Sample copy of Petition to I Tax Ombudsman

[sujittalukder]

Can someone provide a copy of petition filed before Income Tax ombudsman on refund matter.
Though no format is prescribed but some tradition is surely followed in drafting the petition for better presentation of the case.
I need the same for my own purpose and planning to approach the ombudsman.
Your help in this matter is highly solicited.

Regards
Sujit Talukder