"FORM GST DRC -02 [See rule 142(1)(b)} Reference No: - Date:
To GSTIN/ID -~---- ----------------------- Name Address ------ Tax Period: F.Y.:
Section /sub-section under which statement is being issued :
SCN Ref. No.------ Statement Ref. No.---- Date Date- Summary of Statement:
(a) Brief facts of the case:
(b) Grounds :
(c) Tax and other dues:
(Amount in Rs.)
Sr. Ta Tumove Tax Ac POS Ta Interes Penalt Other Tota No. x r Period t (Place X t y s "' .
Fro m T of Supply ) rate 0 1 2 3 4 5 6 7 8 9 10 11 12 Tota .}_ Signature Name Designation Jurisdiction Address Note-
4. Only applicable fields may be filled up.
5. Column nos. 2, 3, 4 and 5 of the above Table i.e. tax rate, turnover and tax period are not mandatory.
6. Place of Supply (POS) details shall be required only if the demand is created under the IGST Act.".