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FORM 17
[See Rule 21]
Memorandum of appeal |
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To,
The Profession Tax Appellate Authority,
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I here appeal and furnish the necessary particulars:- |
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1. |
Registration Certificate No.
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2. |
Name of the employer /person
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3. |
Style of profession / trade/calling
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4. |
Address
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5. |
Period involved under impugned order against which appeal is
preferred |
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6. |
(a) Name of the authority who passed impugned order. |
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(b) date of order |
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(c) Date of service of demand notice |
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(d) Amount demanded |
(i) Tax |
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(ii) Penalty |
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Total |
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(e) Amount of admitted tax |
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(f) Amount
paid:-
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(i) Tax |
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(ii) Penalty |
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Total |
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(g) Amount in dispute |
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7. |
Grounds on which appeal has been preferred
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A certified copy of the impugned order and a copy of Challan
in proof or payment of tax/ penalty are enclosed. |
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The above statement are true to the best of my knowledge and
belief
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Place : |
Signature |
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Date : |
Status |
