[Cites 0, Cited by 0]
[Section 5]
[Entire Act]
Union of India - Subsection
Section 5(3) in The Indirect Tax Dispute Resolution Scheme Rules, 2016
| Form 1[Seerule 3(1)]Form of Declaration under Sub-section (1) Of Section 214 ofthe Finance Act, 2016 (28 of 2016), in Respect of Indirect TaxDispute Resolution Scheme, 2016In DuplicateTo,The Designated Authority........................................................................................Sir/ Madam,I hereby make a declaration under sub section (1) of section214 of the Finance Act, 2016 (28 of 2016). |
| 1. | Name of the declarant (in block letters) |
| 2. | Registration Number |
| 3. | Address (as mentioned in order in original against which appeal has been filed before Commissioner (Appeals) | ||||||||||||||||||||
| 4. | Telephone Number |
| 5. | Order in original number |
| 6. | Date of order in original |
| 7. | Amount demanded Duty/ Tax | ||||||||||||||||||||
| Interest | |||||||||||||||||||||
| Penalty |
| 8. | Commissioner (Appeals) before whom appeal is pending |
| 9. | Appeal No. |
| 10. | Amounts deposited Duty/ Tax | ||||||||||||||||||||
| Interest | |||||||||||||||||||||
| Penalty |
| 11. | Any other information |
| Verification |
| I, ..................................................................... (name in block letters) son/ daughter/ of Shri ............................................ solemnly declare that to the best of my knowledge and belief, - |
| (a) | the information given in this declaration is correct and complete and amount due and other particulars shown therein are truly stated ; |
| (b) | I am not disqualified in any manner from making a declaration under the Scheme with reference to the provisions of section 215 of Finance Act, 2016. |
| (c) | I further declare that I am making this declaration in my capacity as ................... [(designation) (please specify if you are making a declaration on behalf of declarant)] and that I am competent to make this declaration and verify it. |
| Place | Signature of person making declaration | ||
| Date | Name of person making declaration |