FORM GST DRC - 03

[See rule 142(2)&142(3)]

Intimation of payment made voluntarily or made against the show cause notice (SCN) or statement

ARN :AD090220015118M Date :17/02/2020

1. GSTIN 09BEEPS5707R1ZN
2. Name MANORAMA SINGH
3. Cause of Payment Reconciliation statement
4.
5.

6.
Section under which voluntary payment is made

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Details of show cause notice, if payment is made within 30 Reference No:NA
days of its issue
Financial Year 2017-2018
Date of issue:NA

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7. Details of payment made including interest and penalty, if applicable (Amount in Rs.)
Sr. Tax Period Act Place of supply Tax/Cess Interest Penalty,if Others Total Ledger Debit entry no. Date of debit

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No. applicable utilised entry
(Cash/credit)

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1. JUL 2017- IGST Maharashtra 3,000.00 1,200.00 0.00 0.00 4,200.00 Cash DC0902200154311 17/02/2020
MAR 2018
2. JUL 2017- CGST Uttar Pradesh 12,798.00 5,120.00 0.00 0.00 17,918.00 Cash DC0902200154311 17/02/2020
MAR 2018
3. JUL 2017- SGST Uttar Pradesh 12,798.00 5,120.00 0.00 0.00 17,918.00 Cash DC0902200154311 17/02/2020
MAR 2018

8. Reasons, if any -
DUE TO CLERICAL MISTAKE TIHS AMOUNT WAS LEFT TO PAY

9. 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 .
 Signature of Authorized Signatory

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Name: MANORAMA SINGH

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Designation: PROPRIETOR
Date: 17/02/2020

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