FORM GST PMT –04

                                                                                                [See rules85 (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.                                                                                                                                                                                   Signature Place                                                                                                                                         Name of Authorized Signatory Date                                                                                                                                          Designation /Status………………

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)