Declaration form for HRA
Declaration form for HRA
Declaration form for HRA
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F O R M - A<br />
D E C L A R A T I O N<br />
I , ........................................................................... (Name) ......................................<br />
........................................................................................ (Designation and office) declare<br />
as under :-<br />
(a) That I reside in a hired house located at .................................................<br />
...................................................................................... (Full postal address),<br />
belonging to Shri .........................................................................................<br />
.............................................. (Name and full postal address) and I pay him<br />
Rs. ................................................................................................ (Amount<br />
of rent in words and figures) as rent per month. I have been living in this<br />
house continuously from ..................... (Date)<br />
(b)<br />
No other person who is a Government servant resides with me in the above<br />
house.<br />
house :-<br />
OR<br />
The following persons who are Government servant reside with me in the above<br />
Name of Government Servant<br />
Office in which working with full particulars<br />
1 2<br />
The particulars given above are true to the best of my knowledge.<br />
(Signature) ...........................................................<br />
(Name) .................................................................<br />
(Date) ...................................................................
F O R M - B<br />
D E C L A R A T I O N<br />
I , ........................................................................... (Name) ......................................<br />
........................................................................................ (Designation and office) declare<br />
as under :-<br />
(a)<br />
(b)<br />
(c)<br />
That resides in the house located at ............................................ (Full postal<br />
address), which belongs to me/my spouse/children/father/mother (strike off<br />
whichever is inapplicable and if it belong to any one other than self given<br />
the name and address of the a<strong>for</strong>esaid relation to whom it belongs) and I do<br />
not pay rent to anybody. I have been living in this house continuously from<br />
........................ (Date)<br />
That I am paying/contributing towards house or property tax or<br />
maintenance of the house.<br />
No other person who is a Government servant reside with me in the above<br />
house .<br />
house :-<br />
OR<br />
The following persons who are Government servant reside with me in the above<br />
Name of Government Servant<br />
Office in which working with full particulars<br />
1 2<br />
The particulars given above are true to the best of my knowledge.<br />
(Signature) ...........................................................<br />
(Name) .................................................................<br />
(Date) ...................................................................
F O R M - C<br />
D E C L A R A T I O N<br />
I ,.....................................................................................................................<br />
(Name)<br />
(Designation)<br />
declare as under :-<br />
That there has been no change in respect of the house where I live in and<br />
<strong>for</strong> which I had given a declaration in <strong><strong>for</strong>m</strong> "A" / "B" (strike off which is not applicable).<br />
OR<br />
Certain material changes have occurred since ........................(Date) and<br />
hence a fresh declaration in <strong><strong>for</strong>m</strong> "A" / "B" is enclosed.<br />
The particulars given above are true to the best of my knowledge.<br />
(Signature) ...........................................................<br />
(Name) .................................................................<br />
(Date) ...................................................................
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