(Download) HRA declaration format for Teachers and employees

 Teachers and government employees have to submit HRA declaration in January and July every year.  HRA declaration consists of two parts A and B text. Click on the image below to download HRA declaration format.

HRA DECLARATION FORMAT

(As on 1st January/July. ……...(Year) (Go. No. 97SE(B), Di-07.03.2001)

PART-A

I am Married / Unmarried / Widow / Widower: (Strike out which is not applicable)

1. Name of the office/School:....................... … … … … .. 

2. Name of the Employee:................................................. 

3. Designation of the Employee:....................................... 

a) Employees' Present Pay (Band Pay+Grade Pay):

b) HRA: c) Opted for Swasthya Sathi? (Yes/No)

c) Opted for Swasthya Sathi? (Yes/No)

d) Whether you get a Swasthya Sathi card? Yes/No

If, Yes then write the no. of card. …. … …. … .. 

I do hereby declare that the details furnished in PART-A are true to the best of my knowledge.

Date:.                                                 Signature of Employee

PART-B

My wife/husband is/was not in service under the Government of India or Government undertaking or any statutory/local body, educational Institute. (Strike out which is not applicable) Or,

My wife/husband is/was in service and following are the particulars of her/his employment and pay etc drawn by her/him: (Strike out which is not applicable)

i) Name of the Spouse:...................... 

a) Name of the office:.......................... 

b) Address of the Office:.................... 

c) Spouse's Present Pay (Band Pay+Grade Pay)...

d) Spouse's HRA:................................ 

e) Whether spouse is opted for Govt. Housing:.. … … 

f) Whether the spouse is opted for W.B. Health Scheme:........ 

g) Whether spouse is opted for under Swasthya Sathi Scheme: Yes/No

I do hereby declare that the details furnished in PART-B are true at the best of my knowledge.

Date:.                                                  Signature of Spouse

Enclosed: Salary Certificate of Spouse

Verified by

… … … … … … … … ..                              … … … … … … … … … …                                                 S.I.S/HOI/HOO.                                           Sign of HT/TIC with seal

                                                                   (In case of Primary Teachers only)

Click here to download the HRA declaration format.