ANNEXURE-41
Form No. E.A.-6
[See Rule 8 (1)]
Form of Application to the High Court under sub-section (1) of section 35H of 
the Act
In the High Court of Judicature at
In the matter of Appeal No. (Name of the appellant)
Application No………………………of……………………..2001
(To be filled in by the Office)
…………………………………………………………………………………..Applicant.
Vs.
…………………………………………………………………………………..Respondent.
	- State or Union Territory and the Commissionerate from which the application 
is filed:
 
 
- Number of the appeal which gives rise to the reference:
 
 
- Address to which notices may be sent to the applicant:
 
 
- Address to which notices may be sent to the respondent:
 
 
- The appeal noted above was decided by the …………..Bench of the Appellate 
Tribunal on:
 
 
- The notice of the order under section 35C of the Act was served on the 
applicant on:
 
 
- The facts which are admitted and/or found by the Appellate Tribunal and which 
are necessary for drawing up a statement of the case are stated in the enclosure 
for ready reference:
 
 
- The following questions of law arise out of the order of the Appellate 
Tribunal:
 
 
- The applicant, therefore, requires under sub-section (1) of section 35H of 
the Act that the High Court directs the Appellate Tribunal to refer to the High 
Court the question of law referred to in paragraph 8 above.
 
 
- The documents or copies thereof specified below (the translation in English 
of the documents, where necessary) are annexed with the statement of the case.
Signature of the authorised
representative, if any. 
Signature of the applicant.
Verification
I,…………………………..the applicant, do hereby declare that what is stated above is true 
to the best of my information and belief.
Verified today, the……………….day of…………………………….2001……..
Signature of the authorised
representative, if any.
Signature of the applicant.
Notes:-
	- The application and the form of verification shall, if the application is 
made by any person, other than the Commissioner of Customs, be signed by the 
applicant in accordance with the provisions of Rule 3.
 
 
- The application shall be filed in quadruplicate.
 
 
- The fee of Rs. 200/- required to be paid under the provisions of the Act 
shall be through a crossed bank draft drawn in favor of the Registrar of the 
High Court on a branch of any nationalised bank located at the place where the 
High Court is situated and the demand draft shall be attached to the form of 
application.