Form GST APL -07

Form GST APL -07
[See rule 111(1)]

Application to the Appellate Tribunal under sub section (3) of Section 112

1. Name and Designation of the appellant Name:

Name:

Designation Jurisdiction
State / Center -
Name of the State:

2. GSTIN/ Temporary ID /UIN
3. Appellate Order no. Date
4. Designation and Address of the Appellate Authority 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-
    (iii) Period of 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 demanded, disputed and admitted:

Particulars of demand, 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 >

Place:
Date:

<Signature>

Name of the Officer:
Designation:
Jurisdiction:-