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FORM ST-4 Form of Appeal to the Commissioner of Central Excise (Appeals) under section 85 of the Finance Act,1994 (32 of 1994) 1. | No.__________of______20___ | : | | 2. | Name and address of the appellant | : | | 3. | Designation and address of the officer passing the decision or order appealed against and the date of decision or order | : | | 4. | Date of communication of the decision or order appealed against to the appellant | : | | 5. | Address to which notices may be sent to appellant | : | | 5A. | (i) | Period of dispute | : | | | (ii) | Amount of service tax, if any, demanded for the period mentioned in column (i) | : | | | (iii) | Amount of refund, if any, claimed for the period mentioned in column (i) | : | | | (iv) | Amount of interest | : | | | (v) | Amount of penalty | : | | | (vi) | Value of the taxable service for the period mentioned in column (i) | : | | 6. | Whether service tax or penalty or interest or all the three have been deposited? | : | | 6A. | Whether the appellant wishes to be heard in person? | : | | 7. | Relief claimed in appeal | : | |
STATEMENT OF FACTS Grounds of appeal Signature of the authorised representative, if any | Signature of t |
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