[Form-GST-RFD-01 A [Substituted by Notification No. G.S.R. 1251(E), dated 31.12.2018 (w.e.f. 19.6.2017).]]
[See rules 89(1) and 97A]
Application for Refund (Manual)
(Applicable for casual taxable person or non-resident taxable person, tax deductor, tax collector and other registered taxable person)
1.
GSTIN/Temporary ID
2.
Legal Name
3.
Trade Name, if any
4.
Address
5.
Tax period (if applicable)
From To
6.
Amount of Refund Claimed(Rs.)
Act
Tax
Interest
Penalty
Fees
Others
Total
Central tax
State / UT tax
Integrated tax
Cess
Total
7.
Grounds of Refund Claim (select from drop down)
(a)
Excess balance in Electronic Cash Ledger
(b)
Exports of services- with payment of tax
(c)
Exports of goods / services- without payment of
tax (accumulated ITC)
(d)
ITC accumulated due to inverted tax
structure[under clause (ii) of first proviso to Section 54(3)]
(e)
On account of supplies made to SEZ unit/ SEZ
developer(with payment of tax)
(f)
On account of supplies made to SEZ unit/ SEZ
developer (without payment of tax)
(g)
Recipient of deemed export supplies/ Supplier of
deemed export supplies
(h)
{|
On account of order
Sl.No.
Type of order
Order No.
Order date
Order Issuing Authority
Payment reference No., if any
(i)
Assessment
(ii)
Finalization or Provisional assessment
(iii)
Appeal
(iv)
Any other order (specify)
|-
| (i)
| Tax paid on an intra-State supply which is
subsequently held to be inter-State supply and vice versa (change
of POS)
|-
| (j)
| Excess
payment of tax, if any
|-
| (k)
| Any other(specify)
|}
[Declaration
[second proviso to Section 54(3)]
I hereby declare that the goods exported are not subject to any export duty. I also declare that I have not availed any drawback of central excise duty/service tax/central tax on goods or services or both and that I have not claimed refund of the integrated tax paid on supplies in respect of which refund is claimed.
Signature
Name -
Designation/Status]
[Substituted by Notification No. G.S.R. 639(E), dated 15.10.2020 (w.e.f. 19.6.2017).]
Declaration
[section 54(3)(ii)]
I hereby declare that the refund of ITC claimed in the application does not include ITC availed on goods or services used for making 'nil' rated or fully exempt supplies.
Signature
Name -
Designation / Status
[Declaration
[rule 89(2)(f)] [Substituted by Notification No. G.S.R. 63(E), dated 29.1.2019 (w.e.f. 19.6.2017).]]
I hereby declare that tax has not been collected from the Special Economic Zone unit /the Special Economic Zone developer in respect of supply of goods or services or both covered under this refund claim.
Signature
Name -
Designation / Status
Declaration [rule 89(2)(g)]
(For recipient/supplier of deemed export)
In case refund claimed by recipient
I hereby declare that the refund has been
claimed only for those invoices which have been detailed in
statement 5B for the tax period for which refund is being claimed
and the amount does not exceed the amount of input tax credit
availed in the valid return filed for the said tax period. I also
declare that the supplier has not claimed refund with respect to
the said supplies.
In case refund claimed by supplier
I hereby declare that the refund has been
claimed only for those invoices which have been detailed in
statement 5B for the tax period for which refund is being
claimed and the recipient shall not claim any
refund with respect of the said supplies and also the recipient
has not availed any input tax credit on such supplies
Signature
Name -
Designation/Status
Undertaking
I hereby undertake to pay back to the Government
the amount of refund sanctioned along with interest in case it is
found subsequently that the requirements of clause (c) of
sub-section (2) of section 16 read with sub-section (2) of
section 42 of the CGST/SGST Act have not been complied with in
respect of the amount refunded.
Signature
Name -
Designation/Status]
Self-
Declaration [rule 89(2)(l)]
I/We
____________________ (Applicant) having GSTIN/ temporary Id
——-, solemnly affirm and certify that in respect of the
refund amounting to Rs. —/ with respect to the tax, interest,
or any other amount 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.
Signature
Name –
Designation / Status
(This Declaration is not required to be
furnished by applicants, who are claiming refund under clause (a)
or clause (b) or clause (c) or clause (d) or clause (f) of
sub-section (8) of Section 54.)
8. Verification
I/Wehereby 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.
I/We declare
that no refund on this account has been received by me/us
earlier.
Place
Signature of Authorised Signatory
Date
(Name)
Designation/ Status
Annexure-1
Statement -1 [rule 89(5)]
Refund Type: ITC accumulated due to inverted tax structure [clause (ii) of first proviso to Section 54(3)]
(Amount in Rs.)
Turnover of inverted rated supply of goods and services
Tax payable on such inverted rated supply of
goods and services
Adjusted total turnover
Net input tax credit
Maximum refund amount to be claimed [(1×4÷3)-2]
1
2
3
4
5
Statement - 1A [see rule 89(2)(h)]
Refund Type: ITC accumulated due to inverted tax structure [clause (ii) of first proviso to section 54(3)]
Sl No.
Details of invoices of inward supplies of inputs received
Tax paid on inward supplies of inputs
Details of invoices of outward supplies issued
Tax paid on outward supplies
GSTIN of the supplier *
No.
Date
Taxable Value
Integrated Tax
Central Tax
State Tax/Union Territory Tax
No.
Date
Taxable value
Invoice type (B2B/B2C)
Integrated Tax
Central Tax
State Tax/Union Territory Tax
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
* In case of imports or supplies received under reverse charge mechanism [sub-section (3) of section 9 of the CGST Act/ SGST Act or sub-section (3) of section 5 of IGST Act], the GSTIN of supplier will mean GSTIN of applicant (recipient).
