ANNEXURE-V - Form GST - Refund order - Report on - Business Processes for GST on Refund Process - [August 2015]

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 Taxpayer

 

3. Taxpayer’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	Application

 

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

7. Tax Period for which refund claimed

From

To

dd

mm

yy

dd

mm

yy

 

8. Refund Calculation

i)     Refund claimed

ii)    Refund reduced, if any

iii)   Refund allowed (i – ii)

iv)    Interest due in case of delayed payment of refund

v)     Amount of  adjustment against outstanding demand

(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.