RECEIPT OF HOUSE RENT

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

Received a sum of Rs. ____________________________ (Rupees________________
________________________________________________________________________
Towards the rent @____________________ per month from ___________________ to
__________________ in respect of House No.____________________________
_________________________________________________ situated at ____________
_______________________________________________________________________
(Affix Revenue Stamp of Rs.1/-)

Date:
Name:
Address: _________________________
_________________________________
_________________________________
PAN NO._________________________

Signature of the House Owner