Self-Declaration - HRA Rent Payment

Financial Year 2023-24

Employee GG ID :
Employee Emp ID :
Employee Name
Rent Amount per month. Rs.
Landlord Name
Landlord PAN

This is to confirm that I would be paying rent of (Rupees ________________________________

______________________________________________________________________________
_____________________________________________________________________________)

For the period

January 2024 Rs. _____________ per month
February 2024 Rs. _____________ per month
March 2024 Rs. _____________ per month

The proofs / original rent receipts would be submitted on request along with the copy of the
Self declaration.

Date: _______________

Signature of the Employee

Address of the Employee
______________________________________________________________
______________________________________________________________