Form GST – CMP-04
[See rule 6(2)]

Intimation/Application for Withdrawal from Composition Levy

1. GSTIN  
2. Legal name  
3. Trade name, if any  
4.Address of Principal Place of business  
5. Category of Registered Person  
    (i) Manufacturers, other than manufacturers of such goods as may be notified by the Government     □
    (ii) Suppliers making supplies referred to in clause (b) of paragraph 6 of Schedule II    □
    (iii) Any other supplier eligible for composition levy.   □
6. Nature of Business  
7. Date from which withdrawal from composition scheme is sought DD MM YYYY
8. Jurisdiction Centre State
9. Reasons for withdrawal from composition scheme  

10. 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

Signature of Authorised Signatory
Name              

Place
Date

Designation / Status

Note – Stock statement may be furnished separately for availing input tax credit on the stock available on the date preceding the date from which composition option is withdrawn in FORM GST ITC -01.