Application for Electronic
Reference Number of an Invoice
1. GSTIN
2. Name
3. Address
4. Serial
No. of Invoice
5. Date of
Invoice
Details of
Receiver (Billed to)
Details of
Consignee (Shipped to)
Name
Name
Address
Address
State
State
State Code
State Code
GSTIN/Unique
ID
GSTIN/Unique ID
Sr.
Descriptio
HS
Qty.
Uni
Rate
Tota
Discoun
Taxabl
CGST
SGST
IGST
No
n of
Goods
N
t
(per
l
t
e
.
item
value
Rate
Amt.
Rate
Amt.
Rate
Amt.
)
Freight
Insurance
Packing
and Forwarding Charges
Total
Total Invoice Value (In figure)
Total
Invoice Value (In Words)
Amount of
Tax subject to Reverse Charges
Declaration:
Signature
Name of the
Signatory
Designation
/ Status
Electronic Reference Number Date -
Application for Electronic
Reference Number of an Invoice
1. GSTIN
2. Name
3. Address
4. Serial
No. of Invoice
5. Date of
Invoice
Details of
Receiver (Billed to)
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Details of
Consignee (Shipped to)
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Name
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Name
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Address
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Address
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State
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State
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State Code
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State Code
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GSTIN/Unique
ID
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GSTIN/Unique ID
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Sr.
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Descriptio
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HS
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Qty.
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Uni
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Rate
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Tota
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Discoun
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Taxabl
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CGST
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SGST
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IGST
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No
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n of
Goods
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N
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t
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(per
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l
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t
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e
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.
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item
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value
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Rate
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Amt.
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Rate
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Amt.
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Rate
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Amt.
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)
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Freight
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Insurance
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Packing
and Forwarding Charges
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Total
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Total Invoice Value (In figure)
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Total
Invoice Value (In Words)
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Amount of
Tax subject to Reverse Charges
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