FORM GST DRC –04

[See rule 142(2) & 142(3)

Reference No: Date:

To

_______________ GSTIN/ID

________________ Name

________________ Address

Tax Period …………………. F.Y. …………….

ARN – Date –

Acknowledgement of payment made voluntarily–

The payment made by you vide application referred to above is hereby acknowledged to the extent of the amount paid.

This is a system generated acknowledgement and does not require signature.”.

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