FORM GST APL - 01

[See rule 108(1)]

Appeal to Appellate Authority

1. GSTIN/ Temporary ID/UIN –
2. Legal name of the appellant-
3. Trade name, if any –
4. Address -
5. Order no. -                                    Order date -
6. Designation and address of the officer passing the order appealed against-
7. Date of communication of the order appealed against -
8. Name of the authorised representative-
9. Details of the case under dispute 

          (i) Brief issue of the case under dispute-     

           (ii) Description and classification of goods/ services in dispute-

(iii) Period of dispute- 

 (iv) Amount under dispute:

(v) Market value of seized goods

10.Whether the appellant wishes to be heard in person – Yes / No

11. Statement of facts:-                           

12. Grounds of appeal:-                                                          

13. Prayer:-                                                                                      

14. Amount of demand created, admitted and disputed                                                                                                              

^1-b[15. Details of payment of admitted amount and pre-deposit:-

             (a) Details of payment required

(b) Details of payment of admitted amount and pre-deposit ^3-b[(pre- deposit 10% of disputed tax and cess but not exceeding Rs. 20 crore each in respect of CGST, SGST, cess, and not exceeding Rs. 40 crore in respect of IGST)]_3-b

(c) Interest, penalty, late fee and any other amount payable and paid

16. Whether appeal is being filed after the prescribed period - Yes / No

17. If ‘Yes’ in item 17 –

               (a) Period of delay –

              (b) Reasons for delay –

^1-a[18. Place of supply wise details of the integrated tax paid (admitted amount only) mentioned in the Table in sub-clause (a) of clause 15 (item (a)), if any

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>

Place ________________                                                                                                                                        Name of the Applicant

Date _________________