THE GOA GOODS AND SERVICES TAX FORMS 2017
ASSESSMENT

Form GST ASMT - 17

[See rule 100(4)]

Application for withdrawal of assessment order issued under section 64

1. GSTIN /ID
2. Name
3. Details of the order	Reference No.	Date of issue of order
4. Tax Period, if any
5. Grounds for withdrawal

6. 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 Authorized Signatory

Name __________

Designation / Status -------

Date -