FORM-GST-RFD-01 A
[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)
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1.
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GSTIN / Temporary
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ID
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2.
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Legal Name
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3.
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Trade Name, if any
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4.
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Address
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5.
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Tax period
(if applicable)
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From <Year><Month> To <Year><Month>
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6.
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Amount of Refund
Claimed(Rs.)
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Act
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Tax
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Interest
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Penalty
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Fees
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Others
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Total
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Central tax
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State / UT tax
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Integrated tax
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Cess
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Total
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7.
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Grounds of Refund Claim (select from drop down)
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(a)
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Excess balance in Electronic Cash Ledger
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(b)
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Exports of services- with payment of tax
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(c)
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Exports of goods / services- without payment of tax
(accumulated ITC)
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(d)
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ITC accumulated due to inverted tax structure[under clause
(ii) of first proviso to section
54(3)]
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(e)
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On account of supplies made to SEZ unit/ SEZ
developer(with payment of tax)
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(f)
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On account of supplies made to SEZ
unit/ SEZ developer (without payment of tax)
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(g)
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Recipient of deemed export
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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 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.
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Signature
Name –
Designation
/ Status
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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
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DECLARATION [rule 89(2)(f)]
I hereby declare that the Special Economic Zone unit /the
Special Economic Zone developer has not availed of the input tax credit of
the tax paid by the applicant, covered under this refund claim.
Signature
Name –
Designation / Status
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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.)
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8. 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.
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
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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.)
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Turnover
of
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Tax
payable on
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Adjusted
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Net
input tax
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Maximum
refund
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inverted
rated
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such
inverted
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total
turnover
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credit
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amount
to be claimed
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supply
of goods
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rated
supply of goods
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[(1×4÷3)-2]
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1
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2
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3
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4
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5
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Statement- 3A [rule 89(4)]
Refund Type: Export without payment
of tax (accumulated ITC) – calculation of refund amount
(Amount in Rs.)
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Turnover
of zero rated
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Net input tax credit
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Adjusted
total
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Refund
amount
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supply
of goods and services
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turnover
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(1×2÷3)
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1
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2
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3
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4
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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.)
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Turnover
of zero rated
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Net
input tax credit
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Adjusted
total
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Refund
amount
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supply of goods and services
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turnover
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(1×2÷3)
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1
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2
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3
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4
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