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Yearly Rent receipt for the FY 2022-'23

*** This form is mandatoary to claim HRA exemption though rent is paid through online

Tenant ( Qualcomm Employee Name & ID #) Landlord / House owner Name

Rented House - 1 Address Address of House owner

Rented House - 2 Address ( if changed)

Rent Payment Details April 2022 to March 2023


Rented
PAN No
house Mode of Payment
Month Rent Amount in INR (if monthly rent > RS Date of Payment
Address (Cash /Bank)
8,333)
1 or 2
Apr-2022
May-2022
Jun-2022

Jul-2022
Aug-2022
Sep-2022

Oct-2022
Nov-2022
Dec-2022
Rent for the future months *** Mandatory to claim HRA Exemption
Jan-2023
Feb-2023
Mar-2023

I, ….................................................. , son/ daughter of , …................................do hereby certify that


the information given above is complete and correct.

Signature of Tenant (Qualcomm Employee) Signature of House owner

Note: ** Rent payable for the future months is to be updated for HRA exemption
** If monthly rent amount is more than 10,000/-, rental agreement copy is to be submitted
** For online payments - Bank statement for those months is also to be submitted

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