GSTAT FORM -01
[See rule 29 and 49]

Interlocutory Application to the Appellate Tribunal

1. GSTIN or Temporary Identification or Unique Identification Number –
2. Name of the appellant/applicant/respondent –
3. Address of the appellant/applicant/respondent –
4. Original Appeal Number- Date
5. Date of last hearing –
6. Name of the representative –
7. Purpose of the Interlocutory application –
8. Whether the appellant or applicant or respondent wishes to be heard in person –
9. Statement of facts –
10. Grounds of application –
11. Prayer –

Place:
Date:

Signature
Name of the appellant or applicant or respondent
Designation or Status