Form GST APL-04 A

[See rule 113(2)]

Summary of the order and demand after issue of order by the Goods and Services Tax Appellate Tribunal

Whether remand order: Yes / No

Order Reference no.-                                                        Date of order-

1. GSTIN/Temporary ID/UIN –

2. Appeal Case Reference no. –                                                               Date:-

3. Name of the appellant –

4. Name of the Respondent –

5. Order appealed against –

a) Order Type -- Demand, Registration, Refund, Enforcement, Refund & Others

b) Ref Number –

                                                                                             Date –

6. Personal Hearing – (All hearing dates)

7. Status of Order under Appeal- Confirmed/Modified/Rejected

Confirmed – Order under Appeal is confirmed
Modified – Order under Appeal is modified
Rejected - - Order under Appeal is annulled

8. Order in brief: (Free text, Max 2500 characters)–

9. If demand order, then whether demand quantified: (Yes/No) (If the answer is YES, the demand quantified as follows:)

Section-I

Particulars 

 Central tax  State/UT tax  Integrated tax  Cess  Total 
Disputed Amount  Determined Amount  Disputed Amount  Determined Amount  Disputed Amount  Determined Amount  Disputed Amount  Determined Amount  Disputed Amount  Determined Amount 
1  2  3  4  5  6  7  8  9  10  11 
(a) Tax                     
(b) Interest                     
(c) Penalty                     
(d) Fees                     
(e) Others                     
(f) Refund                     

Section-II

Place of Supply/ Name of State/UT 

Demand 

Tax 

Interest 

Penalty 

Other 

Total 
1  2  3  4  5  6  7 
  Amount in dispute           
  Amount Determined           
             
             

Add rows 

            

10. For Other orders and Demand orders which are not quantified

Issues as raised by proper officer  Issues as determined by Appellate/Revisional authority  Order by GST Appellate Tribunal 
     
     
     

11. If remanded with directions:

a) Remanded to: (specify authority to whom remanded. Adjudicating Authority, Appellate authority, Revisional authority, any other)

b) Directions subject to which remanded, if any: (Free text, Max 1000 words)

Section-III (Anti-profiteering)

12. Order In brief: (Drop -Down Values)

a) Reduction in Price

b) Return to Recipient of Amount not passed on, along with interest

c) Deposit in Consumer Welfare Fund/s

d) Penalty Imposed (Amount to be specified)

e) Cancellation of Registration

Place:

Date:

Signature:

Designation:

Jurisdiction: