Government of <<State>>
Department of….
FORM-GST-RFD-04
[See Rule -]
Provisional Refund Order
Reference No : Date: <DD/MM/YYYY>
To
___________ (GSTIN)
___________ (Name)
____________ (Address)
Acknowledgement No. …………Dated ………<DD/MM/YYYY>……..
Sir/Madam,
With reference to your refund application as, following refund is sanctioned to you:
Refund Calculation | SGST | |
i. | Amount of Refund claimed | |
ii. | Reduced by 20% | |
iii. | Balance refund Sanctioned | |
Bank Details | ||
i. | Bank Account no as per application | |
ii. | Bank Account Type | |
iii. | Name of the Account holder | |
iv. | Name of the Bank | |
v. | Address of the Bank /Branch | |
vi. | IFSC | |
vii. | MICR |
Date: Signature (DSC): Place: Name: Designation:
Office Address:
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