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Entry Form XII


[See rule 16(2)]

Form of Appeal against an order of assessment

under section 14



The Deputy /Assistant Commissioner of Entry Tax

The day of 2000



Name (s) of appellant (s)


Assessment year


Assessing Authority passing the assessment orders disputed


Date on which the order was communicated


Address to which notice may be sent to the appellant


Relief claimed in appeal


Value of goods determined by the assessing authority


If value is disputed


(i) Disputed value


(ii) Tax due on the disputed value


If rate of tax is disputed value


(i) Value involved


(ii) Amount of tax disputed


Any other relief claimed


Grounds of appeal, etc.


(Signed) Appellant(s)

(Signed) Authorised representative, if any,




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

Verified today the date of 2000


(Signed) Appellant(s)

(Signed) Authorised representative, if any,





The appeal should be accompanied by the order appealed against in original or by a certified copy thereof unless the omission to produce such order or copy is explained to the satisfaction of the appellate authority and by proof of payment of the tax admitted by the appellant(s) to be due or of such installments thereof as might have become payable.



The appeal should be written in English and should set forth. Concisely and under distinct heads the grounds of appeal (without any argument or narrative) and such grounds should be numbered consecutively.

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