Form HSNS APL 01

(see rule 23)

Form of appeal to the appellate authority under section 29 of the Act

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 the 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 the appellant.

6. (i) Description and classification of specified goods

(ii) Period of dispute

(iii) Amount of cess, if any, demanded for the period mentioned in item (ii)

(iv) Amount of abatement/refund if any claimed for the period mentioned in item (i)

(v) Amount of fine imposed.

(vi) Amount of penalty imposed

(vii) Market value of seized goods.

7. Whether cess or penalty or both is deposited; if not whether any application for dispensing with such deposit has been made. (A copy of the challan under which the deposit is made shall be furnished).

8. Whether the appellant wishes to be heard in person?  

9. Reliefs claimed in appeal.

10. Statement of facts…………………………………………………………………………….

11. Grounds of appeal………………………………………………………………………………

Signature of the Authorise Representative, if any

Signature of the applicant

Verification

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………….

Place…………….

Date…………  

Signature of the Authorised

Signature of the applicant. Representative, if any  

Note.- (1) The grounds of appeal and the form of verification shall be signed by the appellant in accordance with the provisions of rule 23.

(2) The form of appeal including the statement of facts and the grounds of appeal shall be  accompanied by a copy of the decision or order appealed against.