Employee Code: Name:

RECEIPT OF HOUSE RENT

[U/S 1 (13-A) of Income Tax Act]

Received with thanks from _________________________________ (Employee Name) a sum of

Rs..____________ (Rupees__________________________________________ Only) towards the rent
for the month of __________ (Rent paid Month) for my house situated at ________________________
________________________________________________________ (Address of the house).
Place:
1 Rupee
Revenue
Stamp *
Mandatory

Signature of the Owner of the House

House Owner Name:

House Owner Address:

House Owner PAN #:

#- House owner PAN number and Address mandatory for HRA exemption as per Income Tax Act.