🧾 Sample – Form F
(See Rule 22 of the West Bengal Premises Tenancy Rules, 1999)
Application for Deposit of Rent under Section 21 of the West Bengal Premises Tenancy Act, 1997
To
The Learned Rent Controller,
Alipore Judges’ Court,
Kolkata – 700027,
District – South 24 Parganas.
Application No. _______ of 2025
In the matter of:
Deposit of rent by tenant under Section 21 of the West Bengal Premises Tenancy Act, 1997.
1. Name of Tenant:
Shri Inder Chand Agarwala,
Son of Late Sova Chand Agarwala,
Residing at premises no. 1, Tarpan Ghat Road,
Post Office & Police Station – Behala,
Kolkata – 700053, District – South 24 Parganas.
2. Description and Address of the Premises:
Premises being No. 1, Tarpan Ghat Road,
Post Office & Police Station – Behala,
Kolkata – 700053, District – South 24 Parganas.
3. Name and Address of Landlord:
Smt. Gouri Rani Das,
Wife of Late Biswanath Das,
Residing at premises being No. 1, Tarpan Ghat Road,
Post Office & Police Station – Behala,
Kolkata – 700053, District – South 24 Parganas.
4. Period for which Rent is Deposited:
For the month(s) of July 2025, August 2025 and September 2025.
5. Amount of Rent Deposited:
₹ 1,500/- per month, total ₹ 4,500/- (Rupees Four Thousand Five Hundred only).
6. Reason for Deposit:
That the tenant tendered the rent for the said months to the landlord personally within the period prescribed under Section 20 of the said Act, but the landlord wrongfully refused to accept the same. Hence, this deposit is made under Section 21(1) of the Act.
7. Mode of Deposit:
By Demand Draft No. 012345, dated 10.10.2025, drawn on State Bank of India, Behala Branch, in favour of the Rent Controller, Alipore.
8. Declaration:
I, the undersigned tenant, hereby declare that the particulars stated above are true to the best of my knowledge and belief and that the rent for the aforesaid months has not been paid to any person entitled thereto. I further declare that I have not previously deposited rent for the said period in any other proceeding.
Place: Kolkata
Date: 10th October 2025
Signature of Tenant
(Sd/-) Inder Chand Agarwala
(For Office Use)
Received the sum of ₹ 4,500/- (Rupees Four Thousand Five Hundred only) from Shri Inder Chand Agarwala as rent deposit for the months of July, August and September 2025 under Section 21 of the West Bengal Premises Tenancy Act, 1997.
Receipt No. _______ dated _______
Signature of the Rent Controller / Authorised Clerk
Office of the Rent Controller,
Alipore Judges’ Court, Kolkata.
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