Qualcomm Yearly Rent receipt format for the FY 2023-'24

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

Tenant (Qualcomm Employee Name & ID)

Rented House - 1 Address House owner -1 Name & Address

Rented House - 2 Address (if changed) House owner -2 Name & Address

Rent Payment Details April 2023 to March 2024

Rented House Rent per month. Landlord PAN No Mode of Payment Date of Payment
Address.1 or 2 (Cash /Bank)
Month Amount in INR If rent > RS 8,333 pm
Apr-2023
May-2023
Jun-2023
Jul-2023
Aug-2023
Sep-2023
Oct-2023
Nov-2023
Dec-2023
Rent for the future months -No support document is required*** Declara on is Mandatory to claim HRA Exemp on
Jan-2024
Feb-2024
Mar-2024

I, _____________________________, Son/daughter of _____________________________ , do hereby cer fy that the

informa on given above is complete and correct.

Signature of Tenant Signature of House owner 1

(Qualcomm Employee) Signature of House owner 2