ANNEXURE-37
Form No. E.A-2
(see Rule 4)
Form of Application to the Commissioner (Appeals) under sub-section (4) of 
section 35E of the Act No...................................................................................of.......................................................................2001............................................................................................
...........................................................................Applicant.
Vs
.....................................................................................Respondent.
	- 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).
 
 
- Name and address of the respondent.
 
 
- 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.
 
 
- Date on which order under sub-section (1) of section 35E has been passed by 
the Board.
 
 
- Date of communication of the order referred to in (3) above in the 
adjudicating authority.
		- Description and classification of goods
 
 
- Period of dispute
 
 
- Amount of duty, if any, demanded for the period mentioned in column (ii)
 
 
- Amount of refund, if any, claimed for the period mentioned in column (ii)
 
 
- Amount of fine imposed
 
 
- Amount of penalty imposed
 
 
- Market value of seized goods.
 
 
- Reliefs claimed in the application.
Statement of facts
Grounds of application
Signature of the applicant
Note.- The form of application including statement of facts and grounds of 
application shall be filed in duplicate and accompanied by two copies of the 
decision or order passed by the adjudicating authority (one of which at least 
shall be a certified copy) and a copy of the order of the Commissioner of 
Central Excise under sub-section (2) of section 35E of the Act.