FORM NO. I.T.C.P. 29A
[See rule 86(1) of the Second Schedule to the Income -tax Act, 1961]
Appeal to the Chief Commissioner or Commissioner
[Designation of the Chief Commissioner or Commissioner]
No. of 20 20 .
[To be filled in in the office of the Chief Commissioner or Commissioner]
1. Name and address of the appellant.
2. G.I.R. No.
3. Certificate No.
4. Assessment year in connection with which the appeal is
preferred [See footnote 4 ]
5. Tax Recovery Officer passing the order appealed against
6 Rule and sub-rule of the Second Schedule to the Income -
tax Act, 1961, under which the Tax Recovery Officer passed
the order appealed against
7. Date of the order appealed against
8. Relief claimed in appeal.
9. Address to which notices may be sent to the appellant.
Signed
(Appellant)
STATEMENT OF FACTS
GROUNDS OF APPEAL
Signed
(Appellant)
Form of verification
I, the appellant, do hereby declare that what is stated above is true to the best of my
information and belief.
Place : . Signature .
Date : . Status of appellant .
Notes :

1. The form of appeal, grounds of appeal and the form of verification appended
thereto shall be signed by a person in accordance with the provisions of rule
55A(2) of the I.T.C.P. Rules.
2. The form of appeal, statement of facts and the grounds of appeal must be in duplicate.
3. †If the space provided herein for the statement of facts and grounds of appeal is insufficient,
separate enclosures may be used for the purpose.
4. Item 4 not to be filled in if the appeal relates to certificate proceedings for the
realisation of tax required to be deducted/paid under section 195(1).