Memorandum of Appeal — Income Tax

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Appeal to:

FORM OF APPEAL TO THE APPELLATE ADDITIONAL COMMISSIONER. IN THE OFFICE OF APPELLATE ADDITIONAL COMMISSIONER OF TAXES,
Circle of assessment
Name of Appellant and in the case of a firm, also the name of its partners
Income year
Assessment year
Deputy Commissioner of Taxes passing the order	Deputy Commissioner of Taxes Circle- , Taxes Zone- , Chattogram.
Section under which the Deputy Commissioner of Taxes passed the order
Income Tax Demanded
Tax paid
Date of service of the order appealed against or of the notice of demand	Demand Notice received on
Address to which the notice may be sent to the appellant
Relief claimed in appeal
GROUNDS OF APPEALAs per separate sheet attached.

Signature of Appellant

Name in block letter:

Mobile:

VERIFICATION

I/We the appellant, do hereby declare that what is stated above is true to the best of my/our information and belief.