THE GOA GOODS AND SERVICES TAX FORMS 2017
APPEAL AND REVISION

Form GST APL - 06

[See Rule 110(2)]

Cross-objections before the Appellate Tribunal

under sub-section (5) of section 112

Sr. No.

Particulars

Appeal No. - Date of filing-

GSTIN/ Temporary ID/UIN-

Name of the appellant-

Permanent address of the appellant-

Address for communication-

Order no.

Date-

Designation and Address of the officer passing the order appealed against-

Date of communication of the order appealed against-

Name of the representative-

10.

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

(v)

Market value of seized goods-

State or Union Territory and the Commissionerate (Centre) in which the order or decision was passed (Jurisdiction details)-

Date of receipt of notice of appeal or application filed with the Appellate Tribunal by the appellant or the Commissioner of State/Central tax/UT tax, as the case may be-

Whether the decision or order appealed against involves any question relating to place of supply

Yes- No-

In case of cross-objections filed by a person other than the Commissioner of State/UT tax/Central tax

(i) Name of the Adjudicating Authority-

(ii) Order Number and date of Order-

(iii) GSTIN/UIN/Temporary ID-

(iv) Amount involved:

Head	Tax	Interest	Penalty	Refund	Total
Integrated tax
Central tax
State/UT tax
Cess

Details of payment

Head	Tax	Interest	Penalty	Refund	Total
Central tax
State/UT tax
Integrated tax
Cess
Total

In case of cross-objections filed by the Commissioner State/UT tax/Central tax:

(i)

Amount of tax demand dropped or reduced for the period of dispute

(ii)

Amount of interest demand dropped or reduced for the period of dispute

(iii)

Amount of refund sanctioned or allowed for the period of dispute

(iv)

Whether no or lesser amount imposed as penalty

TOTAL

Reliefs claimed in memorandum of cross -objections.

Grounds of Cross objection

Verification

I,______________________________the respondent, do hereby declare that what is stated above is true to the best of my information and belief.

Verified today, the________________day of___________20..._______

Place:

Date:

Name of the Applicant/ Officer:

Designation/Status of Applicant/

officer: