Received a Sum of Rs.____________(Rupees_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
__ _ _ _ _ _ _ _ _ _ _ _ _ _ _) towards House Rent @Rs.__________ (Rs. ___ _ _ _ _ _ _ _ _ _ _ _ _) per month from __________ to ____________ from Sri/Smt____________________________________ in respect of House NO._______________ situated at ___________________________________________________________________________________ ____________________________________________________________________________ (Affix Revenue Stamp of Rs.1/-) Signature of the House Owner Date: Name: Address:________________________ _______________________________ _______________________________ _______________________________ PAN No:_________________________
Note: 1.PAN of Owner not mandatory 2. Revenue stamp necessary for Transaction more than Rs.5000/-.