Form of declaration under Section 94 of the Finance Act, 2008 in respect of Dispute Resolution Scheme, 2008

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..... ...................... Sir/Madam, I hereby make a declaration under section 94 of the Finance Act, 2008. 1. Name of the declarant ................................................................................ (in block letters) 2. Address :............................. ...................................................................... ....................................... .....

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..... Details of writ petition/ appeal/ reference filed before a High Court or the Supreme Court, if any Remarks Service tax + Education cess (Primary) + Secondary and higher education cess Interest Penalty .....

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..... this declaration and statements and annexure accompanying it is correct and complete and amount of tax arrears and other particulars shown therein are truly stated; (b) I am not disqualified under provisions of section 93 of Finance Act, 2008 from making a declaration. I further declare that I am making this declaration in my capacity as ........................ (designation) (Please specify .....

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