ANNEXURE-43

Form No. E.A.-8

[See Rule 9]

Form of revision application to the Central Government under section 35EE of the Act

Revision application No…………………of………………….2001……………….

1. Name and address of the applicant:
   
   
2. Address of the Commissioner (Appeals) passing the order against which the revision application is filed:
   
   
3. The number and date of the order:
   
   
4. Date of communication of the order:
   
   
5. Designation and address of the adjudicating authority against which the order has been passed by the Commissioner (Appeals):
   
   
6. Address to which notices/communications may be sent to the applicant:
   
   
7. Whether the appellant wishes to be heard in person.
   
   
8. .
   1. Description of classification of goods
      
      
   2. Period of dispute
      
      
   3. Amount of duty, if any, demanded for the period mentioned in item (ii)
      
      
   4. Amount of refund , if any, claimed for the period mentioned in item (ii)
      
      
   5. Amount of fine imposed
      
      
   6. Amount of penalty imposed
      
      
   7. Market value of seized goods.
      
9. Whether duty or penalty, if any, has been deposited (a copy/extract of the challan/account-current, as the case may be, under which the deposit is made, shall be furnished):
   
   
10. Relief claimed in application:
    

Statement of facts
Grounds of application

Signature of the authorised
representative, if any.

Signature of the applicant.

Verification

I,…………………………..the applicant, do hereby declare that what is stated above is true to the best of my information and belief.

Verified today, the……………….day of…………………………….2001……..

Signature of the authorised
representative, if any.

Signature of the applicant.

Notes:-

1. The grounds of application and the form of verification shall be signed by the person specified in sub-rule (2) of Rule 3.
   
   
2. Where the application is signed by the authorised representative of the applicant, the document authorising the representative to sign and appear on behalf of the applicant shall be appended to the application.
   
   
3. The application, including the statement of facts and the grounds of application shall be filed in duplicate and shall be accompanied by an equal number of copies of the order against which the application is filed and also the decision/order of the adjudicating authority against which Commissioner (Appeals) passed the order.
   
   
4. The form of application shall be in English (or Hindi) and should set forth concisely and under distinct head grounds of application without any argument or narration and such grounds should be numbered consecutively.
   
   
5. The fee of Rs. 200.00 required to be paid under the provisions of the Act shall be paid under T.R. 6 challan and the duplicate copy of the T.R. 6 challan shall be filed along with the application for revision.