Application for waiver or refund of late fee

On the letterhead of the taxpayer — note that late fee can be waived only by notification under section 128; what is sought here is non-levy under an existing notification, or refund of a fee levied in error

To
The [Assistant Commissioner / Deputy Commissioner] of [Central / State] Tax
[Division], [Commissionerate]
[Through: the Superintendent, ____ Range]

Sub: Late fee of Rs [Late fee levied (Rs)] levied on Form [GSTR-3B / GSTR-1 / GSTR-9] for the tax period [Tax period of the return] — application for relief and for refund of the amount collected — GSTIN [Taxpayer's GSTIN]