RECEIPT OF HOUSE RENT

(under Section 10(13A) of the Income Tax Act)

Received a sum of
Rs________________(Rupees____________________________________________________________

From __________________________________________________________________________towards

the rent per month from ________________________________________________________________

_____________to____________________________________ in respect of House No._______________

Situated at
_____________________________________________________________________________________
_____________________________________________________________________________________

Date: Signature of the House owner

Name:__________________

Address:________________

_______________________

________________________

________________________

PAN NO._________________