FORM. NO. 42
[See rule 81]
Appeal against refusal to recognise or withdrawal of recognition
from a provident fund
To
The Secretary,
Central Board of Direct Taxes,
New Delhi.
The petition of ………........................................ employer(s) carrying on business or profession
............................... at ........................................
Your petitioner(s) applied to (obtained sanction from) the Chief Commissioner or Commissioner of
Income-tax under rule 3(1) of Part A of the Fourth Schedule to the Income-tax Act, 1961, for the
recognition of the provident fund maintained by him (them) for the benefit of his (their)
employees, The Chief Commissioner or Commissioner of Income-tax has refused recognition (with-
drawn recognition) for the reasons stated in his order dated .................................... of which a copy is
attached.
For the reasons set out below your petitioner(s) submit(s) that the fund should be (continued to be)
recognised and pray(s) that the Central Board of Direct Taxes may be pleased to direct  the Chief
 .
Commissioner or Commissioner of Income-tax to  accord recognition
continue the recognition
GROUNDS OF APPEAL
1.
2.
etc.
We/I, ........................................ the petitioner(s) named in the above petition, do declare that what is
stated therein is true to the best of our/my information and belief.
Date ...........................
 …………………………..
Signature
Address of the appellant
Notes :
1. Delete the inappropriate words or letters.
2. The appeal should be accompanied by a fee of rupees one hundred. 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 Board with the appeal. The Board will not accept cheques, drafts, hundies or other negotiable
instruments.