2.The designation and address of the appellant Commissionerate (if the appeal is filed on the basis of the authorisation given by the Committee of Commissioners under sub-section (2A) of section 86 of the Act. A copy of the authorisation shall be enclosed)

3. The designation and address of the appellant (if the appeal is filed on the basis of an order of the Committee of Chief Commissioners under sub-section (2) of section 86 of the Act. A copy of the order shall be enclosed).

4. Name and address of the respondent.

5. Number and date of the order against which the appeal is filed.
 

Dated
 

6. Designation and address of the officer passing the decision or order in respect of which this appeal is being made.

7. State or Union territory and the Commissionerate in which the decision or order was made.

8. Date of receipt of the order referred to in (5) above by the Committee of Commissioners of Central Excise or by the Committee of Chief Commissioners of Central Excise, as the case may be.

9. Whether the decision or order appealed against involves any question having a relation to the rate of service tax or to the value of service for the purpose of assessment.

10. Description of service and whether under ‘negative list’.

11. Period of dispute

12 (i) Amount of service tax demand dropped or reduced for the period of dispute

(ii) Amount of interest demand dropped or reduced for the period of dispute

(ii) Amount of refund sanctioned or allowed for the period of dispute

(iv) Whether no or less penalty imposed?

13. Whether any application for stay of the operation of the order appealed against has been made?

14. Subject matter of dispute in order of priority (please choose two items from the list below)

[i) Taxability - Sl. No. of Negative List, ii) Classification of Services, iii) Applicability of Exemption Notification-Notification No., v) Export of services., v) Import of services., vi) Point of Taxation., vii) CENVAT., viii) Refund., ix) Valuation., x) Others.]
 

15. If the application is against an Order-in- Appeal of Commissioner (Appeals), the number of Orders-in-Original covered by the said Order-in-Appeal.

16. Whether the respondent has also filed an appeal against the order against which this appeal is made?

17. If answer to serial number 16 above is ‘yes’, furnish the details of the appeal.

18. Whether the applicant wishes to be heard in person?

19. Reliefs claimed in application.
 

Note.-The Appeal including the statement of facts and the grounds of appeal shall be filed in quadruplicate accompanied by an equal number of copies of the decision or order (one of which at least shall be a certified copy) passed by the Commissioner of Central Excise/ Service Tax/ Large Taxpayer Unit and a copy of the order passed by the Committee of Commissioners under sub-section (2A) of section 86 of the Act or an order passed by the Committee of Chief Commissioners under sub-section (2) of section 86 of the Act.

*15 digit Permanent Account Number (PAN) - based registration number to be furnished if respondent is a registered person.

**10 digit Commissionerate/ Division/ Range code (Premises Code) to be mandatorily furnished for the registered person. This ‘premises code’ is available in the ST-2 Registration Certificate itself. In case of Centralized registrations the ‘premises code’ of the Main Office for which Centralized registration has been taken, should be indicated.

*** To be furnished for respondents who are non –registered persons. Unique Identification (UID) number to be furnished where PAN is not available.”

(Above FORM ST-7 has been substituted vide NTF. NO. 05/2013-ST, DT. 10/04/2013)

Appeal No._____________of______________20____
_____________________Applicant
               v.
_____________________Respondent.
 

1. Designation and address of the applicant (if the applicant is not the adjudicating authority, a copy of the authorization from the Commissioner of Central Excise to make the application should be enclosed).
    
2. Name and address of the respondent.
    
3. Designation and address of the officer passing the decision or order in respect of which this application is being made and the date of the decision or order.
    
4. State/Union territory and the Commissionerate in which the decision or order was made.
    
5. Date on which order under sub-section (2) of section 86 of the Finance Act, 1994, has been passed by the Board or the date on which the order under sub-section (2A) of section 86 of the Finance Act, 1994, has been passed by the Commissioner of Central Excise.
   
   [Old 5. Date on which order under sub-section(2) of Section 86 of the Finance Act, 1994, has been passed by the Board.]
   
   (Above para (5) has been substituted vide Ntf. No. 5/2001-ST, dt. 9/7/2001)
    
6. Date of communication of the order referred to in (3) above to the adjudicating authority.
    
7. Whether the decision or order appealed against involves any question having a relation to the rate of tax or to the value of taxable service for purpose of assessment; if not , difference in tax or duty involved, or amount of penalty involved or value of goods involved, as the case may be.

7A.

(i) Period of dispute
(ii) Amount of 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 imposed.
(v) Amount of penalty imposed.

8. Reliefs claimed in the application.

Signature of the applicant

Note: The form of application including the statement of facts and grounds of application shall be filed in quadruplicate and shall be accompanied by an equal number of copies of the decision or order passed by the Commissioner of Central Excise (one of which at least shall be a certified copy) and a copy of the order passed by the Board or copies of orders of the Commissioner of Central Excise (Appeals) (one of which shall be a certified copy) and a copy of the order of the Commissioner of Central Excise, as the case may be, under Sub-section(2) of Section 86.