RECEIPT OF HOUSE RENT

(Under Section 1 (13-A) of Income Tax Act)

Received a sum of

______________ (Rupees________________________________

________________________________________________________________________
Towards the rent @____________________ per month from ___________________ to
__________________ in respect of House No.____________________________
_________________________________________________ situated at _____________
________________________________________________________________________

(Affix one Rupee revenue stamp)

Date:

Name:

Address: ______________________________
______________________________________
______________________________________
PAN NO. ______________________________

Signature of the House Owner