FORM NO. 37
[See rule 48]
Reference application under section 256(1) of the Income-tax Act, 1961
IN THE INCOME-TAX APPELLATE TRIBUNAL..............................…………………………....................
IN THE MATTER OF THE ASSESSMENT OF....................................……….............[name of the assessee]
R.A. No. ....................................... of ........................................  ......................... [to be filled in by the office]
Versus
………………………………
 ………………………..
APPLICANT
 RESPONDENT
State from which the application is filed
 …………………………..
Name and number of the appeal which gives rise to the reference ………………………….
The applicant states as follows :-
1. that  the  appeal  noted  above  was  decided  by  the.....................................Bench   of  the  Tribunal
on......................................
2. that notice of the order under sub-section (1) of section 254 of the Income-tax Act, 1961, was served
on the applicant on......................................
3. that the facts which are admitted and/or found by the Appellate Tribunal and which are necessary for
drawing up a statement of the case, are stated in the enclosure for ready reference.
4. that the following questions of law arise out of the order of the Appellate Tribunal:—
(1)
(2)
(3)
5. that the applicant, therefore, requires under sub-section (l)of  section 256 of the aforesaid Act, that a
statement of the case be drawn up and the questions of law numbered...........out of the questions of law
referred to in paragraph 4 above be referred to the High Court.
6. that the  date on which the return of income, for the assessment  year in connection with which  the
reference application is being made, was filed is......................... and the date on which the assessee was
served   with  a notice   calling  upon  him  to   file  the   return  of  income  for  that assessment  year
is......................................
7. that the documents or copies thereof  as specified below (the translation in English of the documents,
where necessary, is annexed)  be forwarded to the High Court with the statement of the case.
……………………………..
 ……………………………..
Signed
 Signed
(Authorised representative, if any)
  (Applicant)

Note:
The application when made by an assessee be accompanied, by a fee specified below:—
(a) in a case where the assessment proceedings were initiated before the 1st day of April, 1971, Rs.
100;
(b) in a case where the assessment proceedings were  initiated after 31st day of March, 1971 but
before the 1st day of  June, 1981, Rs. 125;
(c) in any other case.  Rs.  200.
For the purpose of this Note,  the assessment proceedings shall be deemed to have been initiated on either
of the dates referred to in paragraph 6, whichever is earlier. It is suggested that the fee should be credited
in a branch of the authorised bank or a branch of the State Bank of India or a branch of the Reserve Bank
of India, after obtaining a challan from the Assessing Officer  and the triplicate challan sent to the Appel-
late Tribunal with  the  application. The  Appellate Tribunal will not  accept cheques,  drafts,  hundies or
other negotiable instruments.