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FORM – 2
REIMBURSEMENT OF
CHILDREN EDUCATION ALLOWANCE
{Ref :OM
No. 12011/03/2008 ( Allowance) Dated 02/09/2009}
1. Certified that the children/child mentioned below in respect of whom
re-imbursement of Children Education Allowance claimed is
wholly dependent upon me:-
Name of the Child & Date of
Birth
|
School in which studying
|
Class in which studying &
A/Y
|
Total
Education allowance paid
|
Total Amount of reimbursement claimed
|
(1)
|
(2)
|
(3)
|
(4)
|
(5)
|
1)
|
||||
#Tuition
fees – for the Whole Year 2008-09 / I/II/III/IV- Term/
|
Rs.
|
|||
Purchase of books (one Set/per child /per A/Y)
|
Rs.
|
|||
Purchase of Note books (one Set/per child /per A/Y)
|
Rs.
|
|||
Purchase of Uniforms (Two Sets/per child /per A/Y)
|
Rs.
|
|||
Purchase of school shoes (one Set/per child /per A/Y)
|
Rs.
|
|||
Total to be filled in column 4 above
|
Rs.
|
|||
2)
|
||||
#Tuition
fees – for the Whole Year 2008-09 / I/II/III/IV- Term/
|
Rs.
|
|||
Purchase of books (one Set/per child /per A/Y)
|
Rs.
|
|||
Purchase of Note books (one Set/per child /per A/Y)
|
Rs.
|
|||
Purchase of Uniforms (Two Sets/per child /per A/Y)
|
Rs.
|
|||
Purchase of school shoes (one Set/per child /per A/Y)
|
Rs.
|
|||
Total to be filled in column 4 above
|
Rs.
|
|||
2. Certified that the Education
Allowance indicated against the Child/Children has actually been paid by me (Receipts
enclosed )
(Note :-Copy of School
fee card & Bank challans/Paid up Receipts/ purchase receipts in original
are to be enclosed)
3.
Certified that :-
i) my spouse is
not a Central Government servant
ii) my spouse is a Central Govt. servant and that she/he has not
claimed /will not claim children’s educational allowance in respect of
our child/children.
4.
Certified that during the period covered by the claim the child attended the
school regularly and did not absent himself/herself from the school without
proper leave for a period exceeding one month.
5.
In the event of any change in the particulars given above which affect my
eligibility for children’s educational allowance, I undertake to intimate the
same promptly and also to refund excess payments, if any made.
Note
: # Tuition Fee Means Tuition fee,
Admission fee, lab fee, special fee charged for agriculture, electronics, music
or any other subject, Fee charged for practical work under the programme of
work experience, fee paid for the use of any aid or appliance by the child, library
fee, games/sports fee and fee for extra curricular activities.
Encl : PLACE & Date:
(Signature of the Govt. servant
