The Assam Value Added Tax Rules, 2005. Forms
-

THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-69

[See Rule 47(1)]

MEMORANDUM OF APPEAL FILED BEFORE THE APPELLATE TRIBUNAL

(IN QUADRUPLICATE)

The President

Appellate Tribunal,

	Dated . . . . . . .the . . . . day of _______
	. . . . . . . .. . . . . .. . . . . . .Appellant
	Versus
	. . . . . . . . . . . . . . . .Respondent

01.	Unit and district in which the assessment was made	:
02.	Year of assessment	:
03.	Authority passing the order in dispute	:
04.	Appellate Authority passing the order in appeal under Section______	:
05.	Date of communication of the order appealed against	:
06.	Address to which notice may be sent to the appellant	:
07.	Address to which notice may be sent to the respondent	:
08.	Relief claimed in appeal

(a)	Turnover determined by the Prescribed Authority passing the assessment order disputed.	:

(b)	Turnover confirmed by the Appellate authority	:

(c)	If the turnover is disputed
	(i) Amount of tax disputed
	(ii) Tax due on disputed turnover
	(iii) Reasons of dispute

(d)	If rate of tax is disputed	:
	(i) Amount of tax disputed

(e)	If penalty is disputed	:
	(i) Reason thereof

(f)	Any other relief claimed

09.	Grounds of appeal.	:

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

VERIFICATION

I/We . . . . .. . . . . . . .of M/s. . . . . . . . . . . enclose herewith the certified copy/copies of order appealed against and do here by declare that the facts stated above are true to the best of my/ our knowledge and belief.

Date . . . . . . .. .

Signature . . . .. . . . . . . . .

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

Seal . . . . . . . . . . . . . . . . ..