Scribd
Upload
998 views3 pages

New Tution Fee Form

This document contains a pro forma bona fide certificate and provides information about a student who attended a school or institution. It includes the student's name, admission number, date of birth, class, academic years attended, name of the school, and details about whether the student resided in a hostel and the amount paid. The certificate is to be printed on the institution's letterhead and signed by the head of the institution.

Uploaded by

JPC RTK
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
998 views3 pages

New Tution Fee Form

This document contains a pro forma bona fide certificate and provides information about a student who attended a school or institution. It includes the student's name, admission number, date of birth, class, academic years attended, name of the school, and details about whether the student resided in a hostel and the amount paid. The certificate is to be printed on the institution's letterhead and signed by the head of the institution.

Uploaded by

JPC RTK
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

To be printed on the Letter Head of the Institution with full postal Address

(If there is no printed letter head, Name of the Institution and full postal Address should be
written clearly)

PROFORMA BONAFIDE CERTIFICATE

It is certified that Master/Baby/Kum ………………………………………………..………………..


Admission No………………………………………… Date of Birth ……………………………………
Son/Daughter of Shri/Smt……………………………………………………………………………has
studied in Class ……………………..………. Sec ……………………….. during the previous
Academic year from ……………………… to ……………………………. in this School/Institution.

This institution/School is affiliated/ recognized by ……………………………………………………...

And the affiliation / recognition number is ……………………………………………………………...

*During the year Master/Baby/Mr./Ms..………………………………………… has Resided in the


residential Complex (Hostel) of the school and paid an amount of Rs………………………
(Rupees ………………………………………………………….....................) towards Boarding and
Lodging in the residential complex.

*(Strike out if it is not applicable)

Seal with date

Signature of the Head of the


Institution /School
APPLICATION FOR CHILDREN EDUCATION ALLOWANCE (CEA)/

HOSTEL SUBSIDY (HS)

(As per RBE No.147/2017 and PCPO/SC’s Serial Circular No.185/2017)

01 Name of the Employee:


02 Designation of the Employee:
03 Employee Number :
04 Tkt.No/Pay Bill Unit No:
05 PARTICULARS OF CHILDREN CHILD-1 CHILD-2
Name of the Student
Date of Birth
Class (STD.)
Academic Year
Name of the School
Address

06 Name of Claim Education Allowance Education Allowance


(i) Tick whichever is applicable
Hostel Subsidy Hostel Subsidy
(ii) For disable child, proof of
Disabled Child Disabled Child
percentage of disability should be
enclosed
07 Whether Bonafide Certificate from School Yes No. Yes No
is enclosed
08 Hostel Subsidy : Yes No. Yes No
Whether Bonafide Certificate from School
mentioning the amount of expenditure is
enclosed
09 Claim in Rs.
Contd….2
::2::

Certified that :

 My Child/Children mentioned above in respect of whom reimbursement of education


expenses is claimed is / are wholly depended upon me.
 My wife/Husband is not a Central Government Employee.
 My Wife/Husband is a Central Government Emplyee and that she/he will not claim
reimbursement Education expenses in respect of our Child/ Children.
 My Child/Children in respect of whom reimbursemnet is claimed is / are studying in
recognized schools.
I. I hereby declare that reimbursement of Children Education Allowance has not
been claimed in respect of the Child/Children by a person other than me.
II. I hereby declare that reimbursement of Children Education expenses is claimed for
my eldest two surviving children only.

I hereby declare that the particulars mentioned above are correct to the best of my
knowledge. If any information furnished above is not correct, I am liable to be taken up
under D & AR.

Signature of the Employee with Date

Certification by the Supervisor

The above application is forwarded to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . for


necessary action, duly certifying that the names of the Child/ Children furnished by the
empoloyee have been verified with records maintained in this office and they are the eldest two
surviving children declared by the employee.

Signature of forwarding official


With date & Seal.

You might also like