FORM OF DECLARATION UNDER SECTION 94 OF THE FINANCE ACT, 2008 IN RESPECT OF DISPUTE RESOLUTION SCHEME, 20

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..... ed Authority ………………. ………………. Sir/Madam, I hereby make a declaration under section 94 of the Finance Act, 2008. 1. Name of the declarant : …………………………… (in block letters) 2. Address : ………………………………………….. ………………………………………………………. ……………………..Telephone No…………………. 3. STC Code………………….. 4. Premises code 5. Details of the case and tax arrears proposed for settlement under the Sch .....

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..... nowledge and belief - (a) the information given in this declaration and statements and annexure accompanying it is correct and complete and amount of tax arrears and other particulars shown therein are truly stated; (b) I am not disqualified under provisions of section 93 of Finance Act, 2008 from making a declaration. I further declare that I am making this declaration in my capacity as .....

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