¹[FORM GST RFD-10A

 (See Rule 95)

Application for refund by Canteen Stores Department (CSD)

1. GSTIN               :

2. Name               :

3. Address           :

4. Tax Period (Quarter) : From

To

5. Amount of Refund Claim :

6. Details of inward supplies of goods received:

refund applied for:

8. Details of Bank Account:

a. Bank Account Number

b. Bank Account Type

c. Name of the Bank

d. Name of the Account Holder

e. Address of Bank Branch

f. IFSC

g. MICR

9. Attachment of the following documents with the refund application :

a. Copy of FORM GSTR-3B for the period for which application has been filed

b. Copy of FORM GSTR-2A for the period for which application has been filed

10. Verification

I _______ as an authorised representative of << Name of Canteen Store Department>> hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom. I further declare that all the goods, in respect of which the refund is being claimed, have been received by us and that no refund has been claimed earlier against any of the invoices against which refund has been claimed in this application.

Signature of Authorised Signatory:

Name:

 Designation / Status

Date

Place

Instructions:

1. Application for refund shall be filed on quarterly basis.

2. Applicant should ensure that all the invoices declared by them have the GSTIN of the supplier and the GSTIN of the respective CSD clearly marked on them.]₁