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RECEIPT OF HOUSE RENT

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

Received a sum of ______________ (Rupees________________________________

________________________________From___________________________________

Towards the rent @____________________ per month from ___________________ to

__________________ in respect of House No.____________________________

_________________________________________________ situated at _____________

________________________________________________________________________

Balance due amount Rs._________for the period from _____________to_____________

(Affix one Rupee revenue stamp)

Date: Signature of the House Owner

Land lord Name:

Land lord Address: ______________________________

______________________________

_______________________________

Land lord PAN NO. ______________________________

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