Tuition Fees Form Latest

Download as pdf or txt
Download as pdf or txt
You are on page 1of 2

APPLICATION FOR REIMBURSEMENT OF CHILDREN EDUCATION ALLOWANCE

I , …………………………………., hereby apply for the reimbursement of Children Education


Allowance for my child and relevant particulars are furnished below.

1 (a) Name of the Child (in BLOCK letters): ..........................................................................

(b) Date of Birth : ……………………………………………….

2 (a) Name and address of the School in _________________________________________


which studying : _________________________________________

(b) Class in which presently studying : ...........................................

3. The Academic year for which the Children Education Allowance is applied now:……………………

4. (a) Whether the child for whom Children


Education Allowance applied is disabled child? Yes/No

(b) If yes, indicate the nature of disability:

(c) Indicate the percentage of disability:

(d) Date of disability certificate

5. Tuition fees amount paid:- Rs. ……………..

6 (i) Certified that the fee/amount had actually been paid by me.
(ii) Certified that My wife/husband is/is not a Central Government Servant.
(iii) Certified that my husband/wife Shri/Smt. …………………………….is presently working/
Not working as………………………… in ………………………And that he/she will not apply/ has
not applied for the Children Education Allowance for the child mentioned above.

7. Certified that I or my wife/husband has not claimed and will not claim the Hostel Subsidy in respect
of the child mentioned above.

8. Certified that my child in respect of whom reimbursement of Children Education Allowance


applied is studying in the school/junior college which is recognized and affiliated to Board
of Education/University.

9 The particulars /information furnished above are complete and correct and I have not suppressed
any relevant information. In the event of any change in the particulars given above which affect my
eligibility for reimbursement of Children Education Allowance, I undertake to intimate the same
promptly and also to refund excess payments, if any made. Further I am aware that if at any stage
the information/documents furnished above is found to be false I am liable for disciplinary action.

10 . Details of documents enclosed:

Signature of Employee:
Name:
Designation:
Office:
Date:
Station:

Note :

1. Kindly provide one original copy and one set of complete set of claim
2. All the columns must be filled and No claim will be accepted without Pin No.
An undertaking required from the official along with the Children Education Allowance(CEA)

UNDERTAKING

I , ________________________________, _________ (Post) , hereby declares that :

1. I have total ______(No. of Children) child/children as per details given below:

S.No. Name of the child Son/Daughter Date of Birth

(i) ______________________ ___________ __________


(ii) ______________________ ___________ __________
(iii) ______________________ ___________ __________
(iv) ______________________ ___________ __________

2. I am claiming CEA for my first / Second child, whose name is already added in service
book record/service book.

3. The present claim of CEA pertains to the Academic year ____________ in which my
son /daughter was studying in _______ class.

4. I have not claimed CEA for the same academic year, for ________________ (name of
the child) earlier for the above said period.

5. I am not claiming/have not claimed for more than two classes before class 1st.
(if the official is claiming CEA for Prep./Nursery/K.G./ LKG/UKG etc.)

6. It is certified that my child in respect of whom reimbursement of Children education


Allowance applied is studying in the school which recognized vide no. __________
and affiliated to Board of Education/university___________.

Signature:

Name:
Designation:
Posting:

Pin No.

You might also like