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FORM OF DECLARATION UNDER SUB-SECTION (1) OF SECTION 214 OF THE FINANCE ACT, 2016 (28 OF 2016), IN RESPECT OF INDIRECT TAX DISPUTE RESOLUTION SCHEME, 2016

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..... IN DUPLICATE To, The Designated Authority ........................................... ........................................... Sir/Madam, I hereby make a declaration under sub-section (1) of section 214 of the Finance Act, 2016 (28 of 2016). 1 Name of the declarant (in block letters) 2 Registration Number 3 Address (as mentioned in order-in-original against which appeal .....

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..... ence to the provisions of section 215 of Finance Act, 2016. (c) I further declare that I am making this declaration in my capacity as ................... [(designation) (please specify if you are making a declaration on behalf of declarant)] and that I am competent to make this declaration and verify it. Place Signature of person making declaration Date Name of person making declarati .....

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