Wide Content Page
Forms - Refund
FORM-GST-RFD-04

Provisional Refund Order

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. 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        

Signature (DSC):

Name:

Designation: 

Office Address:

Place:

Date:


Rules