FORM GST APL-03: Application to Appellate Authority u/s 107(2)

FORM GST APL – 03

[See rule 109(1)]

Application to the Appellate Authority under sub-section (2) of Section 107

1. Name and designation of the appellant
   Name-
   Designation-
   Jurisdiction-
   State/Center-
   Name of the State
2. GSTIN/ Temporary ID /UIN
3. Order no. Date-
4. Designation and address of the officer 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-

Description	Central tax	State/ UT tax	Integrated tax	Cess
a) Tax/ Cess
b) Interest
c) Penalty
d) Fees
e) Other charges

7. Statement of facts-

8. Grounds of appeal-

9. Prayer-

10. Amount of demand in dispute, if any –

Particulars of demand/refund, if any	Particulars		Central tax	State/ UT tax	Integrated tax	Cess	Total amount
	Amount of demand created, if any (A)	a) Tax/ Cess					<total>	<total>
		b) Interest					< total>
		c) Penalty					< total>
		d) Fees					< total>
		e) Other Charges					< total>
	Amount under dispute (B)	a) Tax/ Cess					< total>	< total>
		b) Interest					< total>
		c) Penalty					< total>
		d) Fees					< total>
		e) Other Charges					< total>

Place:

Date:

Signature

Name of the Applicant Officer:

Designation:
Jurisdiction: