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Refund Order (ANNEXURE-V)

ANNEXURE-V

Department of ————

Government of ————

Form GST – 

[ See Rule –    ]

Reference No.                                                                                    Date –

Refund order under —– Goods & Services Tax Act, —-

1. GSTIN                            

 

2. Full Name of Tax Payer

 

                         
                         

 

3.  Tax Payer’s address Building Name/ Number                            
Area/ Road                            
Locality/ Market                            
Pin Code              

 

4. Receipt No. & date

of refund application

Receipt No.  –

 

Receipt date –

 

5. Act Tick þ one q  IGST q  CGST q SGST
6. Type of refund application Tick þ one q  Return type q  Return type q Application

Note – Return type can be regular & composition (say, GST-20,21) etc.

 

7. Tax Period for which refund claimed From                 To                
d d mm y y d d mm yy

 

 

(vi) Net amount of refund payable                         (iii + iv – v)                      
9. Details of Bank Account  
i)     Bank Account No.                                
ii)    Bank Account Type                                
iii)   Operated in the name of                                
iv)    Name & Address of Bank/Branch                                
v)     MICR No. / IFSC                                

 

(Signature)

Name

(Designation)

Ward/Circle/Unit/Other

(Place)

(Date)

Note –  Please quote your GSTIN while communicating with the department ——       in this  matter or in any other matter whatsoever.

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