Department of Goods Tax Government of Arunachal Pradesh Department of Goods Tax Government of Arunachal Pradesh (See Rule 68 of the Arunachal Pradesh Goods Tax Rules, 2005) Objection Form under Arunachal Pradesh Goods Tax Act, 2005 To The........ ........ (Name of the Objection Authority) 1. Registration Number 2. Full Name of the Business/Dealer 3. Mailing Address 4. Contact Telephone Number(s) 5. Name, Address and Telephone No of Legal Representative representing in this case 6. Nature of objection Please attach copy of Assessment, order or decision objected against 7. Tax period to which the objection pertains ___ ___ / ___ ___ / ___ ___ ___ ___ to ___ ___ / ___ ___ / ___ ___ ___ ___ DD / MM / YYYY 8. Date of issue of Assessment, order or decision objected against ___ ___ / ___ DD / MM / YYYY ___ / ___ ___ ___ ___ 9. Date of service of Assessment,order or decision objected against ___ ___ / ___ DD / MM / YYYY ___ / ___ ___ ___ ___ 10. Is the objection filed within time prescribed .. Yes (Please tick) .. No 11. If the objection is not filed within time, attach Form DF-02. 12. Is the objection against an assessment? .. Yes .. No 13. If yes, then specify the amount of assessment 14. Specify the amount of said assessment that is not disputed (Please attach proof of payment of said amount) 15. Specify the amount of said assessment that is objected against S. No. As assessed As admitted by the appellant Amount in dispute Taxable turnover of sales subject to tax Tax assessed, penalty imposed, interest charged Net turnover of sales which according to the applicant are liable to tax Tax/penalty/interest 1 2 3 4 16. Do you want a hearing? .. Yes .. No 17. 17. 18. Please specify the list of enclosures 19. Verification I/We _______________ hereby solemnly affirm and declare that the information given in this form and its attachments (if any) is true and correct to the best of my/our knowledge and belief and nothing has been concealed therefrom. Authorised Signatory Name Designation Place Date
