To

(GSTIN)

(Name)

_ (Address)

Provisional Refund Order

Refund Application Reference No. (ARN) …………Dated ………<DD/MM/YYYY>……-Acknowledgement No. …………Dated ………<DD/MM/YYYY>………

Sir/Madam,

With reference to your above mentioned application for refund, the following amount is sanctioned to you on a provisional basis:

Sr. No	Description	Central Tax	State /UT tax	Integrated Tax	Cess
i.	Amount of refund claimed
ii.	10% of the amount claimed as refund (to be sanctioned later)
iii.	Balance amount (i-ii)
iv.	Amount sanctioned		of		refund
	Bank Details
v.	Bank Account No. as per application
vi.	Name of the Bank
vii.	Address /Branch	of		the	Bank
viii.	IFSC
ix.	MICR

Date: Signature (DSC):

Place: Name:

Designation: Office Address:

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