FORM-GST-RFD-05
[See rule 91(3), 92(4), 92(5) & 94]

Payment Order

Payment Order No: -

Date: <DD/MM/YYYY>

'To PAO, CBIC'
Refund Sanction Order No. ……………
Order Date……<DD/MM/YYYY>……….
GSTIN/ UIN/ Temporary ID < >
Name: < >
Refund Amount (as per Order):

Description Integrated Tax Central Tax State/ UT tax Cess
  T I P F O Total T I P F O Total T I P F O Total T I P F O

Total
Net Refund amount
sanctioned		                                                
Interest on delayed
Refund		                                                
Total                                                

Note – ‘T’ stands Tax; ‘I’ stands for Interest; ‘P’ stands for Penalty; ‘F’ stands for Fee and ‘O’ stands for Others

  Details of the Bank  
i. Bank Account no as per application  
ii. Name of the Bank  
iii. Name and Address of the Bank /branch  
iv. IFSC  
v. MICR  

 

Date:
Place:

Signature (DSC):
Name:
Designation:
Office Address:

To
___________ (GSTIN/ UIN/ Temporary ID)
___________ (Name)
____________ (Address)