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GST-RFD-04 

Government of India 

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 

IGST 

CGST

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:

Download PDF Document In English. (Rs.5/-)



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