FORM GST APL – 07

[See rule 111(1)]

Application to the Appellate Tribunal under sub section (3) of Section 112

1. Name and Designation of the appellant

Name:

Designation

Jurisdiction State/Center-

Name of the State:

2. GSTIN/ Temporary ID /UIN-

3. Appellate Order no.                                              Date-

4. Designation and Address of the Appellate Authority passing the order appealed against

5. Date of communication of the order appealed against

6. Details of the case under dispute:

(i) Brief issue of the case under dispute-

(ii) Description and classification of goods/ services in dispute-

(iii) Period of dispute-

(iv) Amount under dispute:

DescriptionCentral taxState/ UT tax Integrated taxCess
a) Tax/ Cess
b) Interest
c) Penalty
d) Fees
e) Other charges

7. Statement of facts –

8. Grounds of appeal –

9. Prayer –

10. Amount demanded, disputed and admitted:

Place:

Date:

<Signature

Name of the Officer:

Designations:

Jurisdiction:

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