To Whomsoever It May Concern

Declaration to be provided by Landlord as per Circular No.08/2013 dated

10.10.2013 issued by Central Board of Direct Taxes (CBDT)

I, ________________________________________________ hereby declare that I own a

residential house located at _________________________________________________
which has been rented to Mr.________________________________________________
from __/__/____ to __/__/_____ for a monthly rental of Rs.______. As per Circular
no.08/2013 dated 10.10.2013 issued by CBDT, I hereby also declare that I receive rent
which exceeds Rs.100,000/- (Rupees One Lac only) per annum and I do not have a valid
Permanent Account Number (PAN).

Name of the Landlord :- ______________________________________

Address :-_______________________________________

________________________________________

________________________________________

Signature of Landlord :

Date :