Employee ID:

HOUSE RENT RECEIPT ( H R A)

I, _____________________________ (Name of the Property Owner), have received a total sum of Rs. ____________

(Rupees _____________________________________________ Only ) from ____________________________ (employee 's name)

during the financial year 2021-2022 towards rent for the house rented out to him/her for the period
from (dd-mm-yyyy) ______________ to (dd-mm-yyyy) __________________.

The Breakup is as follows - Address of the Property Owner

(full postal address)

Month Rent Paid in Rs.

Apr-21
May-21
Jun-21
Jul-21
Aug-21 Contact No:
Sep-21
Oct-21
Nov-21
Dec-21
Jan-22
Signature of the Property Owner
Total - (To sign on revenue stamp)
(Not applicable for Bangalore city address)
(Total Rupees in words: ______________________
______________________________________________) PAN:
Full Postal address of the Rented House Permanent Account Number of Property Owner issued by IT dept
(Mandatory if rent exceeds Rs.1,00,000/- per anum)

Declaration for the rent payable for the month of February /March 2022.

I hereby declare that I will be paying Rs.____________ (Rupees ______________________________________Only)

towards my House Rent for the month of February/March 2020 as shown in the above receipt.
The Breakup of declaration is as follows:-
Month Rent Payable in Rs
Feb-22
Mar-22 Signature of the employee
Total -

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