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:

1Substituted vide Notification no. 74/2018-CT dt 31.12.2018

10. Place of supply wise details of IGST demand

Place:
Date:

Signature:

Name of the Appellate Authority / Revisional
Authority/ Tribunal / Jurisdictional Officer
Designation:
Jurisdiction:

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