FORM NO. 3 - Appeal to the Commissioner of Income-tax (Appeals) Designation of the Commissioner (Appeals) - Equalisation levy Rules, 2016

1 [ FORM NO. 3 [See rule 8 of Equalisation levy Rules, 2016] Appeal to the Commissioner of Income-tax (Appeals) Designation of the Commissioner (Appeals) *No. .of .. EL-3 1. Name and address of the appellant 2. Permanent Account Number/ AADHAAR 3. Financial year in connection with which the appeal is preferred 4. Assessing Officer passing the order appealed against 5. Details of order appealed against (a) Section and sub-section of Chapter VIII of the Finance Act, 2016, under which the order appealed against was passed (b) Date of order (c) Date of service of the notice of demand (d) Document Identification Number 6. Whether a statement has been filed for the financial year in connection with which the appeal is preferred Yes/No 6.1 If reply to 6 is yes, date of filing of statement 6.2 (a) whether equalization levy deducted on specified services, if applicable, has been paid (b) whether equalization levy in respect of e-commerce supply or services made or provided or facilitated, if applicable, has been paid Yes/No/Not Applicable Yes/No/Not Applicable 6.3 If reply to 6.2 is yes, then enter details BSR Code Date of payment Sl. No. Amount 7. **Whether an appeal in relation to any other financial year is pending m the case of the appellant with any Commissioner (Appeals) 7.1 If reply to 7 is yes, then give following details- (a) Commissioner (Appeals), with whom the appeal is pending; (b) Appeal No. and date of filing of appeal; (c) Financial year in connection with which the appeal has been preferred; (d) Assessing Officer passing the order appealed against; (e) Section and sub-section of Chapter VIII of the Finance Act, 2016, under which the Assessing Officer passed the order appealed against; (f) the date of such order 8. Statement of facts 8.1 Facts of case in brief (not exceeding 1000 words) 8.2 List of documentary evidence relied upon 9. Grounds of Appeal 10. Address to which notices may be sent to the appellant 11. Amount in dispute: (a) Equalisation levy: (b) Interest: (c) Penalty: Form of verification I, .., the appellant, do hereby declare that what is stated above is true to the best of my information and belief. Verified today the . Day of Place Date . Signature Notes: 1. The form of appeal shall be verified by a person who is authorised to verify the statement of specified services or e-commerce supply or services in Form No. 1. 2. *These particulars will be filled in the office of the Commissioner (Appeals). 3. **If appeals are pending in relation to more than one financial year, separate particulars in respect of each financial year may be given. 4. The memorandum of appeal shall be accompanied by a fee of one thousand rupees. 5. The fee should be credited in a branch of the authorised Bank or a branch of the State Bank of India or a branch of the Reserve Bank of India after obtaining a challan from the Assessing Officer. ] *************** NOTES:- 1. Substituted vide Notification No. 87/2020 dated 28-10-2020 before it was read as, FORM NO. 3 [See rule of 8 Equalisation levy Rules, 2016] Appeal to the Commissioner of Income-tax (Appeals) Designation of the Commissioner (Appeals) EL-3 *No. of .. 1. Name and address or the appellant 2. Permanent Account Number 3. Financial year in connection with which the appeal is preferred 4. Assessing Officer passing the order appealed against 5. Details or order appealed against (a) Section and sub-section of Chapter VIII of the Finance Act, 2016, under which the order appealed against was passed (b) Date of order (c) Date of service of the notice of demand 6. Whether a statement has been filed for the financial year in connection with which the appeal is preferred Yes/No 6.1 If reply to 6 is yes, date of filing of statement 6.2 whether equalization levy deducted on specified services has been paid Yes/No 6.3 If reply to 6.2 is yes, then enter details BSR Code Date of payment Sl. No. Amount 7. **Whether an appeal in relation to any other financial year is pending in the case of the appellant with any Commissioner (Appeals) 7.1 If reply to 7 is yes, then give following details:- Yes/No (a) Commissioner (Appeals), with whom the appeal is Pending; (b) Appeal No. and date of filing of appeal; (c) Financial year in connection with which the appeal has been preferred; (d) Assessing Officer passing the order appealed against; (e) Section and sub-section of Chapter VIII of the Finance Act, 2016, under which the Assessing Officer passed the order appealed against; (f) the date of such order 8. Statement of facts 8.1 Facts of case in brief (not exceeding 1000 words) 8.2 List of documentary evidence relied upon 9. Grounds of Appeal 10. Address to which notices may be sent to the appellant Form of Verification I, ., the appellant, do hereby declare that what is stated above is true to the best of my information and belief. Verified today the . day of . Place Date . .. Signature Notes: 1. The form of appeal shall be verified by a person who is authorised to verify the statement of specified services in Form No. 1. 2. *These particulars will be filled in the office of the Commissioner (Appeals). 3. **If appeals are pending in relation to more than one financial year, separate particulars in respect of each financial year may be given. 4. The memorandum of appeal shall be accompanied by a fee of one thousand rupees. 5. The fee should be credited in a branch of the authorised Bank or a branch of the State Bank of India or a branch of the Reserve Bank of India after obtaining a challan from the Assessing Officer.