FROM II
(See Rule 9)
(FORM OF MEMORANDUM OF APPEAL)

Before……………………………………………………(**)………………… (Here mention the name and designation of the authority)
Memorandum of appeal under section 13 of the Water (Prevention and Control of Pollution) Cess act, 1977.
Appeal No of …………19……………..
.........................................................
.........................................................
(Here furnish complete postal address)
..............................................  Appellant
Vs.
.........................................................
.........................................................
(Here mention the name and designation of assessing authority)
............................................Respondent
The appellant named above, begs to prefer this memorandum of appeal against the order dated passed by…………………………on the following facts and grounds
FACTS
(Here briefly mention the facts of the case)
GROUND
(Here mention the grounds on which the appeal is made)
1.
2.
3.
4.
PRAYER
In the light of what is stated above, the appellant respectfully prays that he/she/it may be exempted from the payment of, Cess.
He/she/it may be allowed a rebate of 70 per cent as provided for in the Act and the amount of Cess reduced to Rs………………..
The amount of Cess has not been correctly assessed and that it may be reduced to Rs…….
The penalty imposed on him /her/it has been wrongfully imposed and should be set aside.
The penalty imposed on him/her/it is excessive and should be suitably reduced on the basis of the facts as stated.
2.  The amount of Rs ………….(Rupees…………………)     as fee for this appeal has been paid to………………vide receipt No……dated………….
Place:                                                               Signature of the Appellant
Date:                                                                Name
                                                                        Address