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FORM

(See rule 3)

Application for Compounding of Offence

1. Full Name and permanent address of the applicant:

2. Address for communication:

3. (i) Permanent Account Number (PAN):

(ii) Service Tax Registration No:

4. Commissioner of Central Excise/Service Tax having jurisdiction over the applicant:

5. Specific provision(s) of Chapter V of the Finance Act, 1994, against whose violation, prosecution is instituted or contemplated for which application of compounding is being filed:

6. Details of Adjudication Order in relation to the case for compounding:

7. Brief facts of the case and particulars of the offence (s) charged:

8. Whether Show Cause Notice issued:

9. If yes, details of service tax demanded:

10. Whether Show Cause Notice has been adjudicated:

11. If yes, adjudication details:

(a) Amount of service tax confirmed:

(b) Amount of CENVAT credit to be recovered/denied:

12. Whether this is the first offence under Chapter V of the Finance Act, 1994, if not, details of previous cases:

13. Whether any proceedings for the same offence contemplated under any other law, if so, the details thereof:

Name and Signature of the applicant.

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DECLARATION

1. I shall pay the compounding amount, as may be fixed by the compounding authority under sub-rule (3) of rule 4 of the Service Tax (Compounding of Offences) Rules, 2012.

2. I understand that I shall not claim, as of right that the offence committed by me under the Act be compounded.

Name and Signature of the applicant.

VERIFICATION

I, _______ son/daughter/wife of ____________ residing at __________do solemnly declare that I am making this application in my capacity as ______ and I am competent to verify it.

That the contents of this application are true to the best of my knowledge and belief and no information relevant to the facts of the case has been suppressed. The documents accompanying the application are true copies of the originals and the tables showing financial transactions are correct and are duly attested by me.

Verified today the _____________ day of (month) __________ (year) at_________.

Name and Signature of the applicant.

Place:

Date:

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Who We Are

GST India Solution is an effort of firm of professionals who welcome implementation of GST. This is an interactiveplatformthat aspires to disseminate right knowledge to professionals, practitioners and public at large. This platform has beenfloatedbya firm of Chartered Accountants relentlessly working in field of direct and indirect taxes since early 1985.

Goods & Service Tax

Our core competence is statutory compliance, advisory, corporate tax planning and appellate matters of direct and indirect taxesandcorporate training sessions on GST.

The senior partner of the firm has to his credit several professional publications viz., Delhi Sales Tax Right to Use Goods Act, Delhi VAT, Maharashtra VAT, West Bengal VAT, Haryana VAT published by Taxmann. Madhya Pradesh VAT and Chhattisgarh VAT were published by Suvidha Law House, Bhopal. He has also addressed seminars on indirect taxes organized by professional bodies like ICAI, IMA, NIFM etc. and has also contributed articles on subjects of pro. . . . .