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CEA : Proforma for re-imbursement

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CEA : Proforma for re-imbursement 

proforma-for-re-imbursement-of-cea


PROFORMA FOR RE-IMBURESMENT OF CHILDREN EDUCATION ALLOWANCE


CLAIM FOR THE ACADEMIC YEAR: 2017-18
 
I hereby apply for the reimbursement of Children Education Allowance / Hostel-Subsidy for
my child / children and relevant particulars are furnished below:- 

1. Name & Rank of the Govt Servant :
2. Personal No. :
3. Designation :
4. Name of the Unit : ICGS Smarth
5. If Spouse is employed, state whether in Central Govt. PSU, State Govt. (give details with name of the Spouse) : No
6. Designation, Office & B.U. No. of spouse, if spouse is employed in Railway : NA
7. Details of the child / children for whom CEA / Hostel Subsidy claimed:-
Sequence
Name of child
DOB
Standard
(A.Y. 2017-18)
Name & Place of the School / Institution
1st Child
2nd Child

8. Re-imbursement of Expenditure:-

Sequence
Period
Rate of CEA (Rs)
Amount claimed
Remarks
1st Child Apr 17 to Jun 17 @ 1500/- PM 4,500.00 School Fee receipts and other bills attached
Jul 17 to Mar 17 @ 2250/- PM 20,250.00 Fixed amount.
2nd Child Apr 17 to Jun 17 @ 1500/- PM 4,500.00 School Fee receipts and other bills attached
Jul 17 to Mar 17 @ 2250/- PM 20,250.00 Fixed amount.
Total amount claimed Rs
49,500.00

9. Distance of Hostel of child from residence of employee (in case Hostel Subsidy): NA

10. Amount of CEA / Hostel-Subsidy already received up to previous quarter: NIL

11. The Academic year for which CEA / Hostel-Subsidy is applied now: 2017-18

12. (a) Whether the child for whom the CEA is applied for is a disabled child : ¥es / No

(b) If yes, indicate the nature of disability:

(c) Date of disability certificate:

(d) Indicate the percentage of disability:

13. Whether the Bonafide certificate from Head of Institution has been attached : Yes / No

14. For Hostel Subsidy, the Bonafide certificate from mentioning the amount is attached: NA

15. If Yes at Item No. 14, Amount claimed for Hostel Subsidy: Rs NA .

16. (a) Certified that I or my wife / husband is / is not a Central Government servant.

(b) Certified that my wife / husband Sri / Smt ……………………………………………….. is presently
working as ……………………………… in ……………………………………………….. and that he/
she shall not apply / has not applied for the Children Education Allowance for the child / children mentioned above.

(c) Certified that I or my wife / husband-has not claimed this re-imbursement from any other source and will not claim the same in future.

17. Certified that my child in respect of whom re-imbursement of Children Education Allowance is applied is studying in the School / Jr. College which is recognized and affiliated to Board of Education / University. 

18. Certified that I am claiming the CEA in respect of my two eldest surviving children only, The 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.

Date: Apr 18

Place: Goa
(Signature of Govt Servant)
Name: ……………………………
Rank : ……………………………
P.No.: ……………………………

II
COUNTERSIGNED
ICGS Samarth
Goa – 403 803
Date: Apr 18



Source: Confederation [Click here to view / download pdf ]

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