FORM-GST-RFD-01 A⁵⁷

[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 <Year><Month>         To             <Year><Month>

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

⁵⁷Substituted vide Notf no. 74/2018-CT dt 31.12.2018

				(ii)	Finalization   of 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)

⁵⁸ Substituted vide Notf no. 03/2019-CT dt. 29.01.2019 wef 01.02.2019. Before substitution it was “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 application covered under this refund claim.”

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 [rule 89(2)(h)]

Refund Type: ITC accumulated due to inverted tax structure [clause (ii) of first proviso to section 54(3)]

Sl . N o.	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
GS TIN of the sup plier *	N o.	D at e	Tax able Val ue	Integ rated Tax	Cen tral Tax	Stat e Tax /Uni on terri tory Tax	N o.	D at e	Tax able Val ue	Invoic e type (B2B/ B2C)	Integ rated Tax	Cen tral Tax	Stat e Tax /Uni on terri tory 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 recipien t	Invoice details	Shipping bill/ Bill of export/ Endorsed invoice by SEZ	Integrated Tax	Ces s	Integrate d tax and cess involved in debit note, if any	Integrate d tax and cess involved in credit note, if any	Net Integrate d tax and cess (8+9+10 – 11)
No .	Dat e	Valu e	No .	Dat e	Taxabl e 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)]

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
									‖.

]59

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
Integrated tax	Central tax	State/ UT tax	Cess	Place of Supply	Integrated tax	Central tax	State/ UT tax	Cess	Place of Supply
No.	Date	Value	Taxable Value
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15

Statement-7 [rule 89(2)(k)]

⁵⁹ Subsituted vide Notification no. 33/2019-CT dt. 18.07.2019

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