ANNEXURE-34

Form No. E.A-2

(see Rule 4)
Form of Application to the Commissioner (Appeals) under sub-section (4) of section 35E ofthe Act No...........................of................2001............................................................................................
...........................................................................Applicant.

Vs

.....................................................................................Respondent.

1. Designation and address of the applicant (If the applicant is not the adjudicating authority, acopy of the authorisation from the Commissioner of Central Excise to make the applicationshould be enclosed).

2. Name and address of the respondent.

3. Designation and address of the officer passing the decision or order in respect of which thisapplication is being made and the date of the decision or order.

4. Date on which order under sub-section (1) of section 35E has been passed by the Board.

5. Date of communication of the order referred to in (3) above in the adjudicating authority.

6.

(i) Description and classification of goods

(ii) Period of dispute

(iii) Amount of duty, if any, demanded for the period mentioned in column (ii)

(iv) Amount of refund, if any, claimed for the period mentioned in column (ii)

(v) Amount of fine imposed

(vi) Amount of penalty imposed

(vii) Market value of seized goods.

6. Reliefs claimed in the application.
Statement of facts
Grounds of application

Signature of the applicant

Note.- The form of application including statement of facts and grounds of application shall befiled in duplicate and accompanied by two copies of the decision or order passed by theadjudicating authority (one of which at least shall be a certified copy) and a copy of theorder of the Commissioner of Central Excise under sub-section (2) of section 35E of the Act.

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