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“FORM GST DRC- 03
[See rule 142(2) &
142 (3)]
Intimation of payment
made voluntarily or made against the show cause notice (SCN) or
statement or intimation of tax ascertained through FORM GST DRC-01A
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1. |
GSTIN |
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2. |
Name |
< Auto> |
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3. |
Cause of payment |
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Audit, inspection or investigation, voluntary, SCN, annual
return, reconciliation statement, scrutiny, intimation of tax
ascertained through FORM GST DRC-01A, Mismatch (Form GSTR-1 and
Form GSTR-3B), Mismatch (Form GSTR-2B and Form GSTR-3B), others
(specify) |
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4. |
Section under which voluntary
payment is made |
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5. |
Details of show cause notice, if
payment is made within 30 days of its issue scrutiny, intimation
of tax ascertained through Form GST DRC-01A, audit, inspection
or investigation, others (specify) |
Reference No. |
Date of issue |
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6. |
Financial Year |
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7. |
Details of payment made including
interest and penalty, if applicable
(Amount in Rs.) |
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“Sr. No. |
Tax Period |
Act |
Place of supply (POS) |
Tax/Cess |
Interest |
Penalty, if applicable |
Fee |
Others |
Total |
Ledger utilised
(Cash/Credit) |
Debit entry no. |
Date of debit entry |
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(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
(9) |
(10) |
(11) |
(12) |
(13) |
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8. Reasons, if any - << Text box>>
9. 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.
Signature of Authorized
Signatory
Name
Designation / Status
Date – ”.
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