Form GST APL - 06
[See rule 110(2)]

Cross-objections before the Appellate Tribunal
under sub-section (5) of section 112

Sr. No.

Particulars
1 Appeal No. -                                                                                   Date of filing -
2 GSTIN/ Temporary ID/UIN-
3 Name of the appellant-
4 Permanent address of the appellant-
5 Address for communication
6 Order no. Date-
7 Designation and Address of the officer passing the order appealed against-
8 Date of communication of the order appealed against-
9 Name of the representative-
10 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-
(iv)

Amount under dispute

Central tax

State/UT tax

Integrated tax

Cess
  a) Tax        
  b) Interest        
  c) Penalty        
  d) Fees        
  e) Other charges (specify)        
(v) Market value of seized goods-
11 State or Union Territory and the Commissionerate (Centre) in which the order or decision was passed (Jurisdiction details)-
12 Date of receipt of notice of appeal or application filed with the Appellate Tribunal by the appellant or the Commissioner of State/Central tax/UT tax, as the case may be-
13 Whether the decision or order appealed against involves any question relating to place of supply -
Yes             No
14 In case of cross-objections filed by a person other than the Commissioner of State/UT tax/Central tax
  (i) Name of the Adjudicating Authority-
(ii) Order Number and date of Order-
(iii) GSTIN/UIN/Temporary ID-
(iv) Amount involved:
  Head

Tax

Interest

Penalty

Refund

Total
  Integrated tax          
  Central tax          
  State/UT tax          
  Cess          
15 Details of payment
  Head

Tax

Interest

Penalty

Refund

Total
  Central tax          
  State/UT tax          
  Integrated tax          
  Cess          
  Total          
16 In case of cross-objections filed by the Commissioner State/UT tax/Central tax:
 

(i)

 Amount of tax demand dropped or reduced for the period ofdispute  
 

(ii)

 Amount of interest demand dropped or reduced for the period of dispute  
 

(iii)

 Amount of refund sanctioned or allowed for the period of dispute  
 

(iv)

 Whether no or lesser amount imposed as penalty  
    TOTAL  
17 Reliefs claimed in memorandum of cross -objections.  
18 Grounds of Cross objection
 

Verification

I,                                    the respondent, do hereby declare that what is stated above is true to the best of my information and belief.
Verified today, the                                               day of                                  20…                                   

Place:
Date:

<Signature>

Name of the Applicant/ Officer:
Designation/Status of Applicant/ officer: