RECEIPT OF HOUSE RENT PAYMENT (See Section 10 (13A) and Rule 2A)

Received a sum of Rs. _________________ (Rupees___________________ ______________________________________________________________) from Mr./Mrs.______________________________________towards the rent for the month of ___________ Year____________ in respect of House situated at______________________________________________________ ______________________________________________________________ Date: Signature of the Landlord

Name:___________________________

________________________________ Address:_________________________ ________________________________ ________________________________ ________________________________ PAN of Landlord.__________________