SELF DECLARATION BY LANDLORD

I, __________________________________________ (Name of Landlord) presently

residing at____________________________________________________________

__________________________________ (Detailed Address) do hereby confirm that:

I have leased residential premises _________________________________________

_____________________________________________________ (Detailed Address)

to __________________________________________________ (Name of employee & EID)

for the period_______________ (MMM/YYY) to _______________(MMM/YYYY)

I do not hold any Permanent account Number (PAN) issued by the tax authorities in India.

Verification

I _________________________________________ do hereby declare and confirm that what

is stated above is correct, complete and truly stated.

Date Signature

Place