Application under section 376 to defer filing of appeal before the Appellate Tribunal or the High Court

1.

Designation of the Appellant

(Refer Note 1)

2.

Address

(Refer Note2)

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 Account Number (if available)

6.

Tax Deduction and Collection Account Number (if available)

7.

Address

(Refer Note 2)

8.

Contact details

(i)

Mobile Number

Country

Code

Number

(dropdown)

(Repeat, if required)

(ii)

Email ID (if available)

(Repeat, if required)

Part C: Case Details

9.

Tax year in connection with which the appeal is preferred

10.

Total income declared by the assessee for the Tax y e a r referred to in row 9

11.

Details of the order against which appeal is deferred

(i)

section and sub-section under which order is passed

(ii)

Date of Order

dd/mm/yyyy

(iii)

Date of service of 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 section 376(3) of the Act

dd/mm/yyyy

Part D: Question of Law in relevant case for which appeal is deferred

16.

(a)

(i)

Questions of Law in the relevant case

(ii)

section and sub-section of the Act of the relevant case

(iii)

Tax effect

(Repeat, if required)

(b)

Total tax effect

Part E: Details of other case/cases on the basis of which appeal is deferred

17.

(a)

(i)

Name of the assessee

(Refer Note 1)

(ii)

Permanent Account Number (if available)

(iii)

Tax Deduction and Collection Account Number (if available)

(iv)

Court before which the appeal in the other 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, arising in the relevant case of the assessee for the tax year is/are identical with a question of law arising in:––

(i) his case for the tax year

(ii) the case of for the tax year ,

(b) the question(s) of law in other case is/are pending before the jurisdictional High Court under section

365 of the Act or the Supreme Court in an appeal under section 367 of the Act or the Supreme Court in a Special Leave Petition under article 136 of the Constitution against the order of the Appellate Tribu- nal/ jurisdictional High Court as mentioned in row 17 above;

(c) the appeal on the question(s) of law mentioned in row 16 shall be filed in accordance with the provi- sions of section 376(5) and 376(6) of the Act.

Signature:

Name:

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 20 .

Place: ……………… Signature:

Date: … … … … … … . (Name: )

Designation:

: