PART-A

HRA (House Rent Allowance) DECLARATION Self Declaration b E!"lo ee (All t#e fiel$s below are !an$ator ) Employee Id : Employee Name : . Are you the owner of the rented property: (YES / NO): Annual Rent Pa d : .. !ode of Rent Payment : "a#h "he$ue Onl ne tran#fer Details of Rente$ Pro"ert % &&&&&&&&&&&&&&&&&&&&&&&&&'' &&&&&&&&&&&&&&&&&&&&&'' Name of %andlord : "onta&t No of %andlord : (!o' le) (Re# den&e) ((or)) (E* ma l) %andlord addre## for &ommun &at on (pre#ent addre##) : .. PAN (Permanent A&&ount Num'er) of %andlord: &&&&&&&&&&&&&&&'' (As "er Inco!e Ta( act) it is !an$ator to "ro*i$e Lan$lor$s PAN Nu!ber for rental a!ount !ore t#an Ru"ees One La+#' If PAN
(Per!anent Account Nu!ber) of Lan$lor$ is not a*ailable t#en it is !an$ator to ,et Part-- of t#is for! $ul fille$ an$ si,ne$ b our Lan$lor$' It is #i,#l encoura,e$ to sub!it t#e PAN of Lan$lor$ e*en if t#e rental is below t#e aforesai$ a!ount of Ru"ees One La+#')

+he a'o,e nformat on # &omplete- true and &orre&t to the 'e#t of my )nowled.e and I ha,e no rea#on to 'el e,e that th # nformat on &an 'e m #lead n. or na&&urate. I #hall 'e per#onally re#pon# 'le and l a'le f the #ame # found n&orre&t. I underta)e to pro, de any further nformat on wh &h I/! or t# author 0ed repre#entat ,e# may re$ue#t me to pro, de n &onte1t of my 2ou#e Rent Allowan&e. I here'y &on#ent to I/! or t# author 0ed repre#entat ,e# to &onta&t me or my %andlord or the r author 0ed repre#entat ,e# to &olle&t any nformat on re.ard n. my 2ou#e Rent Allowan&e payment#. If any part of the nformat on &onta ned here n ( n&lud n. the a&tual rent pa d) # found to 'e fully or partly n&orre&t then I w ll 'e per#onally l a'le n&lud n. f l n. of or . nal/re, #ed nd , dual ta1 return payment of any d fferent al ta1 to the In&ome*ta1 3epartment. I a&)nowled.e that any na&&urate/m #lead n. nformat on furn #hed 'y me w ll amount to , olat on of the I/! /u# ne## "ondu&t 4u del ne# (/"4) and I/! &an ta)e d #& pl nary a&t on a.a n#t me n&lud n. term nat on of my #er, &e#. (Si,nature of E!"lo ee)

Below are disallowed while considering HRA rent paid evidence Only advance or security not accompanied with monthly rental.

PART-B
DE !ARAT"O# $OR #O# A%A"!AB"!"T& O$ !A#D!ORD PA# 'To (e )illed (y !andlord* 'Applica(le only i) annual rent e+ceeds one la,h and PA# o) !andlord is not availa(le* 'All the )ields (elow are mandatory*

" -------------------. '#ame o) the !andlord*. s/o ------------------.presently residing at -----------------------------------------------------------------------------------------------------------------. Do here(y con)irm that " have given on rent property 'details o) the property on rent* ---------. ------------------------------------------------------------. To 0r. / 0s.------------------------------.. On annual rent o) Rs. ----------.. E))ective )rom -------------------------.. ". )urther con)irm that " do not hand any Permanent account #um(er 'PA#* issued (y the ta+ authorities in "ndia. The a(ove in)ormation is true and correct to the (est o) my ,nowledge and " shall (e personally responsi(le and lia(le i) the same is )ound incorrect. $urther " shall immediately )urnish the PA# i) o(tained (y me su(se1uent to signing this declaration.

Date2 Place2 '3ignature o) !andlord*