(Name) of (Address) upon whom the above assessment dated the day of 20 was served on the day of hereby gives notice of appeal to the Board of Review for a revision of the above assessment.
The following members of the Board are objected to:
The reason for the objection to each member of the Board listed above is as follows:
Appellant’s address for service is
Dated this day of 20 .
Signature of Appellant or his Solicitors or Agent.
[S 783/2004 wef 30/12/2004]
FORM 2
INCOME TAX ACT
(CHAPTER 134)
PETITION OF APPEAL AN APPEAL AGAINST ASSESSMENT NO.
The Petition of Appeal of the said
Sheweth:
(Here set out the name, address and description of the appellant with details of his trade, occupation, business or profession).
(Here set out concisely in numbered paragraphs the facts relating to that part of the income in respect of which the assessment is disputed).
By notice of assessment No. dated the Comptroller of Income Tax assessed your Petitioner for the year of assessment 20 to tax in the sum of $ on the basis of
Your Petitioner on the day of applied to the Comptroller of Income Tax under section 76(2) of the Income Tax Act for the assessment to be reviewed and revised.
On the day of the Comptroller of Income Tax replied that he did not propose to amend the assessment and in consequence of the reply your Petitioner on the day of filed with the Comptroller and the clerk to the Board of Review a Notice of Appeal under section 79(1) of the Income Tax Act.
The grounds of the appeal are as follows:
(Here set out in numbered paragraphs the grounds on which the appeal is based).
Dated this day of 19 .
Signature of Appellant or his Solicitors or Agent.