2[FORM GST APL-04
[See rules 109B, 113 (1) and 115]
SUMMARY OF THE DEMAND AFTER ISSUE OF ORDER BY THE APPELLATE
AUTHORITY, REVISIONAL AUTHORITY, TRIBUNAL OR COURT
Reference no. : Date :
| Particulars | Central tax | State / UT tax | Integrated tax | Cess | Total | |||||
| Amount in dispute / earlier order | Determined Amount | Amount in dispute / earlier order | Determined Amount | Amount in dispute / earlier order | Determined Amount | Amount in dispute / earlier order | Determined Amount | Amount in dispute / earlier order | Determined Amount | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| a) Tax | ||||||||||
| b) Interest | ||||||||||
| c) Penalty | ||||||||||
| d) Fees | ||||||||||
| e) Others | ||||||||||
| f) Refund | ||||||||||
10. Place of supply wise details of IGST demand
| Place of Supply (Name of State / UT) | Demand | Tax | Interest | Penalty | Other | Total |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|
Amount in dispute/ earlier order |
||||||
| Determined Amount | ||||||
Place ________________
Date _________________
Signature:
Name of the Appellate Authority / Revisional Authority/ Tribunal / Jurisdictional Officer Designation: Jurisdiction:]2
1. Inserted vide Notification No. 60/2018 – Central Tax dated 30-10-2018
2. Substituted vide Notification No. 74/2018 – Central Tax dated 31-12-2018 for
"Form GST APL – 04
[See rules 113(1) & 115]
Summary of the demand after issue of order by the Appellate Authority, Tribunal or Court
Order no. –
Date of order -
1. GSTIN/ Temporary ID/UIN -
2. Name of the appellant-
3. Address of the appellant
4. Order appealed against- Number- Date-
5. Appeal no. Date-
6. Personal Hearing –
7. Order in brief-
8. Status of order- Confirmed/Modified/Rejected
9. Amount of demand confirmed:
| Particulars | Central tax | State/UT tax | Integrated tax | Cess | Total | |||||
| Disputed Amount | Determined Amount | Disputed Amount | Determined Amount | Disputed Amount | Determined Amount | Disputed Amount | Determined Amount | Disputed Amount | Determined Amount | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| a) Tax | ||||||||||
| b) Interest | ||||||||||
| c) Penalty | ||||||||||
| d) Fees | ||||||||||
| e) Others | ||||||||||
| f) Refund | ||||||||||
1[10. Details of IGST Demand
| Place of Supply (Name of State/UT) |
Demand
|
Tax
|
Interest
|
Penalty
|
Other
|
Total
|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Disputed Amount | ||||||
| Determined Amount | ||||||
| ]1 |
Place:
Date:
| Signature> |
< Name of the Appellate Authority /Tribunal/
Jurisdictional Officer>
Designation:
Jurisdiction:
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