Employee No .

Receipt Of House Rent

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

Received from Mr/Ms...............(Employee name)

a sum of Rs ........./- (amount in words).....................................................................
Towards the rent @______________________ per month from April________________
to March_____________in respect of the House No ........................................................
.......................................................................
.................................. Bhubaneswar,ORISSA.
Date:
Place:

(Signature of the House Owner)

(Owners name & address)