Table of Contents
FORM GST APL-041
[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 –
- GSTIN/Temporary ID/UIN –
- Name of the appellant / person –
- Address of the appellant / person-
- Order appealed against or intended to be revised – Number- Date-
- Appeal no. Date-
- Personal Hearing –
- Order in brief-
- Status of order- Confirmed / Modified / Rejected
- Amount of demand after appeal / revision:
| Particu lars | Central tax | State / UT tax | Integrated tax | Cess | Total | |||||
| Amo unt in dispu te / earlie r order | Determ ined Amoun t | Amo unt in dispu te / earlie r order | Determ ined Amoun t | Amo unt in dispu te / earlie r order | Determ ined Amoun t | Amo unt in dispu te / earlie r order | Determ ined Amoun t | Amo unt in dispu te / earlie r order | Determ ined Amoun t | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 |
| a) Tax | ||||||||||
| b) Interes t | ||||||||||
| c) Penalt y | ||||||||||
| d) Fees |
Substituted vide Notf no. 74/2018-CT dt 31.12.2018
| e) Others | ||||||||||
| f) Refun d | ; |
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:
Official Income Tax Return filing website: https://incometaxindia.gov.in/
