FORM-GST-RFD-04
[See rule 91(2)]
| Sanction Order No: |
Date: <DD/MM/YYYY> |
To
___________ (GSTIN)
___________ (Name)
____________ (Address)
Provisional Refund Order
Refund Application Reference No. (ARN)
Dated
<DD/MM/YYYY>
-
Acknowledgement No.
Dated
<DD/MM/YYYY>
...
Sir/Madam,
With reference to your above mentioned application for refund, the following
amount is sanctioned to you on a provisional basis:
| Sr. No | Description | Central Tax | State /UT tax | Integrated Tax | Cess |
|
i. |
Amount of refund claimed | ||||
| ii. | 10% of the amount claimed as
refund (to be sanctioned later) |
||||
| iii. | Balance amount (i-ii) | ||||
| iv. | Amount of refund sanctioned | ||||
| Bank Details | |||||
| v. | Bank Account No. as per application | ||||
| vi. | Name of the Bank | ||||
| vii. | Address of the Bank /Branch | ||||
| viii. | IFSC | ||||
| ix. | MICR |
| Date: Place: |
Signature (DSC): |