Sr.
No.

Particulars

1

Appeal No. –                                                              Date of filing –

2

Present Cross-objection being filed by:

• GSTIN/Temporary ID/UIN/CRN/ARN –

• Name –

• e-mail id –

• Contact number –

• Address for communication –

• Designation of officer –

• Office details –

• e-mail id –

• Contact number -

3

Order no. – (Order of the Appellate/Revisional authority) -                                                       Date-

4

Designation alongwith jurisdiction of the officer passing the order appealed against –

Designation:

Jurisdiction: Order Passed by:

5

Date of communication of the order appealed against –

6

Name of the authorized representative, where available –

e-mail id of said representative –

Contact number of said representative

7

Details of the case under dispute –

(i)

Period of dispute -

(ii)

Amount under dispute

Central tax

State/UT tax

Integrated tax

Cess

(a) Tax

(b) Interest

(c) Penalty

(d) Fees

(e) Other charges (specify)

(iii)

Market value of seized goods, where one of the issues involved is seizure/confiscation of goods -

8

Summary of Issues involved and summary of reply thereto – Annexure A

9

Date  of  receipt  of  notice  of  appeal  or  application  filed  with  the  Appellate Tribunal by the taxpayer or the Commissioner of State/Central tax/UT tax, as the case may be - OR Date of receipt of notice of appeal or application filed with the Appellate Tribunal by the person filing the present cross-objection -

10

Demand Table

Category

Tax

As per order of adjudicating authority

As determined by Appellate/Revisional authority

As per the person filing this cross objection

Tax

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Interest

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Penalty

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Penalty

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Fees

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Others

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

Refund

Central Tax

State/UT Tax

Integrated Tax

Cess

Total

11

Reliefs claimed in memorandum of cross-objections.

12

Summary of reply (Annexure B)

13

Grounds of Cross-objection

14

Para-wise reply (upload separately)

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 the same is derived from information, documents and records in my possession and further that nothing has been concealed therefrom.

Verified today, the ______________________________ day of _____month ______________________________ 20...___________

Place :
Date :

<Signature>
Name  of  the  person  filing  this  cross- objection ::
Designation/Status   of   Applicant/officer
:”

S. No 

Sr No 

Issue related to 

As per order of adjudicating authority 

As determined by Appellate/ Revisional authority 

As declared/ claimed by present Appellant 

Reply to ground/issue raised in Appeal before GSTAT 

2 

6 

7