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 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. 1he *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 percenta(e 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 Allowance
now#
S.No. Description of Fee Paid Reciept
No.
Amoun
t
1. 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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*. +ames, Sports fee
-. .a"orator! Fee
/. .i"rar! Fee
0. Fee for e'tra )urricular acti1ities
12. E'penses incurred for 3ne set of te't "oo& and Note
"oo&s
11. E'penses incurred for 3ne set of 4niform
12. E'penses incurred for 3ne set of School Shoes
Total
(b) 1otal Amount of Children Education Allowance Claimed# <s ;. $etails of Cash receipt
No4Counterfoil of Ban8 Chelan4Credit voucher no# =. (i) Certified that the fee4amount
indicated above had actually been paid by me. (ii) Certified that /y wife4husband is4is not a
Central >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 Education
Allowance 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.
1A.Certified that my child in respect of whom reimbursement of Children Education
Allowance applied is studyin( in the school4Bunior colle(e which is reco(niCed and affiliated
to Board of Education4Dniversity.
11.1he particulars 4information furnished above are complete and correct and I have not
suppressed any relevant information. In the event of any chan(e in the particulars (iven
above which affect my eli(ibility 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 sta(e the information4documents furnished above is found to
be false I am liable for disciplinary action.
$etails of documents enclosed# &i(nature of Employee# Name#
$esi(nation#
&tation# !ffice#
$ate#
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