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Declaration under section 125 of the Finance Act (No. 2), 2019 read with rule 3 of the Sabka Vishwas (Legacy Dispute Resolution) Scheme Rules, 2019

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....the Finance Act (No. 2), 2019 read with rule 3 of the Sabka Vishwas (Legacy Dispute Resolution) Scheme Rules, 2019] SABKA VISHWAS (LEGACY DISPUTE RESOLUTION) SCHEME, 2019 (Please read the Scheme carefully before filling the form) Part-A 1. Do you have a Central Excise or Service Tax Registration No. Yes 2. Name of the Declarant 3. Address of the declarant 4. Pin Code 5. Mobile Number 6. Email 7. PAN 8. Select a Commissionerate 1. Central Excise or Service Tax Registration No. 2. Name of the declarant 3. Address of the declarant 4. Pin Code 5. Mobile Number 6. Email 7 PAN Part-B No 8. Please answer Yes or No: 1. Have you been convicted for an offence fo....

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.... [Note: If you answer YES to this question, you are ineligible to proceed further under the VOLUNTARY DISCLOSURE category.] 7. Have you received any written communication from a Central Excise Yes Officer with regard to any audit to be conducted? No [Note: If you answer YES to this question, you are ineligible to proceed further under the VOLUNTARY DISCLOSURE category.] 8. Have you been subjected to any enquiry or investigation under the Central Excise Act, 1944 or Chapter V of the Finance Act, 1994 in respect of the goods/services or both for which this declaration is being made by way of any of the following: Yes No 9. (a) search of premises (b) issuance of summons (c) requiring the p....

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....ee only pending as on A B с 30.06.2019 and Tax Dues Less Tax Relief D final hearing not held before 30.06.2019 9.1.3 Appeal pending as on Appea Foru 1 No. m O-i-O No. and date 30.06.2019, and Duty/Tax/Cess Confirmed in the O-i-O Amount of Duty/Tax/ final hearing Date Cess Whether Departmental Appeal is Pending in Duty Tax/Cess Total amount Total amt. of Tota Amoun Tax 1 t of Dues And amount not held before of 30.06.2019 Filing Relation to the O-i-O of duty under dispute penalt amt. Pre- minus y of deposit late Under dispute any Tax fee other depo....

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.... Reference No. and Date of communicatio n of Quantified Amount Descripti on of Goods/Se rvices Issue Involved Amount Deposited Tax Dues less Tax Relief A B C D E F G 9.3.3 Audit Duty/Tax/Cess Total Reference No. Descripti Issue Involved Amount Deposited Tax Dues less Tax Amount Quantified and Date of communicatio n of Quantified Amount on of Goods/Se rvices A B C D E 9.4 VOLUNTARY DISCLOSURE Duty/Tax/Cess Total Amount Period involved Descripti on of Goods/Se Issue involved Tax Dues less Tax Relief rvices A B C D E F 10. Do you agree with the Tax Dues less Tax Rel....