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.