APPLICATION FOR STAY OF COLLECTION FORM APP 406 OF DISPUTED TAX [Under Section 31(2) & 33(6) ] [ See Rule 39(1) ] 01.Office Address: 03.Name : Address: 04. Tax period 05. Authority passing the order or proceeding disputed. 06 Date on which the order or proceeding was communicated. 07. (1) (a) Tax assessed (b) Tax disputed (2) Penalty / Interest disputed Rs. Rs. Rs. 08 Amount for which stay is being sought 09. Address to which the communications may be sent to the applicant. Signature of the Dealer(s) Signature of the Authorised Representatives if any VERIFICATION I / We__________________________________________ applicant (s) do hereby declare that what is stated above is true to the best of my / our knowledge and belief. Verified to day the _________ day of_________________200 Signature of the Dealer(s) Signature of the Authorised Representatives if any NOTE:-1) The revision application should be accompanied by the original order against which it is filed or by a certified copy thereof unless the omission to produce such order or copy is explained to the satisfaction of the revisional authority. 2) The application should be written in English and should set forth concisely and under distinct heads the grounds of appeal without any argument or narrative and such grounds should be numbered consecutively. The application should be in duplicate. 152
