FORM NO.

36
[See rule 47(1)]
Form of Appeal to the Appellate Tribunal
In the Income-tax Appellate Tribunal New Delhi
Appeal No……………………...
M/s Mihama India Private Limited Versus ld.A.O., National Faceless Assessment Centre, Delhi
Appellant Respondent
Name / designation of the Appellant (as M/s Mihama India Private Limited.
applicable)
Appellant’s Personal Information

PAN (if available) AAJCM4404G

TAN (if available) RTKM08025D

Complete address for sending notices B-138 Ansal Pioneer Industrial

Park, Near Bilaspur Chowk Village:
Pathredi, Tehsil, Manesar,
Gurugram, Haryana

State Haryana

Pin Code 122413

Phone No. with STD code / Mobile No. 9990889606

Email Address saurav-roy@mihama.com

Name or designation of the Respondent Ld. A.O., National Faceless

Respondent ‘s Personal Information

(as applicable) Assessment Centre, Delhi

PAN (if available)

TAN (if available)

Complete address for sending notices Delhi

State Delhi

Pin Code Not Available

Phone No. with STD code / Mobile No. Not Available
(if available)

Email Address (if available) Not Available

 1 Assessment year in connection 2017-18
with which the appeal is preferred

2 Total income declared by the (4,29,38,955)

assessee for the assessment year
referred to in item 1

3 Details of the order appealed

against
Appeal Details

a Section and sub-section under 143(3) r.w.s.144C (13) read with

which the order is passed section 144B of the Act

b Date of order 22/02/2022

c Date of service or 24/02/2022

communication of the order.

4 Income-tax Authority passing the Ld. A.O., National Faceless

order appealed against Assessment Centre, Delhi
5 The State and District in which the Delhi
jurisdictional Assessing Officer is
located

6 Section and sub-section under 143(3) r.w.s.144C (13) read with

which the original order is passed section 144B of the Act

7 If appeal relates to any

assessment: -

a Total income as computed by Rs 1,12,10,050/-

the Assessing Officer for the
Amounts disputed in appeal

assessment year referred to

in item 1

b Total amount of additions or Rs 5,41,49,002/-

disallowances made in the
assessment.

c Amount disputed in appeal Rs.5,41,49,002/-

8 If appeal relates to any penalty :-

a Total amount of penalty NA

imposed as per order

b Amount of penalty disputed NA

in appeal
 9 If appeal relates to any other
matter: -

a Amount disputed in appeal NA

10 Grounds of Appeal Tax effect relating to each Ground
of appeal
(see note below)

1. As per attachment As per attachment

Total tax effect (see note below) 56,96,685/-
11 Whether there is any delay in filing No
of appeal
(if yes, please attach application
Appeal filing details

seeking condonation of delay)

12 Details of Appeal Fees Paid

BSR Code Date of Sl. No. Amount

Payment

6390340 18/04/2022 03409 10000

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Signed
(Appellant)
Name: Sameer Munshi

Designation: Director

VERIFICATION

I, Sameer Munshi, in the capacity of Director of the Appellant-Company, do hereby declare that
what is stated above is true to the best of my information and belief.

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Place: New Delhi Signature
Date: Name: Sameer Munshi
Designation: Director