The Assam Value Added Tax Rules, 2005. Forms
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THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-68

[See Rule 46]

MEMORANDUM OF APPEAL

(in duplicate)

To,

The . . . . . . . . . . . . . . . .

		Dated. . . . . . . .the . . . . . .the day of ______.

01.	Name and address of the applicant	:
02.	Certificate of Registration No	:
03.	Assessment year	:
04.	Name and designation of the officer who passed the final order.	:
05.	Date of final order	:
06.	Date of communication of the final order	:
07.	Date of communication of the final order	:

(a)	Turnover determined by the Prescribed Authority	:

(b)	If the turnover is disputed -	:

	(i) Disputed turnover

	(ii) Tax due on the disputed turnover

	(iii) Reasons of dispute

(c)	If the rate is disputed-	:

	(i) Turnover involved.

	(ii) Amount of tax disputed-

(d)	If the penalty is disputed	:

	(i) Reasons thereof.

(e)	Any other relief claimed	:

8	Grounds of appeal in brief	:

	Signature . . . . . . . . . . . . . .
	Status . . . . . . . . . . . . . . . . .
	Seal . . . . . . . . . . . . . . . . . . .

VERIFICATION

I/We . . . . . . . . . . .of M/s.. . . . . . . . . . . . . enclose herewith the certified copy of final order passed and the receipted copy of Challan No.. . . . . . . . . . . Dated . . . . . . . . . . .showing deposit of tax-assessed/penalty imposed and do hereby declare that the facts stated above are true of the best of my/ our knowledge and belief.

Date . . . . . . . . . .	Signature . . . . . . . . . . . . . .
	Status . . . . . . . . . . . . . . . . .
	Seal . . . . . . . . . . . . . . . . . . .