RECEIPT OF HOUSE RENT

(Under Section 10 (13-A) of Income Tax Act)

Received a sum of Rs. _________________ (Rupees___________________)

from _____________(Name of the employee) towards the rent for the period
from____________________ (From Date) to_________________(To Date) in
respect of the house situated at _______________(House Address).

Date:

(Signature of the Landlord)

Name:_______________________

Address:_____________________
____________________________
____________________________
____________________________
PAN_________________________

Note:
1. The signature of the house owner should be affixed on a revenue stamp.