FORM ETLA-14

To
The Deputy Commissioner,
_____________
FORM ETLA-14
[See Rule 15]
Form of Appeal against an order of assessment under
Section 23
Stamp for Court
fees Stamps
Ref: Appeal under section 23 of the Rajasthan Tax on Entry of Goods into Local
Areas Act, 1999, against the order dated__________ of ____________.
1. Name (s) of appellant (s)
2. Assessment year
3. Assessing authority passing the Assessment order disputed
4. Date on which the order was communicated
5. Address to which notice may be sent to the Appellant
6. Relief claimed in appeal
a. value of goods determined by the assessing authority
b. If value is disputed
(i) Disputed value
(ii)Tax due on the disputed value
(c) If rate of tax is disputed
(i) Value involved
(ii) Amount of Tax disputed
(d) Grounds of appeal, etc.
Place Signature of the Appellant (s)

Date Authorised representative, if any
VERIFICATION
I/We, ____________________ the appellant (s) named in the above appeal do hereby
declare that what is stated therein is true to the best of my/our knowledge and belief.
Verified today of day of 20__
______________
Signature of the Appellant (s)
Authorised representative, if any