GOODS AND SERVICES TAX RULES, 2017

APPEALS AND REVISION FORMAT

Form GST APL - 05

[See Rule < __ >]

Appeal to the Appellate Tribunal

 

1. GSTIN/ Temporary ID/UIN -

    

2. Name of the appellant-

    

3. Address of the appellant-

    

4. Order appealed against-

 Number- Date-

5. Name and Address of the Authority passing the order appealed against -

    

6. Date of communication of the order appealed against -

7. Name of the representative -

8. Details of the case under dispute:

(i) Brief issue of the case under dispute

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

(iii) Period of dispute

(vi) Amount under dispute:

Description Central tax State/ UT
tax		 Integrated
tax		 Cess

a) Tax/ Cess

        

b) Interest

        

c) Penalty

        

d) Fees

        

e) Other charges

        

(vii) Market value of seized goods

9. Whether the appellant wishes to be heard in person?

10. Statement of facts

11. Grounds of appeal

12. Prayer

13. Details of demand created, disputed and admitted

 

Particulars of
demand		 Particulars Central tax State/UT tax Integrated tax Cess Total amount
Amount
demanded/
rejected >,
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>
Amount
admitted
(C)

a) Tax/ Cess

                 < total> < total >

b) Interest

 < total>

c) Penalty

 < total>

d) Fees

 < total>

e) Other charges

 < total>

14. Details of payment of admitted amount and pre-deposit:
(a) Details of amount payable :

Particulars   Central
tax		 State/UT
tax		 Integrated
tax		 Cess Total amount
  a) Admitted
amount

Tax/ Cess

         < total> < total >

Interest

 < total>

Penalty

 < total>

Fees

 < total>

Other charges

 < total>
b) Pre-deposit(20% of disputed
tax)

Tax/ Cess

        

< total>

(b) Details of payment of admitted amount and pre-deposit (pre-deposit 20% of the disputed admitted tax and cess)

Sr.
No.		 Description Tax
payable		 Tax
payable		 Paid through
Cash/ Credit
Ledger		 Debit
entry no.		 Amount of tax paid
Integrated
tax		 Central
tax		 State/UT
tax		 CESS
1 2 3 4 5 6 7 8 9

1.

Integrated tax

 Cash Ledger            
Credit Ledger            

2.

Central tax

 Cash Ledger            
Credit Ledger            

3.

State/UT tax

 Cash Ledger            
Credit Ledger            

4.

CESS

 Cash Ledger            
Credit Ledger            

(c) Interest, penalty, late fee and any other amount payable and paid:

Sr. No. Description Amount payable Debit
entry no.		 Amount paid
Integrated
tax		 Central
tax		 State/UT
tax		 CESS Integrated
tax		 Central
tax		 State/UT
tax		 CESS
1 2 3 4 5 6 7 8 9 10 11
1.

Interest

                  
2.

Penalty

                  
3.

Late fee

                  
4.

Others (specify)

                  

Verification

     

I, < _________________________ >, hereby solemnly affirm and declare that the information given hereinabove is true and correct to

   

the best of my knowledge and belief and nothing has been concealed therefrom.
Place:      
Date:     < Signature>    
      Name:
      Designation:
      Jurisdiction: