RECEIPT OF HOUSE RENT PAYMENT

(See Section 10 (13A) and Rule 2A)

Received a sum of Rs. _________________ (Rupees___________________

______________________________________________________________)

from Mr./Mrs.______________________________________towards

the rent for the month of ___________ Year____________ in respect of House

situated at______________________________________________________

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Date: Signature of the Landlord

Name:___________________________

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Address:_________________________

________________________________

________________________________

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PAN of Landlord.__________________