Qualcomm Yearly Rent receipt format for the FY 2023-24

This form is mandatory to claim HRAfor any mode of payment (Cash or Bank or UPI)
***

Tenant (Qualcomm Employee Name &ID)

M.Sai ManobhiRam |8361
House owner -1 Name & Address
Rented House-1 Address
B226, Roghavendras MiyYa Saraswati Janapai, S224
Pamchajaa, AS Roju Wogar Ragharemdra't Mima Poncla
jeya Miyapn
House owner -2 Name & Address
Rented House- 2 Address (if changed)

Rent Payment Details April 2023 to March 2024

Rented House Mode of Payment Date of Payment
Rent per month. Landlord PAN NO
(Cash /Bank)
Month Address.1 or 2 Amount in INR|If rent > RS 8,333 pm

Apr-2023 8333 Cash l-4-23

May-2023 8333 Cash
Jun-2023
2333 1-6-2
Jul-2023
8333 --23
Aug-2023 8233
Sep-2023 8333
Oct-2023 &322 l-l0- 2?
Nov-2023 8333
Dec-2023 8337 |-12-2
Rent for the future months -No support document is required*** Declaration is Mandatory to claim HRA Exemption

Jan-2024 B33? |-|-2y

Feb-2024 8333 Cast 1-2-2y
Mar-2024 8323 Cosh 1-3-2y

, MSai Manobhì Kam Son/daughter of

linformation given above is complete and correct.
Ms Nagesoa kaa ,do hereby certify that the
Signature of Tenant Signature of House owner 1
(Qualcomm Employee) |Signature of House owner 2
PAN Valid
Rent Amount
Number of Rental
(01 Apr '23 to 31 Rent paid through
Rent paid in cash Bank the Landlord Agreement
Mar '24)
Not Not
Upto Rs 8,333/
Per month Yearly rent receipt & mandatory mandatory
Yearly rent receipt with continuous 3 months
per YES Not
> Rs. 8,333/- landlord signature is bank statement.
month mandatory. (Landlord slgnature is
Mandatory mandatory
>= Rs. 10,000/ not mandatory) YES YES
Per month Mandatory Mandatory