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Entry Form XVI


(See rule 20)

Memorandum of Appeal Order under section 33 of the Goa Tax on Entry of Goods Act, 2000


Appeal Order No.

Appellant (s) V/s Respondent

Appeal against the order of the Commissioner, dated and passed in.


Office in which the assessment was made:


Assessment year:


Assessing Authority passing the original order:


State if the order was modified at any time previously by any officer subordinate to the Commissioner and if so in what manner (state the results of modification briefly).


Date of communication of the order of the Commissioner.


Address to which notice may be sent to the appellant.


Address to which notice may be sent to the respondent.


Relief claimed in appeal.


(a) Value determined by the Assessing Authority.


(b) Value as modified prior to suo motu by the Commissioner.


(c) Value of goods modified and fixed by the Commissioner.


(d) Relief claimed.


(e) Grounds of appeal


(i) state the facts disputed briefly.


(ii) state the questions of law raised decision by the High Court.


(Signed) Appellant (s)

(Signed) Authorised Representative,

if any



I/We, ............................................................ the appellant(s) do hereby declare that what is stated above is true to the best of my/ our knowledge and belief.

Verified today the day of



(Signed) Appellant (s)

(Signed) Authorised Representative

, if any



1 The appeal should be accompanied by a certified copy of the order of the Commissioner appealed against.
2 The appeal should be accompanied by a sum of Rs.500/-.
3 The appeal should be written in English and should set forth concisely and under distinct heads, the facts of the case, grounds of appeal and the points of law raised consecutively.
4 The number and year of appeal as allotted by the office of the Tribunal and appearing in the notice of appeal received by the respondent is to be filled in here by the respondent.
5 If the space provided is found insufficient, separate enclosures may be used for the purpose.
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