Children Education Allowance Form NITC 7th CPC

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NATIONAL INSTITUTE OF TECHNOLOGY CALICUT

KOZHIKODE-673601

Form for claiming reimbursement of Children Education Allowance and Hostel Subsidy for Children of
permanent staff members

(Ref. OM No. A-27012/02/2017-Estt.(AL) Dated 17.07.2018)

Claim Applied for (Please Tick ): Children Education Allowance Hostel Subsidy Both

1. Name and Employee ID No. (in block letters) :


2. Designation and Department :
th
3. Pay Level as per 7 CPC :
4. Contact No. :

Details of children (Two eldest surviving only) for which the claim is made for:
A. Child 1:
1. Names of Child :
2. Age and Date of Birth of the Child :
3. Class and Name of School :
4. Academic year of study/ Period :
B. Child 2:
1. Names of Child :
2. Age and Date of Birth of the Child :
3. Class and Name of School :
4. Academic year of study/ Period :

(Attach separate sheet with details of extra child/children in case the number of children exceeds two due to second child birth resulting
in multiple births)

Details of Amounts Claimed:


A. Children Education Allowance

Claim For Whether Child Period of study (with Amount Admissible per Child per Amount (in
is Divyang total No. of months) month Rs.)
(Y/N
Child 1 Rs. 2250/- (Rs. 4500/- in case of Divyang
child)
Child 2 Rs. 2250/- (Rs. 4500/- in case of Divyang
child)

Total
B. Hostel Subsidy

Claim For Distance of Hostel Period of study (with Amount Claimed Amount Admissible (In Rs.)
of Child from total No. of months) (In Rs.)
(For Office Use only)
Residence (in KM)
Child 1
Child 2

Total
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Documents attached:
A. In case of claims submitted for Children Education allowance:
1. Certificate issued by the Head of the Institution/School confirming that the child studied in the school for the period
/year for which claim has been submitted.
2. Self-attested copy of report card.
3. Self-attested fee receipt(s) (Including e-receipts) confirming the fee deposited for the entire academic year
4. Disability Certificate(s) attached (In case of Divyang Children)

A. In case of claims submitted for Hostel Subsidy:


1. Certificate issued by the Head of the Institution/School confirming that the child studied in the school for the period
/year for which claim has been submitted & mentioning the amount of expenditure towards lodging and boarding in
the residential complex of the institution.
2. Self-attested copy of report card & fee receipt(s) (Including e-receipts) indicating amount of expenditure towards
lodging and boarding in the residential complex of the institution.

Self Declaration:

1. The child / children mentioned above in respect of whom reimbursement has been claimed are wholly dependent upon me.

2. The above expenses have not been claimed for Income Tax benefits.

3. The reimbursement of the above expenses has not been claimed by the spouse who is also a Govt. servant (This is applicable in
case both the spouses are Govt. Servants).
4.

5. The facts and figures given in the reimbursement bill are true to the best of my knowledge and belief.

6. The claims are made only for the two eldest surviving children, except when the number of children exceeds two due to second
child birth resulting in multiple births.
7. In the event of any change in the particulars given above which affect the eligibility of submitted claim, I undertake to int imate
the same promptly and refund the excess payment (if any) made to me.

Date: …………………
....................................................................
Place: ............................... Signature of the Employee with date

For Accounts Office use only

S.No. Particulars Period of study Amount Claimed (In Amount Sanctioned


Rs.) (In Rs.)
1. Children Education Allowance
2. Hostel Subsidy
Total

Dealing Hand Jr. Superintendent Sr. Superintendent DR (Fin.)

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