RECEIPT OF HOUSE RENT

(Under Section 1 (13-A) of Income Tax Act )

Received a sum of Rs. _______________ (Rupees ____________ only) from
_______________, towards the rent in respect of House No._______________
situated

at

____________________________________________________________________
_________

@____________________

per

month

from

_________

to

__________________ period.

(Affix Revenue Stamp of Rs.1/-)

Date:
Name:
Address:

PAN No:

Signature of the House Owner