Bihar Value Added Tax Rules, 2005 FORMS
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Form A-VI

Memorandum of appeal under section 72 of the Bihar Value Added Tax Act, 2005

[See rule 45(3)]

Office of the ________________________ of Commercial Taxes (Appeals) ________________ Division

To,

The________________________ of Commercial Taxes (Appeals) _________________ Division

I _______________________ (full name) son of __________________________ (full name) hereby prefer this appeal against the order, dated ____ passed by ________________ and furnish the following particulars for that purpose:-

Name and style of the Firm

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

Taxpayer Identification No.

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

Address to which communication should ordinarily be dispatched.

(a) Mohalla/ Road ..............................................	(b) Village/ Town .................................................
(c) Post office ....................................................	(d) Police-station .................................................
(e) Sub-division .................................................	(f) District ............................................................
(g) Pincode .......................................................	(h) Telephone .....................................................

Period to which the appeal relates. .......................................................................................................

Details of service of demand notice .....................................................................................................

Details of Turnover and Tax Assessed

(To be furnished only in case of an application for revision concerning an assessment / re-assessment)

_______________________________________________________________________________________________
Particulars		As determined by Assessing Authority	As Admitted by the Appellant
_______________________________________________________________________________________________
1		2	3
_______________________________________________________________________________________________
(a)	Gross turnover	..........................................	.........................................
(b)	Taxable turnover	..........................................	.........................................
(c)	Total amount of tax assessed or re-assessed.	..........................................	.........................................
(d)	Section under which Assessment or re-assessment made.	..........................................	.........................................

7	Amount of penalty, if any imposed and section under which imposed. ..................................................................
8	Details of payment made
	Challan No.	Date	Amount
1.	..........................................	..........................................	..........................................
2.	..........................................	..........................................	..........................................

9	Amounts in dispute :
	(a) Tax	Rs. ......................................	(c) Interest	Rs. ........................................
	(b) Penalty	Rs. ......................................	(d) Total	Rs. ........................................
10	List of papers and documents filed :
	(a) Certified copy of the order appealed against, together with the notice of demand.
	(b) Two extra copies of this memorandum.
	(c) ...................................................................................................................................................................
	(d) ...................................................................................................................................................................
	(e) ...................................................................................................................................................................
	(f) ...................................................................................................................................................................
11	Statement of the facts of the case and prayer
	(a) The facts of the case are as follows:-
	................................................................................................................................................................................. .................................................................................................................................................................................
	(b) The points at issue are as follows:-
	................................................................................................................................................................................. .................................................................................................................................................................................
	(c) Grounds for appeal are as follows:-
	................................................................................................................................................................................. .................................................................................................................................................................................
	(d) Relief sought is as follows:-
	................................................................................................................................................................................. .................................................................................................................................................................................

VERIFICATION

I do hereby declare that the above particulars and statements are correct and complete to the best of my knowledge and belief.

Place____________________________	Signature ______________________
Date ____________________________	Status ________________________

ACKNOWLEDGMENT

Received on ___________________ from ______________________ memorandum of appeal in Form A-VI, for the period _____________ together with/without the papers and documents specified at item 13 of the memorandum of appeal. The appeal number allotted is _____________________ of ___________________

Signature of receiving authority

Designation