Application for adjustment of the amount paid through FORM GST DRC-03 against the order of demand

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..... 3 through which payment made 7. Date of filing of DRC-03 Auto 8. Amount paid through DRC-03 Auto (Amount in Rs.) Sr. No. Tax Period Act Place of Supply (POS) Tax/ Cess Interest Penalty Fee Others Total 1 2 3 4 5 6 7 8 9 10 Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Auto Total Auto Auto Auto Auto Auto Auto Auto Auto Auto 9. Reference no. of the or .....

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..... en used towards any other demand/ payment to be made by me. I also undertake to pay back to the Government the amount so adjusted using this form along with applicable interest, if any of the details declared above are found to be false subsequently. I will also be liable to penal action under Section 122(1)(x) of CGST Act. 13. Verification - I hereby solemnly affirm and declare that the informati .....

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