
 
 
 
 
 
 
RECEIPT OF HOUSE RENT 
(Under Section 1 (13-A) of 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._________________________
 
 
Rupee 
Revenue 
Stamp