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March 25, 2017

APPLICATION FOR REIMBURSEMENT OF CHILDREN EDUCATION ALLOWANCE


APPLICATION   FOR  REIMBURSEMENT  OF  CHILDREN  EDUCATION  ALLOWANCE
FOR THE YEAR 20__ - 20 ­­­__
                I  hereby  apply  for the  reimbursement of  Children Education Allowance (CEA)  for my child and  relevant  particulars  are furnished  below:
1 (a)       Name of the Child (in BLOCK letters)       :               __________________________
   (b)       Date of Birth of the child                                               :               __________________________
2 (a)       Name and address of the School in which             :               __________________________
                Studying                                                                              :               __________________________
   (b)       Class  in which  studying                                                :               __________________________
3              Details of  Children Education Allowance (CEA) claimed already in earlier  quarters:
Quarter of Year
Academic Year
Amount  Claimed
June to August


September to November


December to February


March to May


4.            The Quarter of year and Academic year for which  the CEA is  applied  for:
Quarter of Year
Academic Year
Amount  (Rs.)












5.(a)       Whether the child  for  whom  CEA applied is  disabled ?                :               Yes / No
   (b)       If yes,  indicate the nature of disability                                   :              
   (c)        Indicate the percentage of  disability                                                      :
   (d)       Date of  disability certificate                                                                        :

6. (a)      Details of  expenses  incurred  towards  school fee / for purchase  of  text  books & note books,  uniforms & sheets and  for  reimbursement of  CEA:

S.No.
Description of fee paid
Receipt No.
Amount (Rs.)
1.
Tuition Fee


2.
Admission Fee


3.
Special fee  charged for Agriculture Electronics, music or any other  subject


4.
Fee  charged  for  practical  work  under  the programme of work experience


5.
Fee  paid for the use of any aid or Appliance


6.
Games / Sports fee


7.
Laboratory fee


8.
Library fee


9.
One set of Text Books &  Note  Books


10.
Expenses  incurred for two set of Uniform


11.
Expenses  incurred for  one set of School Shoes



Total



6.(b)      Total amount of  CEA  claimed    :               Rs. ______________

7.(i)        Certified  that  the  fee / amount  indicated above  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  Sri / Smt. _____________________________  is presently  working  as  __________  in  ______________________ and that   he / she  will not  apply  / has not applied for the Children Education Allowance  for the child  mentioned  above.

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

9.            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.

10.          The  particulars / information  furnished  above  are  complete  and  correct  and  I have  not  suppressed  any  relevant  information.   In the event  of ny  change in the  particulars  given  above  which  affect my  eligibility  for reimbursement of CEA,  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.
11.          Details of  documents  enclosed:

                                                                                                Signature of Employee:
                                                                                                N A M E                                :
Date:                                                                                     Designation                        :
Station:                                                                                Office where working    :







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