Appeals and Revision Formats

GOODS AND SERVICES TAX RULES, 2017

APPEALS AND REVISION FORMAT

Form GST APL - 04

[See Rule < __ >]

Summary of the demand after issue of order by the Appellate Authority, Tribunal or Court

Order no. -
Date of order -

1. GSTIN/ Temporary ID/UIN -

2. Name of the appellant-

3. Address of the appellant-

4. Order appealed against-
Number- Date-

5. Appeal no.
Date-

6.Personal Hearing –

7. Order in brief-

8. Status of order- Confirmed/Modified/Rejected

9. Amount of demand confirmed:

Particulars	Central tax		State/UT tax		Integrated tax		Cess		Total
Particulars	Disputed Amount	Determined Amount	Disputed Amount	Determined Amount	Disputed Amount	Determined Amount	Disputed Amount	Determined Amount	Disputed Amount	Determined Amount
1	2	3	4	5	6	7	8	9	10	11
a) Tax
b) Interest
c) Penalty
d) Fees
e) Others
f) Refund

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

Order no. -		Date of order -
1. GSTIN/ Temporary ID/UIN -
2. Name of the appellant-
3. Address of the appellant-
4. Order appealed against-	Number-	Date-
5. Appeal no.	Date-