Form GST APL - 05
[See Rule 110(1)]
Appeal to the Appellate Tribunal
(vii) Market value of seized goods
9. Whether the appellant wishes to be heard in person?
10. Statement of facts
11. Grounds of appeal
12. Prayer
13. Details of demand created, disputed and admitted
14. Details of payment of admitted amount and pre-deposit:
(a) Details of amount payable :
(b) Details of payment of admitted amount and pre-deposit (pre-deposit of 20% of the disputed tax and cess but not exceeding Rs. 50 crore each in respect of CGST, SGST or cess or not exceeding Rs. 100 crore in respect of IGST and Rs. 50 crore in respect of cess)
(c) Interest, penalty, late fee and any other amount payable and paid:
15. Place of supply wise details of the integrated tax paid (admitted amount only) mentioned in the Table in sub-clause (a) of clause 14 (item (a)), if any
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.