeal under section 84 / application for revision under section 87/review under section 88: -

(a) The particulars of your appellant's / applicant's turnover of sales, taxable turnover of purchases, taxable contractual transfer price, etc and of tax, tax credit, interest, penalty and late fee, as assessed under section 45/section 46/section 48(1)/ section 48(2) /section 50/section 51/section 53A, and as modified / confirmed in appeal, [Put <f applicable] and the relevant amounts admitted to be payable by your appellant / applicant are given below:-

SI. No	Particulars	Amount as per demand notice/ order (Rs.)	Admitted Amount (Rs.)
SI. No	Particulars	Turnover/sale or purchase price /TCTP etc.	Tax ,Interest, late fee etc.	Turnover /sale or Purchase Price /TCIP etc.	Tax interest late fee etc.
I	Turnover of sales on which tax is payable and output tax thereon
II	Taxable turnover of purchases and output tax thereon
III	Taxable contractual transfer price (TCTP) and output tax thereon
IV	Total output tax
V	(A) Net tax credit allowed u/s 22(17)
	(B) Amount of ITC adjusted with tax payable under C.S.T. Act, 1956
	I Amount of ITC already refunded u/s 61/22(8A)
	(D) Amount of ITC surrendered u/s 22(8 A)
	(E) Net tax credit carried forwarded to next period
	(F) Amount of ITC adjusted with output tax for this period
VI	Input tax credit accumulated during the period [for EC holders]
VII	Remission of tax under section 118(1)1 [for EC holders]
VIII	Net Tax Payable / Further unadjusted Net Tax Credit
IX	Deferment of tax under section 118(1)(a) [for EC holders]
X	Penalty imposed u/s 45(2) / 46(2)
XI	Late fee payable u/s 32(2)
XII	(a) Interest payable for the period u/s 33/34
XII	(b) Interest payable for the period u/s 34A
XIII	Tax, interest, penalty and late fee paid by challans
XIV	Tax deducted at source as per Form 18 furnished
XV	Total amount of tax, interest, penalty and late fee paid
XVI	Sale price and tax thereon under section 16A [ for casual dealers]
XVII	Purchase price and tax thereon under section 17A [for casual dealers]
VIII	Any other item not specified above (specify)

(e) The particulars of your appellants / applicants disputed amounts of turnover of sales, taxable turnover of purchases, taxable contractual transfer price, etc. and tax, tax credit, insert, penalty and late fee are given below :

SI. No.	Particulars	Turnover /TCTP(Rs.)	Tax /tax credit/interest/late fee /penalty in dispute (Rs.)
I	Turnover of sales on which tax is payable and output tax thereon
II	Taxable turnover of purchases and output tax thereon
III	Taxable contractual transfer price and output tax thereon
IV	Net tax credit allowed u/s 22(17)
V	Input tax credit accumulated during the period [for EC holders]
VI	Net tax payable / Further unadjusted net tax credit
VII	Interest determined / re-determined u/s 50 / 51
VIII	Late fee payable u/s 32(2)
IX	Penalty imposed u/s 45(2)/46(2)
X	Tax, interest, penalty and late fee paid by challans
XI	Tax deducted at source as per Form 18 furnished
XII	Total amount of tax, interest, penalty and late fee in dispute
XIII	Tax payable under section 16A [for casual dealers]
XIV	Tax payable under section 17A [for casual dealers]
XV	Any other item not specified above (specify) .........................................

(f) Particulars in respect of an order, other than an order of provisional assessment or any other assessment, as relevant for the application for revision under section 86 / review under section 88 : -

Particulars	Amount of demand as per order (Rs.)	Admitted Amount (Rs.)	Disputed amount (Rs.)
(a) Order imposing penalty under *section 23(4)/ section 25(2)/ section 27E/ section 30C/ section 30E/ section 39(4)/ section 40(5)/ section 65/ section 77/ section 78/ section 79/ section 80(5)/ section 96(1)/ section 101(1)/ section 117 :
(b) Order for demand of security under section 26 / section 80(3): State the nature of order [ e.g. amendment of RC]:.
(c) Amount of demand by an order under section/rule ........
(d) Any other order under section ................................... Of the Act

12. Your appellant / applicant has made the following payments in respect of the order referred to in 10 or 11 above.

(A) Before order referred to in serial 10 / serial 11 above is passed		(B) After order referred to in * serial 10 / serial 11 above is passed [if payment of one type is by more than one challan, mention the total amount and attach separate sheet]
Particulars	Amount	Particulars	Amount	Date	Name of bank	branch	Challan No.
Tax		Tax
Interest		Interest
Penalty		Penalty
Late Fee		Late Fee
Security		Security

13. Your appellant / applicant has collected Rs. .............................................. as tax under the WBVAT Act, 2003 for the period.

14. Being aggrieved by the afore-mentioned order dated .................................... of ............................................ [designation of authority] your appellant / applicant begs to prefer this appeal / revision / review petition on he following grounds :-

GROUNDS

(Here enter the grounds on which you rely for the purpose of this appeal / revision / review petition attach separate sheet, if required)

Your appellant / applicant, therefore, prays that he may be assessed accordingly or that he may be declared not to be chargeable to tax, penalty, late fee and interest under the Act or that the provisional assessment or any other assessment made may be modified/cancelled and/or remanded to the assessing authority for reassessment or that the order dated ............................. imposing penalty/demanding security may be set aside and/or that your *appellant / applicant may be granted such relief or reliefs as may be deemed just and proper.

Verification

I, ............................................................................................................... the appellant / applicant, do hereby declare that all tax, interest, late fee and penalty admitted to be due in respect of the order of provisional assessment or any other assessment / imposition of penalty / demand of security / any other order against which this petition for

appeal / revision / review is submitted has been paid as shown in 12(B) above, and that what is stated herein is true to the best of my knowledge and belief.

Place: Signature.............

Date : Name of the appellant/applicant.............

Status ............................

Put (tick) in appropriate box wherever required. Strike out or remove what is not applicable.

[# To be signed by the appellant / applicant dealer or casual dealer or person or by an agent duly authorised in writing in this behalf.]