CEA : Proforma for re-imbursement

CEA : Proforma for re-imbursement

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
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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.
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(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.
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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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