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 From <Year><Month> To <Year><Month>
(if applicable)
6. Amount of Refund Act Tax Interest Penalty Fees Others Total
Claimed (Rs.)
Central tax
State / UT tax
Integrated tax
Cess
Total
7. Grounds of (a) Excess balance in Electronic Cash Ledger
Refund Claim (b) Exports of services- with payment of tax
(select from drop (c) Exports of goods / services- without payment of tax (accumulated ITC)
down) (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. Type of order Order Order Order Payment
No. No. date Issuing reference
Authority no., if any
(i) Assessment
57
Substituted vide Notf no. 74/2018-CT dt 31.12.2018
234
(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)
[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].
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)]
[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]58
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.”
235
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
236
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
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 Tax payable Adjusted Net input tax Maximum refund
inverted rated on such total credit amount to be
supply of inverted rated turnover claimed
goods and supply of [(1×4÷3)-2]
services goods and
services
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 Details of invoices Tax paid on Details of invoices of Tax paid on
. of inward supplies inward supplies of outward supplies outward supplies
N of inputs received inputs issued
o.
GS N D Tax Integ Cen Stat N D Tax Invoic Integ Cen Stat
TIN o. at able rated tral e o. at able e type rated tral e
of e Val Tax Tax Tax e Val (B2B/ Tax Tax Tax
the ue /Uni ue B2C) /Uni
sup on on
plier terri terri
* tory tory
Tax Tax
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
237
* 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. Invoice details Integrated tax Cess BRC/ Integrated Integrated Net
No. FIRC tax and tax and Integrated
cess cess tax and
involved involved cess
in debit in credit (6+7+10 -
note, if note, if 11)
any any
No. Date Value Taxable Amt. No. Date
value
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. Invoice details Goods/ Shipping bill/ Bill of EGM BRC/
No. Services export Details FIRC
(G/S)
No. Date Value Port No. Date Ref Date No. Date
code No.
1 2 3 4 5 6 7 8 9 10 11 12
Statement- 3A [rule 89(4)]
238
Refund Type: Export without payment of tax (accumulated ITC) – calculation of refund
amount
(Amount in Rs.)
Turnover of zero rated Net input tax Adjusted total Refund amount
supply of goods and credit turnover (1×2÷3)
services
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 Invoice details Shipping Integrated Ces Integrate Integrate Net
of bill/ Bill Tax s d tax and d tax and Integrate
recipien of cess cess d tax and
t export/ involved involved cess
Endorsed in debit in credit (8+9+10
invoice note, if note, if – 11)
by SEZ any any
No Dat Valu No Dat Taxabl Amt
. e e . e e .
Value
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 Net input tax Adjusted total Refund amount
supply of goods and credit turnover (1×2÷3)
services
1 2 3 4
239
[Statement 5B [rule 89(2)(g)]
Refund Type: On account of deemed exports (Amount in Rs)
Sl. Details of invoices/credit notes/debit Tax paid
No. notes of outward supplies in case refund is
claimed by supplier/Details of invoices of
inward supplies in case refund is claimed
by recipient
GSTIN No. Type Central State Cess
of the (Invoice/ Tax Tax
supplier Taxable Credit Integrated /Union
Date
Value Note/ Tax territory
Debit Tax
Note)
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‘ Invoice details Details of tax paid on transaction Taxes re-assessed on transaction
GSTIN/ considered as intra –State / inter-State which were held inter State / intra-
UIN transaction earlier State supply subsequently
Integrated Central State/ Cess Place Integrated Central State/ Cess Place
Name
tax tax UT of tax tax UT of
(in case No. Date Value Taxable tax Supply tax Supply
B2C) 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
240
Refund Type: Excess payment of tax, if any in case of last return filed.
(Amount in Rs.)
Tax period ARN of Date of Tax Paid in Excess
return filing Integrated Central State/ Cess
return tax tax UT tax
1 2 3 4 5 6 7
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