FORM-GST-RFD-04
[See rule 91(2)]
Sanction Order No:
Date:
To
___________ (GSTIN)
___________ (Name)
____________ (Address)
Provisional Refund Order
Refund Application Reference No. (ARN) …………Dated ……………-
Acknowledgement No.…………Dated ……………...
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. | Amount claimed | ||||
| iii. | Amount claimed | ||||
| 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 |
Signature (DSC):
Name:
Designation:
Office Address:
Place:
Date:
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