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Appeal to Appellate Authority

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..... e : Description Central tax State/UT tax Integrated tax Cess (a) Tax/Cess (b) Interest (c) Penalty (d) Fees (e) Other charges (v) Market value of seized goods 10. Whether the appellant wishes to be heard in person - Yes/No 11. Statement of facts :- 12. Grounds of appeal :- 13. Prayer :- 14. Amount of demand created, admitted .....

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..... amount and pre-deposit:- (a) Details of payment required 3 [ Particulars Central Tax State/ UT Tax Integrated Tax Cess Total amount (a) Admitted amount Tax/ Cess total total ] Interest total Penalty total Fees total Other Charges total (b) Pre-deposit (10% of disput .....

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..... 2. Central tax Cash Ledger Credit Ledger 3. State/UT tax Cash Ledger Credit Ledger 4. CESS .....

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..... 4. Others (specify) ] 16. Whether appeal is being filed after the prescribed period - Yes/No 17. If Yes in item 17 - (a) Period of delay - (b) Reasons for delay 2 [ 18. Place of supply wise details of the integrated tax paid (admitted amount only) mentioned in the Table in sub-clause (a) of clause 15 (item (a)), if any Place of Supply (Name of State/UT) .....

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..... total total Interest total Penalty total Fees total Other charges total (b) Pre-deposit (10% of disputed tax) Tax/Cess total (b) Details of payment of admitted amount and pre-deposit (pre-deposit 10% of the disputed tax and cess) Sr. No. Description Tax payable Paid through Cash/Credit Ledger Debit entry no. Amount of tax paid Central tax .....

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..... 2 3 4 5 6 7 8 9 10 11 1. Interest 2. Penalty 3. Late fee 4. Others (specify) 2. Inserted vide Notification No. 03/2019-Central Tax dated 29-01-2019 w.e.f. 01-02-2019 .....

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