Gst Refund Forms Centre Gst Rfd 01

Government of India /State 

Department of.. 

FORM-GST-RFD-01 

[See rule------] 

Refund Application Form 

1. GSTIN:

2. Name :

3. Address:

4. Tax Period:

From <DD/MM/YY> 

To <DD/MM/YY> 

5. Amount of Refund Claimed :

Tax 

Interest  Penalty  Fees  Others  Total 

IGST 
CGST 

SGST 

Total 

6. Grounds of Refund Claim: (selected from the drop down)

a. Excess balance in Cash ledger

b. Exports  of goods / services

c. Supply of goods / services to SEZ/EOU

d. Assessment/provisional assessment/ Appeal/ Order No

e.

ITC accumulated due to inverted duty structure

7. Details of Bank Account ( to be auto populated from RC)

a. Bank Account Number
b. Name of the Bank
c. Bank Account Type
d. Name of account holder
e. Address of Bank Branch
IFSC
f.
g. MICR

: 
: 
: 
: 
: 
: 
: 

8. Whether Self-Declaration  by Applicant  u/s____ , If applicable            Yes/No 

 Self-Declaration 

I/We, M/s. ____________________ (Applicant) having GSTIN  -------, solemnly affirm and certify that 
in respect of  the refund amounting to INR---/ with respect to the tax and interest  for the period from---to-
---, claimed in the refund application, the incidence of such tax and interest  has not been passed on  to any 
other person.  

(This Declaration is not required to be furnished by applicants, who are claiming refund under sub rule<>  of the 
GST Rules<.>.) 

9. Verification

I/We  <Taxpayer  Name>  hereby  solemnly  affirm  and  declare  that  the  information  given  herein  above  is
true and correct to the best of my/our knowledge and belief and nothing has been concealed therefrom.

Place 

Date 

Signature of Authorized Signatory 

(Name) 

   Designation/ Status 

Note: 1) A separate statement has to be filed under sub-rule (4) of rule 1 of draft Goods and Services Tax refund 
rule. 

 Annexure-1 Statement containing the number and date of invoices under <.>of GST Rules, 

Sr. 
No. 

Tax Period: _____ 

Details of Invoices 

IGST 

CGST 

SGST 

No.  Date  UQC 

Value 

Qty 

Goods/ 

HSN/ 
SAC 

Taxable 
value 

Rate  Amt  Rate  Amt  Rate  Amt 

Services 

 Annexure-2 

Certificate 

This is to certify that the refund amounting to INR <<    >> -------------- (in word) claimed by M/s ----------------- 
(Applicant’s  Name)  GSTIN-------  for  the  tax  period  <  ---->,  the  incidence  of  tax  and  interest  as  claimed  by  the 
applicant, has not been passed on to any other person. This certificate is based on the examination of the Books of 
Accounts and other relevant particulars maintained by the applicant. 

Signature of the Chartered Accountant/ Cost Accountant: 

Name: 

Membership Number: 

Place:       

Date:   

  This  Declaration  is  not  required  to  be  furnished  by  applicants,  who  are  claiming  refund  under  sub-section<>of 
section<> of the Act 

Note: The certificate is to be filed by applicants wherever applicable.