THE MAHARASHTRA STATE TAX ON PROFESSIONS TRADES, CALLINGS AND EMPLOYMENTS RULES, 1975. - FORMS
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FORM XVI

APPEAL/REVISION APPLICATION AGAINST AN ORDER OF ASSESSMENT / APPEAL / PENALTY / INTEREST

(see rule 25)

	....................................................
	.....................................................

I here by appeal / apply for revision and furnish the necessary particulars.

(i)

Registration certificate No. ...................... Enrolment Certificate No. ..........................

(ii)

Name of the Employer and status ...................................

(iii)

Style of Profession, Trades, Calling, etc. .............................

(iv)

Location and address .........................................

(v)

Period involved under impugned orders against which Appeal / Revision, is preferred i.e. From ........................... To .................................

(vi)

(a)

Name of the authority who passed the impugned order .......................................

(b)

Date of the passing of the impugned order ...............................................................

(c)

Date of Service of Notice of Demand ......................................................................

(d)

Amount of (i) Tax ....................................................................................................

Amount of (ii) Penalty ....................................................................................................

Amount of (iii) Interest ...................................................................................................

Total ..........................................................................................

(e)

Amount of admitted Tax .......................................................................................

(f)

Amount paid	(i) Tax .........................................................................
	(ii) Penalty ...................................................................
	(iii) Interest .......................................................................

(g)

Amount in dispute .........................................................................................

Grounds ..................... .........................................................................................

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A certified copy of the impugned order is attached .

The above statements is true to the best of my knowledge and belief and the tax, penalty and interest payable by me has been paid in full.

Place ..........................	Signature ......................................
Date ...........................	Status ...........................................