FORM GST APL-04: Summary of Demand after issue of Order by Appellate/Revisional Authority, Tribunal or Court

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 –

1. GSTIN/ Temporary ID/UIN –
2. Name of the appellant / person –
3. Address of the appellant / person
4. Order appealed against or intended to be revised – Number- Date
5. Appeal no. Date
6. Personal Hearing –
7. Order in brief
8. Status of order- Confirmed / Modified / Rejected
9. Amount of demand after appeal / revision:

Particulars	Central tax		State / UT tax		Integrated tax		Cess		Total
1	2	3	4	5	6	7	8	9	10	11
a) Tax	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
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: