Form 1

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..... 2 Registration Number .....

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..... 7 Amounts demanded Duty/ Tax .....

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..... 9 Appeal No. .....

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..... VERIFICATION I, ...................................................... (name in block letters) son/daughter/of Shri ............................................ solemnly declare that to the best of my knowledge and belief, - (a) the information given in this declaration is correct and complete and amount due and other particulars shown therein are truly stated ; (b) I am not dis .....

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