125. Form GST APL - 03
Form GST APL – 03
[See rule 109(1)]
Application to the Appellate Authority under sub-section (2) of Section 107
- Name and designation of the appellant Name-Designation-Jurisdiction-State/Center-Name of the State-
- GSTIN/ Temporary ID /UIN-
- Order no. Date-
- Designation and address of the officer passing the order appealed against-
- Date of communication of the order appealed against-
- Details of the case under dispute-
- Brief issue of the case under dispute-
- Description and classification of goods/ services in dispute-
- Period of dispute-
- Amount under dispute-
| Description | Central tax | State/ UT tax | Integrated tax | Cess |
| a) Tax/ Cess | ||||
| b) Interest | ||||
| c) Penalty | ||||
| d) Fees | ||||
| e) Other charges |
- Statement of facts-
- Grounds of appeal-
- Prayer-
- Amount of demand in dispute, if any –
| Particulars of demand/refund, if any | Particulars | Central tax | State/UT tax | Integrated tax | Cess | Total amount | |
| Amount of demand created, if any (A) | a) Tax/ Cess | < total > | < total > | ||||
| b) Interest | < total > | ||||||
| c) Penalty | < total > | ||||||
| d) Fees | < total > | ||||||
| e) Other charges | < total > | ||||||
| Amount under dispute (B) | a) Tax/ Cess | < total > | < total > | ||||
| b) Interest | < total > | ||||||
| c) Penalty | < total > | ||||||
| d) Fees | < total > | ||||||
| e) Other charges | < total > |
| Signature> |
Place: Date:
Name of the Applicant Officer: Designation:
Jurisdiction:
