Form GST ASMT – 04
[See rule 98(3)]
Reference No.: …………                                                                                                                                                                                                Date

To
GSTIN -
Name -
Address -
Application Reference No. (ARN) ………..                                                                                                                             Dated ……..

Order of Provisional Assessment

This has reference to your application mentioned above and reply dated-------, furnishing information/documents in support of your request for provisional assessment. Upon examination of your application and the reply, the provisional assessment is allowed as under:

                                                                    << text >>

The provisional assessment is allowed subject to furnishing of security amounting to Rs.---------------- (in words) in the form of ----------- (mode) and bond in the prescribed format by ---- ---------- (date).

Please note that if the bond and security are not furnished within the stipulated date, the provisional assessment order will be treated as null and void as if no such order has been issued.

Signature
Name
Designation