FORM ST-4
- Document type
- Form
- Dated
- Category
- Form & Annexure
Form of Appeal to the Commissioner of Central Excise (Appeals) under section 85 of the Finance Act,1994 (32 of 1994)
FORM ST-4
Form of Appeal to the Commissioner of Central Excise (Appeals) under
section 85 of the Finance Act,1994 (32 of 1994)
| 1. | No.__________of______20_________ | : |
| 2. | Name and address of the appellant | : |
| 3. | Designation and address of the officer passing the decision or order appealed against and the date of decision or order | : |
| 4. | Date of communication of the decision or order appealed against to the appellant | : |
| 5. | Address to which notices may be sent to appellant | : |
| 5A. | (i) Period of dispute | : |
| (ii) Amount of service 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 | : | |
| (v) Amount of penalty | : | |
| (vi) Value of the taxable service for the period mentioned in column (I) | : | |
| 6. | Whether service tax or penalty or interest or all the three have been deposited? | : |
| 6A. | Whether the appellant wishes to be heard in person? | : |
| 7. | Relief claimed in appeal | : |
Grounds of appeal
| Signature of the authorized representative, if any | Signature of the appellant |
I,______________________ the appellant, do hereby declare that what is stated above is true to the best of my information and belief.
- Verified today, the ____________________ day of _________20__
Place:
Date :
| Signature of the authorized representative, if any | Signature of the appellant or his authorized representative |
- Note:
- The form of appeal including the statement of facts and the grounds of appeal shall be filed in duplicate and shall be accompanied by a copy of the decision or order appealed against.