FORM GST DRC - 04

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

Reference No:                                                                                      Date:

To

_______________ GSTIN/ID

----------------------- Name

_______________ Address

Tax Period -------------                                                                          F.Y. ----------

ARN -                                                                                                                    Date -

Acknowledgement of payment made voluntarily.

The payment made by you vide application referred to above is hereby acknowledged to the extent of  the amount paid.

This is a system generated acknowledgement and does not require signature.