(1)

.

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| You are hereby

advised to pay the amount of tax as ascertained above alongwith

the amount of applicable interest and penalty under section 74(5)

by ........... , failing which Show Cause Notice will be issued

under section 74(1).

|-

| In case you wish to

file any submissions against the above ascertainment, the same

may be furnished by............ in Part B of this Form

|-

|

| Proper Officer

|-

|

| Signature....................

|-

|

| Name.........................

|}

Designation............................

{|

Upload Attachment

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| Part B

Reply to the

communication for payment before issue of Show Cause Notice

[See Rule 142 (2A)]

|-

| No.:

| Date:

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| To

|

|-

| Proper Officer,

|

|-

| Wing / Jurisdiction.

|

|-

| Sub.: Case

Proceeding Reference No.......- Payment/Submissions in response

to liability intimated under Section 73(5)/74(5) – reg.

|-

| Please refer to

Intimation ID....... in respect of Case ID........vide which

the liability of tax payable as ascertained under section 73(5) /