RECEIPT OF HOUSE RENT

Received a sum of Rs. _________________ (Rupees___________________

_____________________________________________________________

from (Mr./Ms.)__________________________________________________

towards rent @ ____________________ per month from________________

________to________________________ in respect of the residential premises

bearing address (full address with PIN) ________________________________

_____________________________________________________________

Affix One
Rupee
Revenue
Stamp

Date : Signature of the House Owner

Name:___________________________

Address:_________________________

________________________________

________________________________

________________________________

PAN NO._________________________