FORM GST DRC-03A
[See rules 142(2B)]
Application for adjustment of the amount paid through FORM GST DRC-03 against the order of demand
| 1 | GSTIN | |
| 2 | Legal Name | <Auto> |
| 3 | Trade Name, if any | <Auto> |
| 4 | ARN of DRC 03A | <Auto> |
| 5 | Date of Filing of DRC 03A | <Auto> |
| 6 | ARN of the DRC 03 through which payment made | |
| 7 | Date of filing of DRC 03 | <Auto> |
| 8 | Amount paid through DRC 03 | <Auto> |
(Amount in Rs.)
| Sr.No. | Tax period | Act | Place of Supply (POS) | Tax/Cess | Interest | Penalty | Fee | Others | Total |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| Total | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| 9 | Reference no. of the order of demand against which payment was intended to be made (including rectification / appeal order) | |
| 10 | Date of issue of Order | <Auto> |
| 11 | Amount of Demand | <Auto> |
(Amount in Rs.)
| Sr.No. | Tax period | Act | Place of Supply (POS) | Tax/Cess | Interest | Penalty | Fee | Others | Total |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| Total | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> | <Auto> |
| 12 | Undertaking I hereby undertake that the payment made vide the FORM GST DRC-03 with unique ARN number mentioned at S. No. 6 above, has actually been paid by me as ̳payment towards demand‘ intended to bepaid against the demand (with unique ARN number of FORM GST DRC -07, or GST DRC-08 or FORM GST APL-04, as the case may be, mentioned at S. No. 9 above) and has not been used towards any other demand/ payment to be made by me. I also undertake to payback to the Government the amount so adjusted using this form along with applicable interest, if any of the details declared above are found to be false subsequently. I will also be liable to penal action under Section 122(1)(x) of CGST Act. |
| 13 | Verification- I hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom. |
Date…………………….
Signature of Authorized Signatory
Name
Designation / Status