Form GST APL-04
[See rules 109B,
113 (1) and
115 ]
SUMMARY OF THE DEMAND AFTER ISSUE OF ORDER BY THE APPELLATE AUTHORITY,
REVISIONAL AUTHORITY, TRIBUNAL OR COURT
Reference no. - Date -
1. GSTIN/ Temporary ID/UIN -
2. Name of the appellant / person -
3. Address of the appellant / person
4. Order appealed against or intended to be revised -
Number-
Date
5. Appeal no.
Date
6. Personal Hearing –
7. Order in brief8. Status of order- Confirmed / Modified / Rejected
9. Amount of demand after appeal / revision:
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Particulars
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Central tax |
State / UT tax |
Integrated tax |
Cess |
Total |
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| Amount in dispute/earlier order |
Determined Amount |
Amount in dispute/earlier order |
Determined Amount |
Amount in dispute/earlier order |
Determined Amount |
Amount in dispute/earlier order |
Determined Amount |
Amount in dispute /earlier order |
Determined Amount |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
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a) Tax |
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b) Interest |
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c) Penlty |
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| d) Fees | ||||||||||
| e) Others | ||||||||||
| f) Refund | ||||||||||
10. Place of supply wise details of IGST demand
| Place of Supply (Name of State / UT) | Demand | Tax | Interest | Penalty | Other | Total |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Amount in dispute / earlier order | ||||||
| Determined Amount | ||||||
Place: Date:
Signature:
Name of the Appellate Authority / Revisional
Authority/ Tribunal / Jurisdictional Officer
Designation:
Jurisdiction: