In the High Court of _______ or Income-tax Appellate Tribunal _______ (strike out whichever is inapplicable)

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.... (Refer Note 2) 3. Contact details   (i) Mobile Number Country Code Number       (dropdown)         (Repeat, if required)   (ii) Email ID         (Repeat, if required) Part B: Respondent's Personal Information 4. Name (Refer Note 1) 5. Permanent....

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.... Order / Notice of Demand dd/mm/yyyy 12. Income-tax authority or the Appellate Tribunal passing the order against which appeal is deferred   13. The State and District in which the jurisdictional Assessing Officer is located   14. section and sub-section under which the original order is passed   15. Due date for filing of application as per secti....

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.... case is pending (Dropdown)     (v) Question of law in the other case on the basis of which appeal in the relevant case is deferred       (vi) Case No. of the other case     (b) (Repeat as required)   Part F: Declaration It is hereby certified that-- (a) the question(s) of law mentioned in row 16, a....

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....__________ Designation: ______________ Verification I, ____________, Permanent Account Number _________, do hereby declare that what is stated above is true to the best of my information and belief. I further declare that I am making the declaration in my capacity as _________ and that I am competent to make this declaration and verify it. Verified today the ____________ day of _________ ....