8/11/2019 Application for Children Education Allowance

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APPLICATION FOR REIMBURSEMENT OF CHILDREN EDUCATION

ALLOWANCE

I hereby apply for the reimbursement of Children Education Allowance for my child andrelevant particulars are furnished below.

1(a) Name of the Child (in B!C" letters) #(b) $ate of Birth #

%(a) Name and address of the &chool in 'hich studyin #(b) Class in which studyin #

. $etails of Children Education Allowance (CEA)

Claimed already in earlier *uarters #+uarter of ,ear #

Academic ,ear #

Amount Claimed #-une to Au #

&ep to Nov #

$ec to eb #/arch to /ay #

0. he *uarter of year and Academic year for which the

Children Education Allowance is applied now#+uarter of year #

Academic ,ear #2.(a) 'hether the child for whom Children

Education Allowance applied is disabled child3 ,es4No

(b) If yes5 indicate the nature of disability #

(c) Indicate the percentae of disability #(d) $ate of disability certificate #

6(a) $etails of e7penses incurred towards school fee4 for purchase of te7t boo8s 9 note

boo8s5 uniforms 9sheets and for which reimbursement of Children Education Allowancenow#

S.No. Description of Fee Paid Reciept

No.

Amoun

t1. Tuition Fees

2. Admission Fees

3. Special fee charged for Agriculture Electronics music

or an! other Su"#ect

$. Fee charged for practical %or& under The programme

of %or& e'perience

(. Fee paid for the use of an! aid orAppliance "! the )hild

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8/11/2019 Application for Children Education Allowance

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*. +ames, Sports fee

-. a"orator! Fee

/. i"rar! Fee

0. Fee for e'tra )urricular actiities

1. E'penses incurred for ne set of te't "oo& and Note

"oo&s11. E'penses incurred for ne set of 4niform

12. E'penses incurred for ne set of School Shoes

Total

(b) otal Amount of Children Education Allowance Claimed# overnment &ervant. (iii) Certified that my husband4wife &hri4&mt. Is presently

wor8in as in And that he4she will not apply4has not applied for the Children EducationAllowance for the child mentioned above.

?.Certified that I or my wife4husband has not claimed and will not claim the @ostel &ubsidy

in respect of the child mentioned above.

1.Certified that my child in respect of whom reimbursement of Children EducationAllowance applied is studyin in the school4unior collee which is reconied and affiliated

to Board of Education4Dniversity.

11.he particulars 4information furnished above are complete and correct and I have not

suppressed any relevant information. In the event of any chane in the particulars ivenabove which affect my eliibility for reimbursement of Children Education Allowance5 I

underta8e to intimate the same promptly and also to refund e7cess payments5 if any made.urther I am aware that if at any stae the information4documents furnished above is found to

be false I am liable for disciplinary action.

$etails of documents enclosed# &inature of Employee# Name#$esination#

&tation# !ffice#

$ate#

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