Children Education Allowance Application Form

Children Education Allowance Scheme

Reimbursement of Children Education Allowance and Hostel Subsidy

Application Form

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 studying : ...........................................
3. Details of Children Education Allowance (CEA) Claimed already in earlier quarters: 
Quarter of Year : .........................
Academic Year: .............................
Amount Claimed: ......................
June to Aug : ...........................
Sep to Nov : .......................................
Dec to Feb :..........................................
March to May : .......................................
4. The quarter of year and Academic year for which the
    Children Education Allowance is applied now:
Quarter of year : ............................
Academic Year : ...........................
5.(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:
 

6(a) Details of expenses incurred towards school fee/ for purchase of text books & note books, uniforms &sheets and for which reimbursement of Children Education Allowance now:

S.No.	Description of Fee Paid	Reciept No.	Amount
1.	Tuition Fees	-	-
2.	Admission Fees	-	-
3.	Special fee charged for AgricultureElectronics, 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 orAppliance by the Child	-	-
6.	Games/ Sports fee	-	-
7.	Laboratory Fee	-	-
8.	Library Fee	-	-
9.	Fee for extraCurricular activities	-	-
10.	Expenses incurred forOne set of text book and Note books	-	-
11.	Expenses incurred forOne set of Uniform	-	-
12.	Expenses incurred forOne set of School Shoes	-	-
Total		-	-

(b) Total Amount of Children Education Allowance Claimed: Rs 7. Details of Cash receipt No/Counterfoil of Bank Chelan/Credit voucher no: 8. (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 Shri/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.

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

10.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.

11.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.

. Details of documents enclosed: Signature of Employee: Name:

Designation: Office: Date: Station:

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