126. Form GST APL – 04

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Form GST APL – 04 [See rules 113(1) & 115] Summary of the demand after issue of order by the Appellate Authority, Tribunal or Court Orde

92. FORM-GST-RFD-07

15__15__2019__Rate

11-04-2018 Rate

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-

Status of order- Confirmed/Modified/Rejected
Amount of demand confirmed:

Particu lars	Central tax	State/UT tax	Integrated tax	Cess	Total
Dispu ted Amou nt	Determi ned Amount	Dispu ted Amou nt	Determi ned Amount	Dispu ted Amou nt	Determi ned Amount	Dispu ted Amou nt	Determi ned Amount	Dispu ted Amou nt	Determi ned Amount
1	2	3	4	5	6	7	8	9	10	11
a) Tax
b) Intere st
c) Penalt y
d) Fees
e) Other s
f) Refun d

Place: Date:

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<p>< Name of the Appellate Authority /Tribunal/</p>

<p>Jurisdictional Officer></p>

<p>Designation: Jurisdiction:</p>
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