Appeal to the Commissioner (Appeals) Designation of the Commissioner (Appeals)

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....peals) *No..............of 20........................... 1. Name and address of the appellant    2. Permanent Account Number   3. Assessment year in connection with which the appeal is preferred   4. Assessing Officer passing the order appealed against   5. Section and sub-section of the Black Money (Undisclosed Foreign Income and ....

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....sputed amount referred to in item 10 has been paid (if yes, give details of date of payment, challan number and amount paid)   12. **Where an appeal in relation to any other assessment year is pending in the case of the appellant with any Commissioner (Appeals), give the details as to the- (a) Commissioner (Appeals), with whom the appeal is pending; (b) assessment y....

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....nbsp;                       ........................... Signed (Appellant) STATEMENT OF FACTS GROUNDS OF APPEAL ........................... Signed (Appellant) Form of Verification I, ................................, the appellant, do hereby declare that what is stated above is true to the best of my information a....