GSTAT FORM -01
[See rule 29 and 49]
Interlocutory Application to the Appellate Tribunal

1. GSTIN or Temporary Identification or Unique Identification Number -

2. Name of the appellant/applicant/respondent -

3. Address of the appellant/applicant/respondent -

4. Original Appeal Number-                                             Date-

5. Date of last hearing -

6. Name of the representative -

7. Purpose of the Interlocutory application -

8. Whether the appellant or applicant or respondent wishes to be heard in person -

9. Statement of facts -

10. Grounds of application -

11. Prayer -

Place:

Date:

Signature
Name of the appellant or applicant or respondent
Designation or Status