FORM 3 - Form of appeal to the Appellate Tribunal - Black Money (Undisclosed Foreign Income and Assets) and Imposition of Tax Rules, 2015

FORM 3 [ See rule 7(1)] Form of appeal to the Appellate Tribunal In the Appellate Tribunal *Appeal No ..of 20 .. APPELLANT versus RESPONDENT 1. The State in which the assessment was made 2. Permanent Account Number of the assessee (Appellant/Respondent) 3. Section under which the order appealed against was passed 4. Assessment year in connection with which the appeal is preferred 5. Total undisclosed foreign income and asset assessed by the Assessing Officer for the assessment year referred to in item 4 6. The Assessing Officer passing the original order 7. Section of the Black Money (Undisclosed Foreign Income and Assets) and Imposition of Tax Act, 2015 under which the Assessing Officer passed the order 8. The Commissioner (Appeals) passing the order under section 12/15/45 9. Date of communication of the order appealed against 10. Address to which notices may be sent to the appellant 11. Address to which notices may be sent to the respondent 12. Relief claimed in appeal GROUNDS OF APPEAL 1. 2. 3. 4. etc. . . Signed Signed (Authorised representative, if any) (Appellant) 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 . .. Signed Notes: 1. The memorandum of appeal shall be in triplicate accompanied by two copies (at least one of which should be a certified copy) of the order appealed against, two copies of the relevant order of the Assessing Officer, two copies of the grounds of appeal before the first appellate authority, two copies of the statement of facts, if any, filed before the said appellate authority. 2. The memorandum of appeal by an assessee under sub-section (1) of section 18 of the shall be accompanied by a fee of twenty five thousand rupees. 3. The fee shall be credited in a branch of the authorised Bank or a branch of the State Bank of India or a branch of the Reserve Bank of India after obtaining a challan and the triplicate challan shall be sent to the Appellate Tribunal with a memorandum of appeal. The Appellate Tribunal shall not accept cheques, drafts, hundies or other negotiable instruments. 4. The memorandum of appeal shall be written in English or, if the appeal is filed in a Bench located in any such State as is for the time being notified by the President of the Appellate Tribunal for the purposes of rule 5A of the Income-tax (Appellate Tribunal) Rules, 1963, then, at the option of the appellant, in Hindi, and shall set forth, concisely and under distinct heads, the grounds of appeal without any argument or narrative and such grounds shall be numbered consecutively. 5. *The number and year of appeal will be filled in the office of the Appellate Tribunal. 6. Delete the inapplicable columns. If the space provided is found insufficient, separate enclosures may be used for the purpose.