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

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..... 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 .....

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..... 4 Telephone number .....

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..... Interest Penalty .....

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..... Penalty 11 Any other inf .....

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..... 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 .....

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