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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