Gst Refund Forms State Gst Rfd 04

Government of <<State>> 

Department of.. 

FORM-GST-RFD-04 

[See Rule -] 

Provisional Refund Order 

Date: <DD/MM/YYYY> 

Reference No : 

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: 

Place: 

Signature (DSC): 

Name: 

Designation: 

Office Address: