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Final GST Rules - Refund Formats: EximGuru.com



GOODS AND SERVICES RULES, 2017
REFUND FORMS

List of Forms

Sr. No Form Number Content
1 GST RFD-01 Application for Refund
2 GST RFD-02 Acknowledgement
3 GST RFD-03 Deficiency Memo
4 GST RFD-04 Provisional Refund Order
5 GST RFD-05 Payment Advice
6 GST RFD-06 Refund Sanction/ Rejection Order
7 GST RFD-06 Interest on delayed refund order (same as refund order)
8 GST RFD-07 Order for complete adjustment of sanctioned Refund/ order for withholding of refund
9 GST RFD-08 Notice for rejection of application for refund
10 GST RFD-09 Reply to show cause notice
11 GST RFD-10 Application for Refund by any specialize agency of UN or Multilateral Financial Institution and Organization, Consulate or Embassy of foreign countries, etc.

FORM-GST-RFD-01

[See rule------]

Application for Refund

Select: Registered / Casual/ Unregistered/Non-resident taxable person

1. GSTIN/Temporary ID:
2. Legal Name:
3. Trade Name, if any:
4. Address:
5. Tax Period: From    <DD/MM/YY>   To   <DD/MM/YY>
6. Amount of Refund Claimed:

Act Tax Tax Penalty Fees Others Total
Central Tax            
State Tax            
UT Tax            
Integrated Tax            
Cess            
Total            

7. Grounds of Refund Claim: (select from the drop down):
a. Excess balance in Electronic Cash ledger
b. Exports of goods / services- With payment of Tax
c. Exports of goods / services- Without payment of Tax, i.e., ITC accumulated
d. On account of assessment/provisional assessment/ appeal/ any other order
i. Select the type of Order:
Assessment/ Provisional Assessment/ Appeal/ Others
ii. Mention the following details:
1. Order No.
2. Order Date <calendar>
3. Order Issuing Authority
4. Payment Reference No. (of the amount to be claimed as refund)
(If Order is issued within the system, then 2, 3, 4 will be auto populated)
e. ITC accumulated due to inverted tax structure (clause (ii) of proviso to section 54(3)
f. On account of supplies made to SEZ unit/ SEZ Developer or Recipient of Deemed
Exports
i. Select the type of supplier/ recipient:
1. Supplier to SEZ Unit
2. Supplier to SEZ Developer
3. Recipient of Deemed Exports
g. Tax paid on a supply which is not provided, either wholly or partially, and for which
invoice has not been issued
h. Tax paid on an intra-State supply which is subsequently held to be inter-State supply
and vice versa
i. Excess payment of tax, if any
j. Any other (specify)
8. Details of Bank Account (to be auto populated from RC in case of registered taxpayer)
a. Bank Account Number :
b. Name of the Bank :
c. Bank Account Type :
d. Name of account holder :
e. Address of Bank Branch :
f. IFSC :
g. MICR :
9. Whether Self-Declaration filed by Applicant u/s 54(4), if applicable   Yes No

DECLARATION (Rule…)

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.

Signature
Name –
Designation / Status

DECLARATION (Rule…)

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…)

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

SELF- DECLARATION

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. (This Declaration is not required to be furnished by applicants, who are claiming refund under sub rule<> of the GST Rules<…>.)

10. Verification

I/We 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. We declare that no refund on this account has been received by us earlier.

Place
Signatory
Date

Signature of Authorized
(Name)
Designation/ Status

Note: 1) A separate statement has to be filed under sub-rule (4) of rule 1 of draft Goods and Services Tax refund

Statement 1:

 

(Note: - All statements are auto populated from the corresponding returns taxpayer have to select the invoices accordingly and fields like egm/ebrc to be filled if the same was not filled in the return)

Statement in case of Application under Rule 1 sub rule 2 (g):

Annexure-1

Statement containing the number and date of invoices under <…>of GST Rules,

For Inward Supplies:
As per GSTR- 2 (Table 4):

Tax Period: ……

GSTIN/Name ofunregisteredsupplier   Invoice details State (in case of unregistered supplier) Integrated Tax Central Tax State Tax/ UT Tax CESS Col. 17 Col. 18 Col. 19 Col. 20/21/22/23
No. Date ValueGoods/ Services (G/S) HSN/ SAC Taxable value UQC QTY Rate (%) Amt. Rate (%) Amt. Rate (%) Amt. Rate (NA) Amt. Integrated Tax Central Tax State Tax/ UT Tax Cess
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2324
                                              
                                              

Col. 17: POS (only if different from the location of recipient)
Col. 18: Indicate if supply attracts reverse charge (Yes / No)
Col. 19: Eligibility of ITC as (inputs/capital goods/input services/ none)
Col. 20/21/22/23: Amount of ITC available

For Outward Supplies:
As per GSTR- 1 (Table 5):

Tax Period: ……

>
GSTIN/ UIN Invoice details Integrated Tax Central Tax State Tax/ UT Tax CessCol. 16 Col. 17 Col. 18 Col. 19 Col. 20 Col. 21 Col. 22
No. Date Value Goods/ services (G/S) HSN/ SAC Taxable Value UQC QTY Rate (%) Amt Rate (%) Amt Rate (%) Amt Rate (NA) Amt
1 2 3 4 5 6 7 23A 23B 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
   

Col. 16: POS (only if different from the location of recipient)
Col. 17: Whether supply made to SEZ / SEZ developer (Yes / No)
Col. 18: Tax option for supplies made to SEZ / SEZ developer (With Integrated Tax/ Without Integrated Tax)
Col. 19: Deemed Exports (Yes/No)
Col. 20: whether supply attracts reverse charge (Yes / No)
Col. 21: Whether tax on this invoice is paid on provisional basis (Yes /No)
Col. 22: GSTIN of e-commerce operator (if applicable)

Place
Date

Signature of Authorized Signatory
(Name)
Designation/ Status

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------

Statement 2:

Statement in case of Application under Rule 1 sub rule 2 (b) and (c):

Exports with payment of Tax:

Tax Period: ……

Invoice Shipping bill/ Bill of export Tax payment option Integrated Tax Whether tax on this invoice is paid on provisional basis (Yes /No) EGM Details BRC/ FIRC
No. Date Value Goods/ Services (G/S) HSN/ SAC UQC QTY Taxable value Port Code No. Date With Integrated Tax Without Integrated Tax Rate (%) Amt. Ref No. Date No. Date
1 2 3 4 5 15A 15B 6 7 8 9 10 11 12 13 14 15 15C 15D 15E

(* Shipping Bill and EGM are mandatory; – in case of goods; BRC/ FIRC details are mandatory– in case of Services)

Place
Date

Signature of Authorized Signatory
(Name)
Designation/ Status

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Statement 3:

Exports without payment of Tax:

Tax Period: ……

 

Invoice Shipping bill/ Bill of export Tax payment option Integrated Tax Whether tax on this invoice is paid on provisional basis (Yes /No) EGM Details BRC/ FIRC
No. Date Value Goods/ Services (G/S) HSN/ SAC UQC QTY Taxable value Port Code No. Date With Integrated Tax Without Integrated Tax Rate (%) Amt. Ref No. Date No. Date
1 2 3 4 5 15A 15B 6 7 8 9 10 11 12 13 14 15C 15D 15E 15F

(* Shipping Bill and EGM – in case of goods are mandatory; BRC/ FIRC details are mandatory– in case of Services)

Place
Date

Signature of Authorized Signatory
(Name)
Designation/ Status

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Statement 4:

Statement in case of Application under Rule 1 sub rule 2 (d) and (e):

Refund by the supplier of SEZ/ Developer:

GSTR- 1 Table 5

Tax Period: ……

GSTIN/ UIN Invoice details Integrated Tax Central Tax State Tax/ UT Tax Cess Col. 16 Col. 17 Col. 18 Col. 19 Col. 20 Col. 21 Col. 22 ARE Date of Receipt Payment Details
No. Date Value Goods/ services (G/S) HSN/ SAC Taxable Value UQC QTY Rate (%) Amt Rate (%) Amt Rate (%) Amt Rate (NA) Amt No. Date Ref No. Date
1 2 3 4 5 6 7 23A 23B 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23C 23D 23E 23F 23G

Col. 16: POS (only if different from the location of recipient)
Col. 17: Whether supply made to SEZ / SEZ developer (Yes / No)
Col. 18: Tax option for supplies made to SEZ / SEZ developer (With Integrated Tax/ Without Integrated Tax)
Col. 19: Deemed Exports (Yes/No)
Col. 20: whether supply attracts reverse charge (Yes / No)
Col. 21: Whether tax on this invoice is paid on provisional basis (Yes /No)
Col. 22: GSTIN of e-commerce operator (if applicable)
Col. 23 C/D: ARE (Application for Removal of Export)
Col. 23 E: Date of receipt by SEZ/ Developer (as per re warehousing certificate)
Col. 23 F/G: Particulars of Payment Received

(* In case of Goods: ARE and Date of Receipt by SEZ/ Developer are mandatory; In case of Services: Particulars of Payment Received is mandatory)

GSTR 5- Table 6

Tax Period: ……

 

GSTIN/ UIN Invoice details Integrated Tax Central Tax State Tax/ UT Tax Cess Col. 16 Col. 17 Col. 18 Col. 19 Col. 20 ARE Date of Receipt Payment Details
No. Date Value Goods/ services (G/S) HSN/ SAC UQC QTY Taxable Value Rate (%) Amt. Rate (%) Amt Rate (%) Amt Rate (NA) Amt No. Date Ref No. Date
1 2 3 4 5 6 21A 21B 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21C 21D 21E 21F21G

Col. 1: GSTIN / UIN/ Name of the un registered recipient (Supplier to SEZ/ Developer)
Col. 16: POS (only if different from the location of recipient)
Col. 17: Whether supply made to SEZ / SEZ developer (Yes / No)
Col. 18: Tax option for supplies made to SEZ / SEZ developer (With Integrated Tax/ Without Integrated Tax)
Col. 19: Deemed Exports (Yes/No)
Col. 20: Whether tax on this invoice is paid on provisional basis (Yes /No)
Col. 21 C/D: ARE (Application for Removal of Export)
Col. 21 E: Date of receipt by SEZ/ Developer (as per re warehousing certificate)
Col. 21 F/G: Particulars of Payment Received

(* In case of Goods: ARE and Date of Receipt by SEZ/ Developer are mandatory; In case of Services: Particulars of Payment Received is mandatory)

Place
Date

Signature of Authorized Signatory
(Name)
Designation/ Status

Statement 5:

Statement in case of Application under Rule 1 sub rule 2 (d) and (e):

Refund by the EOU/ Recipient of Deemed Exports:

Tax Period: ……

 

GSTIN/ Name of unregistered supplier Invoice details State (in case of unregistered supplier) Integrated Tax Central Tax State Tax/ UT Tax Cess Col. 17 Col. 18 Col. 19 Col. 20/21/22/23 ARE Date of Receipt
No. Date Value Goods/ Services (G/S) HSN/ SAC Taxable Value UQC QTY   Rate (%) Amt Rate (%) Amt Rate (%) Amt Rate (NA) Amt Integrated Tax Central Tax State Tax/ UT Tax Cess No. Date
1 2 3 4 5 6 7 24A 24B 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24C 24D 24E
   

Col. 17: POS (only if different from the location of recipient)
Col. 18: Indicate if supply attracts reverse charge (Yes / No)
Col. 19: Eligibility of ITC as (inputs/capital goods/input services/ none)
Col. 20/21/22/23: Amount of ITC available
Col. 24 C/D: ARE (Application for Removal of Export)
Col. 24 E: Date of receipt by SEZ/ Developer (as per re warehousing certificate)

(* In case of Goods: ARE and Date of Receipt are mandatory)

Place
Date

Signature of Authorized Signatory
(Name)
Designation/ Status

Statement 6:

Statement in case of Application filed under Rule 1(2)(j)

[Refund u/s 77(1) & 77(2) -Tax wrongfully collected and paid ]

Order Details (issued in pursuance of Section 77 (1) and (2): Order No: Order Date:

GSTIN/ UINName(in case B2C)   Details of invoice covering transaction considered as intra –State / inter-State transaction earlier Transaction which were held inter State / intra-State supply subsequently
Invoice details Integrated Tax Central Tax State Tax Cess Place of Supply (only if different from the location of recipient) Integrated Tax Central Tax State Tax Cess Place of Supply (only if different from the location of recipient)
  No. Date Value Taxable Value Amt Amt Amt Amt Amt Amt Amt Amt
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
                             

Statement 7:

Statement in case of application filed under Rule 1(2)(k)

Refund on account excess payment of tax

Sr. No.  Tax period Reference no. of return Date of filing return Excess amount available in Liability Register
Integrated Tax Central Tax State Tax Cess
1 2 3 4 5 6 7 8
               

Annexure-2
[See Rule …]
Certificate

This is to certify that in respect of the refund amounting to INR << >> -------------- (in words) claimed by M/s ----------------- (Applicant’s Name) GSTIN/ Temporary ID------- for the tax period < ---->, the incidence of tax and interest, has not been passed on to any other person. This certificate is based on the examination of the Books of Accounts, and other relevant records and Returns particulars maintained/ furnished by the applicant.

Signature of the Chartered Accountant/ Cost Accountant:

Name:

Membership Number:

Place:

Date:

This Certificate is not required to be furnished by the applicant, claiming refund under clause (a) or clause (b) or clause (c) or clause (d) or clause (f) of sub-section (8) of section 54 of the Act.

FORM-GST-RFD-02
[See Rule ---]
Acknowledgment

Your application for refund is hereby acknowledged against

Acknowledgement Number :

Date of Acknowledgement :

Date of Acknowledgement :

Applicant’s Name :

Form No. :

Form Description :

Jurisdiction (tick appropriate) :

Centre State/ Union Territory:

Filed by :

Refund Application Details
Tax Period  
Date and Time of Filing  
Reason for Refund  

 

Amount of Refund Claimed:

Tax Interest Penalty Fees Others Total
Central Tax            
State Tax            
UT Tax            
Integrated Tax            
Cess            
Total

 


 

Note 1: The status of the application can be viewed by entering ARN through Track Application Status” on the GST System Portal.

Note 2: It is a system generated acknowledgement and does not require any signature.

FORM-GST-RFD-03
[See Rule --]
Deficiency Memo

Date: < DD/MM/YYYY >

Reference No.

To

___________ (GSTIN/ UIN/ Temporary ID)

___________ (Name)

____________ (Address)

Subject: Refund Application Reference No. (ARN) …………Dated ………

……-Reg.

Sir/Madam,

This has reference to your above mentioned application filed under section 54 of the Act. Upon scrutiny of your application, certain deficiencies have been noticed below:

Sr No Description( select the reason from the drop down of the Refund application)
1 < MULTI SELECT OPTION >
2  
  Other { any other reason other than the reason select from the ‘reason master’}

You are advised to file a fresh refund application after rectification of above deficiencies

Date:
Place:

Signature (DSC):
Name of Proper Officer:
Designation:
Office Address:

FORM-GST-RFD-04
[See Rule -]

Date: < DD/MM/YYYY >

Sanction Order No:

To

___________ (GSTIN)

___________ (Name)

____________ (Address)

Provisional Refund Order

Refund Application Reference No. (ARN) …………Dated ………

……-

Acknowledgement No. …………Dated ………

……...

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 Tax 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 of refund sanctioned          
Bank Details          
v Bank Account No. as per application          
vi Name of the Bank          
vii Address of the Bank /Branch          
viii IFSC          
ix MICR          

Date:

Place:

Signature (DSC):
Name:
Designation:
Office Address:

FORM-GST-RFD-05
[See Rule-----]
Payment Advice

Date: < DD/MM/YYYY >

Payment Advice No: - 

To < Centre > PAO/ Treasury/ RBI/ Bank

Refund Sanction Order No. ……………

Order Date……< DD/MM/YYYY >……….

GSTIN/ UIN/ Temporary ID < >

Name: < >

Refund Amount (as per Order):

  Central Tax State Tax UT Tax Integrated Tax Cess
Net Refund amount sanctioned          
Interest on delayed Refund          
Total          

 

  Details of the Bank  
i Bank Account no as per application  
ii Name of the Bank  
iii Name and Address of the Bank /branch  
iv IFSC  
v MICR  

 

Date:

Place:

Signature (DSC):
Name:
Designation:
Office Address:

To

___________ (GSTIN/ UIN/ Temporary ID)

___________ (Name)

____________ (Address)

FORM-GST-RFD-06
[See Rule --]

Date: < DD/MM/YYYY >

Order No.:

To

___________ (GSTIN/ UIN/ Temporary ID)

___________ (Name)

____________ (Address)

Show cause notice No. (If applicable)

Acknowledgement No. …………

Dated ………< DD/MM/YYYY >

Refund Sanction/Rejection Order

Sir/Madam,

This has reference to your above mentioned application for refund filed under section 54 of the Act*/ interest on refund*. Upon examination of your application, the amount of refund sanctioned to you, after adjustment of dues (where applicable) is as follows:

*Strike out whichever is not applicable

Sr no Description Central Tax State Tax UT Tax Integrated Tax Cess
i Amount of refund/interest* claimed          
ii Refund sanctioned on provisional basis (Order No….date) (if applicable)          
iii Refund amount inadmissible << reasondropdown >>< Multiple reasons to be allowed >          
iv Gross amount to be paid (1-2-3)          
v Amount adjusted against outstanding demand (if any) under the existing law or under the Act. Demand Order No…… date……, Act Period< Multiple rows possible- add row to begiven >          
vi Net amount to be paid          

*Strike out whichever is not applicable

&1. I hereby sanction an amount of INR _________ to M/s ___________having GSTIN ____under subsection (5) of section 54) of the Act/under section 56 of the Act@ @Strike out whichever is not applicable

(a) #
and the amount is to be paid to the bank account specified by him in his application/
(b) the amount is to be adjusted towards recovery of arrears as specified at serial number 5 of the Table
above/
(c) an amount of -----rupees is to be adjusted towards recovery of arrears as specified at serial number 5
of the Table above and the remaining amount of ----rupees is to be paid to the bank account specified
by him in his application#
. .

#Strike-out whichever is not applicable.

Or &2. I hereby credit an amount of INR _________ to Consumer Welfare Fund under sub-section (…) of Section (…) of the Act. .

&3. I hereby reject an amount of INR _________ to M/s ___________having GSTIN ____under sub-section (…) of Section (…) of the Act.

& Strike-out whichever is not applicable

Date:

Place:

Signature (DSC):
Name:
Designation:
Office Address:

FORM-GST-RFD-07
[See Rule-----]

Date: < DD/MM/YYYY >

 Reference No.

To
___________ (GSTIN/UIN/Temp.ID No.)
___________ (Name)
____________ (Address)
Acknowledgement No. …………
………<DD/MM/YYYY>…

Dated

Order for Complete adjustment of sanctioned Refund

Part- A

Sir/Madam,

With reference to your refund application as referred above and further furnishing of information/ filing of documents against the amount of refund sanctioned to you has been completely adjusted against outstanding demands as per details below:

  Refund Calculation Integrated Tax Central Tax State Tax UT Tax Cess
i Amount of Refund claimed          
ii Net Refund Sanctioned on Provisional Basis (Order No…date)          
iii Refund amount inadmissible rejected <<reason dropdown>>          
iv Refund admissible (i-ii-iii)          
v Refund adjusted against outstanding demand (as per order no.) under existing law or under this law. . Demand Order No…… date……
<<Multiple rows may be given>>
         
vi Balance amount of refund          

I hereby, order that the amount of claimed / admissible refund as shown above is completely adjusted against the outstanding demand under this Act / under the existing law. This application stands disposed as per provisions under sub-section (…) of Section (…) of the Act.

