FORM GST RFD-10A

(See Rule 95B)

Application for refund by Canteen Stores Department (CSD)

1. GSTIN

2. Name :

3. Address :

4. Tax Period (Quarter) : From <DD/MM/YY>To <DD/MM/YY>

5. Amount of Refund Claim :<INR><In Words>

6. Details of inward supplies of goods received:

7. Total refund applied for:

 8. Details of Bank Account:-

a. Bank Account Number

b. Bank Account Type

c. Name of the Bank

d. Name of the Account Holder

e. Address of Bank Branch

f. IFSC

g. MICR

9. Attachment of the documents along with the refund application:

10. Verification

I ________ as an authorised representative of << Name of Canteen Stores Department>> 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. I further declare that all the goods, in respect of which the refund is being claimed, have been received by us for the purpose of subsequent supply of such goods to the Unit Run Canteens of the CSD or to the authorized customers of the CSD and that no refund has been claimed earlier against any of the invoices against which refund has been claimed in this application.