Form GST PMT-04
[See rules 85(7), 86(6) & 87(12)]

Application for intimation of discrepancy in Electronic Credit Ledger/Cash Ledger/ Liability Register

1. GSTIN  
2. Name (Legal)  
3. Trade name, if any  
4 Ledger / Register in
which discrepancy noticed
□Credit ledger □Cash ledger  

  □Liability register
5. Details of the discrepancy  
 

Date

 Type of tax Type of discrepancy Amount involved
    Central Tax    
    State Tax    
    UT Tax    
    Integrated Tax    
    Cess    
6. Reasons, if any
   
7. Verification
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief.
Place
Date		 Name of Authorized Signatory
Designation /Status………………

Signature

Note –

‘Central Tax’ stands for Central Goods and Services Tax; ‘State Tax’ stands for State Goods and Services Tax; ‘UT Tax’ stands for Union territory Goods and Services Tax; ‘Integrated Tax’ stands for Integrated Goods and Services Tax and ‘Cess’ stands for Goods and Services Tax (Compensation to States)