Part-B

Order for withholding the refund

With reference to your refund application as referred above and further furnishing of information/ filing of documents against the amount of refund sanctioned to you has been withheld against following reasons as per details below:

Refund Order No.:          
Date of issuance of Order:          
  Refund Calculation Integrated Tax Central Tax State Tax UT Tax Cess
i Amount of Refund Sanctioned          
ii Amount of Refund With held          
iii Amount of Refund Allowed          

Reasons for withholding of the refund:

<<Text>>

I hereby, order that the amount of claimed / admissible refund as shown above is withheld for the above mention reason. This order is issued as per provisions under sub-section (…) of Section (…) of the Act.

Date:

Place:

Signature (DSC):
Name:
Designation:
Office Address:

FORM-GST-RFD-08
[See Rule-----]
Notice for rejection of application for refund

Date: <<DD/MM/YYYY>>

 To
___________ (GSTIN/ UIN/ Temporary ID)
___________ (Name)
____________ (Address)

ACKNOWLEDGEMENT No……

ARN…………

 Dated ………<<DD/MM/YYYY>>……

This has reference to your above mentioned application for refund, filed under section 54 of the Act. On examination, it appears that refund application is liable to be rejected on account of the following reasons:

Sr No Description (select the reasons of inadmissibility of refund from the drop down) Amount Inadmissible
i    
ii    
iii Other{ any other reason other than the reasons mentioned in ‘reason master’}  

You are hereby called upon to show cause as to why your refund claim, to the extent of the amount specified above, should not be rejected for reasons stated above.

You are hereby directed to furnish a reply to this notice within fifteen days from the date of service of this notice.

You are also directed to appear before the undersigned on DD/MM/YYYY at HH/MM. If you fail to furnish a reply within the stipulated date or fail to appear for personal hearing on the appointed date and time, the case will be decided ex parte on the basis of available records and on merits.

Date:

Place:

Signature (DSC):
Name:
Designation:
Office Address:

FORM-GST-RFD-09
[See Rule-----]
Reply to show cause notice

Date: <<DD/MM/YYYY>>

1 Reference No. of Notice  
2 GSTIN / UIN  
3 Name of business (Legal)  
4 Trade name, if any  
5 Reply to the notice  
6 List of documents uploaded  
7 Verification

I __________________________________________ hereby solemnly affirm and declare thatthe information given hereinabove is true and correct to the best of my knowledge and belief andnothing has been concealed therefrom.

Signature of Authorized
Signatory
Name
Designation/Status

Place Date ---
<<DD/MM/YYYY>> 

 

Place

Date

FORM GST RFD-10
[See Rule-----]

Application for Refund by any specialized agency of UN or any Multilateral Financial Institution and Organization, Consulate or Embassy of foreign countries, etc.

1. UIN :
2. Name :
3. Address :
4. Tax Period (Quarter) :            From <DD/MM/YY>              To
                                                  <DD/MM/YY>
5. Amount of Refund Claim :                <INR> <In Words>

  Amount
Central Tax  
State Tax  
UT Tax  
Integrated Tax  
Cess  
Total

6. Details of Bank Account:
a. Bank Account Number
b. Bank Account Type
c. Name of the Bank
d. Name of the Account Holder/Operator
e. Address of Bank Branch
f. IFSC
g. MICR

7. Reference number and date of furnishing FORM GSTR-11 .

8. Verification

I _______ as an authorized representative of << Name of Embassy/international organization >> hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and nothing has been concealed therefrom. That we are eligible to claim such refund as specified agency of UNO/Multilateral Financial Institution and Organization, Consulate or Embassy of foreign countries/ any other person/ class of persons specified/ notified by the Government.

Date:
Place:

Signature of Authorized Signatory:
Name:
Designation / Status:

 


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