[See Rule 5 of the Wealth Tax Rules, 1957]
FORM OF APPEAL TO THE COMMISSIONER (APPEALS)
UNDER SECTION 23 OF THE WEALTH TAX ACT, 1957.
WEALTH TAX RANGE _________________________________
+WTA No. of
1.Name and address of the appellant2.Permanent Account Number / GIR No.
3.Assessment year in connection with which
the appeal is preferred.
4.Asessing Officer / Valuation Officer passing
the order appealed against
5.Where valuation of any asset has been referred
to the Valuation Officer, designation
and address of such Valuation Officer
6.Section and sub-section of the Wealth-tax Act,
1957, under which the Assessing
Officer / Valuation Officer passed
the order appealed against and the
date of such order
7.Where the appeal relates to any assessment,
penalty/fine, the date of service
of the relevant notice of demand
8.In any other case, the date of service of the
intimation of the order appealed
9.Section of the Wealth-tax Act, 1957, under
which the appeal is preferred
10.Where return has been filed by the appellant
for the assessment year in
connection with which the appeal
is preferred, whether tax due on
the net wealth returned has been
paid in full. (If the answer is in
the affirmative, give details of
the date of payment and amount paid).
* Relief claimed in appeal
** Where an appeal in relation to any other
year is pending in the case of the appellant with any
Commissioner (Appeals), give the details as to the -
(a) Commissioner (Appeals) with whom the appeal
(b) Assessment year in connection with which the
appeal has been preferred
(c) Assessing Officer / Valuation Officer passing
the order appealed against
(d) Section and sub-section of the Act, under
which the Assessing Officer / Valuation Officer
passed the order appealed against and the dateof such order
11. Address to which the notices may be sent to
___________________________________________________________________________STATEMENT OF FACTS *
GROUNDS OF APPEAL*
FORM OF VERIFICATION
____________________ the appellant, do hereby declare that what is stated above is true to the best of my information and belief.
(STATUS OF THE APPELLANT)
1. The form of appeal, grounds of appeal and the form of verification appended thereto shall be signed by a person in accordance with the provisions of section 15A of the Wealth-tax Act, 1957.
2. The memorandum of appeal, statement of facts and the grounds of appeal must be in duplicate and should be accompanied by a copy of the order appealed against and the notice of demand in original, if any.
3. Delete the inappropriate words.
4. + The particulars will be filled in, in the office of the Commissioner (Appeals).
5.* If the space provided herein is insufficient, separate enclosures may be used for the purpose.
6. ** If appeals are pending in relation to more than one assessment year, separate particulars in respect of each assessment year may be given.
Section 138 of Negotiable Instruments Act
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