registration number (FCRN) of the company or Form 1A
reference number (Service request number (SRN) of Form 1A)
(b) Global location number (GLN) of company
2.(a) Name of the company
(b) Address of the
registered office or
of the principal place
of business in India
of the company
3. Name of the applicant (in case of under liquidation company or in case company has not been incorporated or
where the service for which refund is sought does not belong to any company)
5. Payee details for the refund cheque
(c) *City
Line II
(b) *Address Line I
(g) *e-mail ID
(d) *State
(a) Name of payee
3. Name of the applicant (in case of under liquidation company or in case company has not been incorporated or
where the service for which refund is sought does not belong to any company)
(e) Country
6. *Bank account number
7. In case of direct deposit into your bank account, provide following details corresponding to above account number
Cheque Direct deposit into your bank account
(c) Type of account
(d) MICR code
(a) Bank name
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