The Orissa Value Added Tax Rules, 2005 FORMS
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Body

FORM VAT-502

FORM OF MEMORANDUM OF APPEAL TO THE TRIBUNAL

[Refer sub-rule (1)(a) of rule 93]

01. Office address

D	D		M	M		Y	Y	Y	Y
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TIN/SRIN

03.

Appellant(s)

(Name and full address)

Versus

Respondent(s)

(Full address)

4	Circle/Range/LTU in which assessment was made
5	Tax period(s) for which assessment was made
6	Designation of the assessing authority passing the order of assessment/the order of penalty, now appealed against and the date of his order
7	Designation of the appellate authority passing the order in appeal under Section 78 of the Act and the date of his order
8	Date of receipt of the appellate order under Section 78 of the Act by the appellant(s)
9	Full address to which notices may be sent to the appellant(s)
10	Details of turnover

As determined by Assessing Authority	As determined by 1st Appellate Authority	As claimed by the appellant
1	2	3
(i) Gross turnover
(ii) Taxable turnover
(iii) Tax
(iv) Penalty
(v) Interest

Assessment of tax/penalty/interest in dispute and fee paid thereon

12. GROUNDS OF APPEAL

13.

VERIFICATION

I_______________________________ son of __________________________________ (status) _______________________ of the business known as M/s. ______________________ at (address) _____________________, the appellant(s), do hereby declare that what is stated in the memorandum is true to the best of my knowledge and belief.

Place ___________________

Date____________________

Signature of the appellant

VERIFICATION

I _________________________ (designation) _____________________________ on behalf of the State Government do hereby declare that what is stated in this memorandum is true to the best of my knowledge and belief based on official records.

Place_________________

Date___________________

Signature

Designation