FORM NO.
35
[See rule 45]
Appeal to the Commissioner of Income Tax (Appeals) –1, Nashik
Designation of the Commissioner (Appeals) - 1, Nashik
*NO. ……….…. OF…………………….. 20…..-20……
Personal Details
1. Name and Address of the Appellant. Shri Nitin Bhaurao Raut
2. Address of the Appellant. 114/B, Jeevan Jyoti
Housing Society, By Pass
Road, Chaitanya colony,
Amravati -444606
3. Permanent Account Number. AFXPR7402R
Order against which appeal is filed
4. Assessment Year in connection with which the appeal is 2012-13
preferred
5. Assessing Officer/Valuation Officer passing the order Income Tax Officer Ward – 3(1),
appealed against. Nashik
6. Sec. And Sub-sec. Of the Income-tax Act, 1961, under Sec. 143(3) r.w.s 147
which the Assessing Officer/Valuation Officer passed the
order appealed against and the date of such order.
7. Date of Order 06.12.2019
8. Date of service of Order / Notice of Demand 08.12.2019
Pending Appeals
9. Where an appeal in relation to any other assessment No
year is pending in the case of the appellant with any
Commissioner (Appeals)
If Yes, furnish following
a. Commissioner (Appeals), with whom the
appeal is pending
b. Appeal No
c. Date of filing of appeal
d. Assessment year/ financial year in connection
with which the appeal has been preferred
e. Income-tax Authority passing the order
appealed against
f. Section and sub-section of the Income-tax
Act,1961, under which the order appealed
against hasbeen passed
g. Date of such Order
Appeal Details
10. Section and clause of the Income-tax Act, 1961, under S.246A(1)(a) of IT Act, 1961
which the appeal is preferred.
11. If appeal relates to any assessment? Yes
a. Amount of Income Assessed (in Rs.) Rs.38,07,300/-
b. Total Addition to Income (in Rs.) Rs.38,07,300/-
c. In case of Loss, total disallowance of Loss in NIL
assessment (in Rs.)
d. Amount of Addition/ Disallowance of Loss Rs. 38,07,300/-
disputed in Appeal (in Rs.)
e. Amount of Disputed Demand (in Rs.)-Enter Nil Rs. 28,97,900/-
in case of Loss
12. If appeal relates to penalty? Not Applicable
a. Amount of penalty as per order (in Rs.)
b. Amount of penalty disputed in Appeal (in Rs.)
Details of Taxes Paid
13. Where a return has been filed by the appellant for the Yes
assessment year in connection with which theappeal is
filed, whether tax due on income returned has been
paid in full
If reply is Yes, then enter following details of return
and taxes paid
a. Acknowledgement number 793550720120819
b. Date of filing 12.08.2019
c. Total tax paid Nil
14. Where no return has been filed by the appellant for Not Applicable
the assessment year, whether an amount equalto the
amount of advance tax as per section 249(4)(b) of the
Income-tax Act, 1961 has been paid
If reply to 9 is Yes, then enter details
15. If the appeal relates to any tax deductible under Not applicable
section 195 of the Income-tax Act,1961 and borne by
the deductor,details of tax deposited under section
195(1)
Statement of Facts, Grounds of
Appeal and additional evidence
16. Statement of Facts As per statement of facts
17. Whether any documentary evidence other than the 1. Copy of Income Tax Return
evidence produced during the course of proceedings Acknowledgement
before the Income-tax Authority has been filed in terms 2. Copy of Allotment Letter
of Rule 46A 3. Copy of Sale Agreement
If Yes, furnish the list of such documentary 4. Copy of Passport Extracts
Evidence, 5. Copy of Bank Statement
6. Copy of Loan Statement
7. Copy of Employment
certificate
18. Grounds of Appeal As per grounds of appeal
(Relevant Section(s) of IT Act & Issue)
19. Details of Appeal Fees paid
BSR Code 0350218
Date of Payment 12.01.2018
Serial Number 01437
Amount Rs.1,000/-
20. Address to which notices may be sent to the appellant. 114/B, Jeevan Jyoti Housing
Society, By Pass Road, Chaitanya
colony, Amravati -444606
FOR NITIN BHAURAO RAUT
Signatory
PLACE- PUNE
DATE-04.01.2020
