THE ASSAM GOODS AND SERVICES TAX FORMS 2017
RETURN

Body

Form GSTR-5A

(See Rule 64)

Details of supplies of online information and database access or retrieval services by a person located outside India made to non-taxable persons in India

1.	GSTIN of the supplier-
2.	(a) Legal name of the registered person -
	(b) Trade name, if any -
3.	Name of the Authorised representative in India filing the return -
4.	Period:	Month -	Year -
4(a)	ARN:
4(b)	Date of ARN:
5.	Taxable outward supplies made to consumers in India

(Amount in Rupees)

Place of supply (State/UT)	Rate of tax	Taxable value	Integrated tax	Cess
1	2	3	4	5

5A. Amendments to taxable outward supplies to non-taxable persons in India

(Amount in Rupees)

Month	Place of supply (State/UT)	Rate of tax	Taxable value	Integrated tax	Cess
1	2	3	4	5	6

6. Calculation of interest, or any other amount

(Amount in Rupees)

Sr. No.	Description	Place of supply (State/UT)	Amount due (Interest/ Other)
Sr. No.	Description	Place of supply (State/UT)	Integrated tax	Cess
1	2	3	4	5
1.	Interest
2.	Others
	Total

7. Tax, interest and any other amount payable and paid

(Amount in Rupees)

Sr. No.	Description	Amount payable		Debit entry no.	Amount paid
Sr. No.	Description	Integrated tax	Cess	Debit entry no.	Integrated tax	Cess
1	2	3	4	5	6	7
1.	Tax Liability (based on Table 5 & 5A)
2.	Interest (based on Table 6)
3.	Others (based on Table 6)

Verification

I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom.

	Signature
Place	Name of Authorized Signatory..............
Date	Designation /Status