FORM GST DRC -02

[See rule 142(1)(b)]

Reference No:                                                                                                       Date:

To

                               GSTIN/ID

Name

                               Address

SCN Ref. No. ——-                                        Date –

Statement Ref. No. —-                                    Date –

Section /sub-section under which statement is being issued –

Summary of Statement

• Brief facts of the case

• Grounds

• Tax and other dues

(Amount in Rs.)

361