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tdhe fbraftemen) DOCTOR HARISINGH GOUR SERSIT ALAYA, SAGAR (M.P.) APPLICATION FOR CHILDREN EDUCATION ALLOWANCE (CEA) FOR THE ACADEMIC YEAR. (Maximum upto first 02 surviving children) Name of the Employee (in capital letters) Station/ Office 2 Design and Station/Office Design Employee No. 3. Level Basic Pay Rs 4 Basic Pay and Level Child-2 Particulars of Children Child-1 i) Name of the Student i) Date of Birth ii) Class iv) Class studled during year ) Name of the school/college and address . Education Allowance L Education Allowance 6 Nature fclaim Hostel Subsidy 2. Hostel Subsidy (Tick whichever is applicable) . Disabled Child 3. Disabled Child 7. Whether Bonafide Certificate from School/College is enclosed Hostel Subsidy: 8 Whether Bonafide Certificate from School/College mentioning the amount af expenditure is Claim in Rs 10 1+2 Child Claim in Rs. Total Rs. ...
... 2 ... i) I hereby declare that:- Mychild/children mentioned above in respect of whom reimbursement of eduction expenses is claimed is/are wholly depended up me. My wife/husband/is not a Central Government Employee My wife/husband is a Central Govt, Employec and th reimbursement education expenses in respect of our childichildten My child/children in respect of whom relmbursement is recognized school and not studying in the same class 01/ she/he will not claim claimed is/are studying in which he/she failed in last year * Family declaration particulars as certified for pass issuing authority are enclosed. hereby declare that reimbursement of Children Education claimed in respect of the child/children by a person other than me. Allowance has not been tion ) I hereby declare that reimbursement of Children Education expenses is claimed for my. eldest two eldest two surviving children only the best of my hereby declare that the particulars mentioned above are correct knowledge. If any inlormation furnished above My Composition is as under:- not correct, I am liable for all as per rules Remarks Relationship S. Age Name Date of Birth not 2 10sc 3 well 4 5. Place Date:.. Signature of the Applicant Name: Designation: Emp. No A/c No, Mob. No. Signature of the forwarding official With Office Seal Documents to be enclosed: CEA application filled in all respect 1 2 Bonafide Certificate from school/College-Proforma-I Bonafide Certificate from school/College for Hostel Suhsidv.Prnforms 1 ce
PROFORMA-I CERTIFICATE FROM SCHOOL (Children Education Allowance) School/Collage Name: This to certify that Master/Baby/Mr/Ms. Son/Daughter of Smt/Sri Roll No. is a Bonafide of this Convent/School/College and is Studied in Class During The Acdemic Year e Date of Birth as per school record: e In Word Admission Register No. to Date: rc Signature of the Head of the Institution/School/College (with stamp and seal)