GOODS AND SERVICES TAX RULES, 2017

APPEALS AND REVISION FORMAT

Form GST APL - 03

[See Rule < __ >]

Application to the Appellate Authority under sub-section (2) of Section 107

 

 1. Name and designation of the appellant

   Name-
    Designation-
    Jurisdiction-
    State/Center-
    Name of the State-

2. GSTIN/ Temporary ID /UIN-

3. Order no.                                                                           Date-

4. Designation and address of the officer passing the order appealed against-

5. Date of communication of the order appealed against-

6. Details of the case under dispute-

(i) Brief issue of the case under dispute-

(ii) Description and classification of goods/ services in dispute-

(iv) Amount under dispute-

 

Description Central tax State/ UT
tax		 Integrated
tax		 Cess

a) Tax/ Cess

        

b) Interest

        

c) Penalty

        

d) Fees

        

e) Other charges

        

 7. Statement of facts-

8. Grounds of appeal-

9. Prayer-

10. Amount of demand in dispute, if any -

 

Particulars of
demand/refun
d, if any

 Particulars Central
tax		 State/UT
tax		 Integrated
tax		 Cess Total amount

Amount of
demand
created, if
any
(A)

a) Tax/ Cess

         < total > < total >

b) Interest

 < total >

c) Penalty

 < total >

d) Fees

 < total >

e) Other charges

 < total >

Amount
under
dispute
(B)

a) Tax/ Cess

         < total > < total >

b) Interest

 < total >

c) Penalty

 < total >

d) Fees

 < total >

e) Other charges

 < total >
       
Date:     < Signature>    
      Name:
      Designation:
      Jurisdiction: