Form 1 - Form 1 - Indirect Tax Dispute Resolution Scheme Rules, 2016

Form 1 [See rule 3(1)] FORM OF DECLARATION UNDER SUB SECTION (1) OF SECTION 214 OF THE FINANCE ACT, 2016 (28 OF 2016), IN RESPECT OF INDIRECT TAX DISPUTE RESOLUTION SCHEME, 2016 IN DUPLICATE To, The Designated Authority ............................................ ............................................ Sir/Madam, I hereby make a declaration under sub section (1) of section 214 of the Finance Act, 2016 (28 of 2016). 1 Name of the declarant (in block letters) 2 Registration Number 3 Address (as mentioned in order in original against which appeal has been filed before Commissioner (Appeals) 4 Telephone number 5 Order in original number 6 Date of order in original 7 Amounts demanded Duty/ Tax Interest Penalty 8 Commissioner (Appeals) before whom appeal is pending 9 Appeal No. 10 Amounts deposited Duty/ Tax Interest Penalty 11 Any other information VERIFICATION I, ...................................................... (name in block letters) son/daughter/of Shri ............................................ solemnly declare that to the best of my knowledge and belief, - (a) the information given in this declaration is correct and complete and amount due and other particulars shown therein are truly stated ; (b) I am not disqualified in any manner from making a declaration under the Scheme with reference to the provisions of section 215 of Finance Act, 2016. (c) I further declare that I am making this declaration in my capacity as ................... [(designation) (please specify if you are making a declaration on behalf of declarant)] and that I am competent to make this declaration and verify it. Place Signature of person making declaration Date Name of person making declaration Instructions for filling the Form 1. This Form should be submitted to the Commissioner of Customs or the Commissioner of Central Excise notified as designated authority under section 87(b)(ii) of the Finance (No. 2) Act, 1998. 2. Use separate Form for each appeal in respect of which declaration is being made. 3. No column shall be left blank. Wherever the entry is not relevant the column shall be filled in as 'Not applicable'. 4. In Row 2, registration number is to be filed only in respect of registered Central Excise and Service Tax Assessee. In respect of all others the row should be shown as Not applicable . 5. In case of any deposits made in the matter against the amounts demanded please indicate the same in row 10. 6. Any other information relevant to the case may be briefly indicated under row 11.