Statement - 2 [rule 89(2)(c)]
Refund Type: Exports of services with payment of tax
(Amount in Rs.)
Sr. No.
Invoice details
Integrated tax
Cess
BRC/ FIRC
Integrated tax and cess involved in debit
note, if any
Integrated tax and cess involved in credit
note, if any
Net Integrated tax and cess (6+7+10-11)
No.
Date
Value
Taxable value
Amt.
No.
Date
1
2
3
4
5
6
7
8
9
10
11
12
Statement - 3 [rule 89(2)(b) and 89(2)(c)]
Refund Type : Export without payment of tax (accumulated ITC)
(Amount in Rs.)
Sr. No.
Invoice details
Goods/ Services (G/S)
Shipping bill/ Bill of export
EGM Details
BRC/ FIRC
No.
Date
Value
Port code
No.
Date
Ref No.
Date
No.
Date
1
2
3
4
5
6
7
8
9
10
11
12
]
Statement- 3A [rule 89(4)]
Refund Type: Export without payment of tax (accumulated ITC) - calculation of refund amount
(Amount in Rs.)
Turnover of zero rated supply of goods and
services
Net input tax credit
Adjusted total turnover
Refund amount (1×2÷3)
1
2
3
4
Statement-4 [rule 89(2)(d) and 89(2)(e)]
Refund Type: On account of supplies made to SEZ unit or SEZ Developer (on payment of tax)
(Amount in Rs.)
GSTIN of recipient
Invoice details
Shipping bill/ Bill of export/ Endorsed
invoice by SEZ
Integrated Tax
Cess
Integrated tax and cess involved in debit
note, if any
Integrated tax and cess involved in credit
note, if any
Net Integrated tax and cess (8+9+10–11)
No.
Date
Value
No.
Date
Taxable Value
Amt.
1
2
3
4
5
6
7
8
9
10
11
12
Statement-5A [rule 89(4)]
Refund Type: On account of supplies made to SEZ unit / SEZ developer without payment of tax (accumulated ITC) - calculation of refund amount
(Amount in Rs.)
Turnover of zero rated supply of goods and
services
Net input tax credit
Adjusted total turnover
Refund amount (1×2÷3)
1
2
3
4
[Statement 5B [rule 89(2)(g)] [Substituted by Notification No. G.S.R. 513(E), dated 18.7.2019 (w.e.f. 19.6.2017).]
Refund Type: On account of deemed exports
(Amount in Rs)
Sl No.
Details of invoices/credit notes/debit notes of outward
supplies in case refund is claimed by supplier/Details of invoices of inward
supplies in case refund is claimed by recipient
Tax Paid
GSTIN of the supplier
No.
Date
Taxable Value
Type (Invoice/Credit Note/Debit Note)
Integrated Tax
Central Tax
State Tax/Union Territory Tax
Cess
1
2
3
4
5
6
7
8
9
10
Statement-6 [rule 89(2)(j)]
Refund Type: On account of change in POS (inter-State to intra-State and vice versa)
Order Details (issued in pursuance of sections 77(1) and 77(2), if any:
Order No:
Order Date:(Amount in Rs.)
Recipients' GSTIN/ UIN Name (in case B2C)
Invoice details
Details of tax paid on transaction considered
as intra –State / inter-State transaction earlier
Taxes re-assessed on transaction which were
held inter State / intra-State supply subsequently
No.
Date
Value
Taxable Value
Integrated tax
Central tax
State/ UT tax
Cess
Place of Supply
Integrated tax
Central tax
State/ UT tax
Cess
Place of Supply
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Statement-7 [rule 89(2)(k)]
Refund Type: Excess payment of tax, if any in case of last return filed.
(Amount in Rs.)
Tax period
ARN of return
Date of filing return
Tax Paid in Excess
Integrated tax
Central tax
State/ UT tax
Cess
1
2
3
4
5
6
7
Form-GST-RFD-01 B
[See rules 91(2), 92(1), 92(3), 92(4), 92(5) and 97A]
Refund Order details
1.
ARN
2.
GSTIN / Temporary ID
3.
Legal Name
4.
Filing Date
5.
Reason of Refund
6.
Financial Year
7.
Month
8.
Order No.:
9.
Order issuance Date:
10.
Payment Advice No.:
11.
Payment Advice Date:
12.
Refund Issued To :
Drop down: Taxpayer / Consumer Welfare Fund
13.
Issued by:
14.
Remarks:
15.
Type of Order
Drop Down: RFD- 04/ 06/ 07 (Part A)
16.
Details of Refund Amount (As per the manually
issued Order):
Description
Integrated
Tax
Central
Tax
State/
UT tax
Cess
T
I
P
F
O
Total
T
I
P
F
O
Total
T
I
P
F
O
Total
T
I
P
F
O
Total
a.
Refund amount clamied
b.
Refund Sanctioned on provisional basis
c.
Remaining Amount
d.
Refund amount in-admissible
e.
Gross amount to the paid
f.
Interest (if any)
g.
Amount adjusted against outstanding demand under the existing law
or under the Act
h.
Net amount to be paid
17.
Attachments
(Orders)
RFD-04;
RFD-06; RFD 07 (Part A)
Date:Place:
Signature
(DSC):Nmae:Designation;Office Address:]
[FORM GST RFD-01 W] [Inserted by Notification No. G.S.R. 333(E), dated 18.5.2021 (w.e.f. 19.6.2017).]
[Refer Rule 90(5)]
Application for Withdrawal of Refund Application