RECEIPT OF HOUSE RENT

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

Received a sum of Rs. ____________________________ (Rupees________________

________________________________________________________________________
Towards the rent @____________________ per month from ___________________ to
__________________ in respect of House No.____________________________
_________________________________________________ situated at ____________
_______________________________________________________________________
(Affix Revenue Stamp of Rs.1/-)

Date:

Name:
Address: _____________________
______________________________
______________________________
PAN No: _____________________

Signature of the House Owner