Form of application to Appellate
Tribunal under Section 86(2) [or Sec.86(2A) of the Finance Act, 1994 (32 of
1994)]
In the Customs, Excise and
Gold(Control) Appellate Tribunal Appeal
No._____________of______________20_________________________Applicant
v.
_____________________Respondent.
1.
Designation and address
of the applicant (if the applicant is not the adjudicating authority, a
copy of the authorisation from the Commissioner of Central Excise to
make the application should be enclosed).
2.
Name and address of the
respondent.
3.
Designation and address
of the officer passing the decision or order in respect of which this
application is being made and the date of the decision or order.
4.
State/Union territory and
the Commissionerate in which the decision or order was made.
5.
Date on which order under
sub-section(2) of Section 86 of the Finance Act, 1994, has been passed
by the Board or the date on which the order under sub-section (2A) of
Section 86 of Finance Act,1994 has been passed by the Commissioner of
Central Excise.
6.
Date of communication of
the order referred to in (3) above to the adjudicating authority.
7.
Whether the decision or
order appealed against involves any question having a relation to the
rate of tax or to the value of taxable service for purpose of
assessment; if not , difference in tax or duty involved, or amount of
penalty involved or value of goods involved, as the case may be.
7A.
(i)
Period of dispute
(ii)
Amount of tax, if any,
demanded for the period mentioned in column (i)
(iii)
Amount of refund, if any,
claimed for the period mentioned in column (i)
(iv)
Amount of interest
imposed.
(v)
Amount of penalty
imposed.
8.
Reliefs claimed in the
application.
STATEMENT OF FACTS
Grounds of application
Signature of the applicant
Note: The form of application
including the statement of facts and grounds of application shall be filed in
quadruplicate and shall be accompanied by an equal number of copies of the
decision or order passed by the Commissioner of Central Excise (one of which at
least shall be a certified copy) and a copy of the order passed by the Board or
copies of orders of the Commissioner of Central Excise (Appeals) (one of which
shall be a certified copy) and a copy of the order of the Commissioner of
Central Excise, as the case may be, under Sub-section(2) of Section 86.
FORM
(see sub-rule (4) of rule 5)
Return under rule 5 of the Service Tax Credit Rules, 2002
(For the period from________ to________)
Input service
Sl No.
Date and no. of document
on which credit is availed
Details of input service
provider
Details of input service
ST regd. No.
Address
Description
Value
Credit taken
Service tax credit
Opening balance
Credit taken
Credit utilised
Closing balance
Place:-
Date :-
Name and signature of the
assessee or
his authorised representative".
