FORM GST DRC-19
[See rule 156]

To,
Magistrate,
<<Name and Address of the Court>>

Demand order no.:                                                                                                                                                     Date:
Reference number of recovery:                                                                                                                                   Date:
Period:

Application to the Magistrate for Recovery as Fine

A sum of Rs. << ----- >> is recoverable from <<Name of taxable person>> holding <<GSTIN>> on account of tax, interest and penalty payable under the provisions of the Act. You are requested to kindly recover such amount in accordance with the provisions of clause (f) of sub-section (1) of section 79 of the Act as if it were a fine imposed by a Magistrate.

Signature
Name
Designation

Place:
Date: