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    Cea New Form

    Uploaded by

    Manoj Rungta
    This document contains a pro forma for applying for reimbursement of children education allowance or hostel subsidy. It requests information such as the employee's name and details, spouse employment details if applicable, children's details including name, DOB and age, academic year and school/class details. It also requests certification that the information provided is true and the claimant will refund any excess payment. Supporting documents like bona fide certificates and declarations must be attached.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Cea New Form

    Uploaded by

    Manoj Rungta
    279 views4 pages
    This document contains a pro forma for applying for reimbursement of children education allowance or hostel subsidy. It requests information such as the employee's name and details, spouse employment details if applicable, children's details including name, DOB and age, academic year and school/class details. It also requests certification that the information provided is true and the claimant will refund any excess payment. Supporting documents like bona fide certificates and declarations must be attached.

    Original Title

    CEA NEW FORM (1)

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    This document contains a pro forma for applying for reimbursement of children education allowance or hostel subsidy. It requests information such as the employee's name and details, spouse employment details if applicable, children's details including name, DOB and age, academic year and school/class details. It also requests certification that the information provided is true and the claimant will refund any excess payment. Supporting documents like bona fide certificates and declarations must be attached.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    279 views4 pages

    Cea New Form

    Uploaded by

    Manoj Rungta
    This document contains a pro forma for applying for reimbursement of children education allowance or hostel subsidy. It requests information such as the employee's name and details, spouse employment details if applicable, children's details including name, DOB and age, academic year and school/class details. It also requests certification that the information provided is true and the claimant will refund any excess payment. Supporting documents like bona fide certificates and declarations must be attached.

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    © All Rights Reserved
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    of 4

    Annexure-‘A’

    PROFORMA FOR RE-IMBURSEMENT OF CHILDREN EDUCATION ALLOWANCE / HOSTEL


    SUBSIDY IN TERMS OF RBE No. 147/2017

    CLAIM FOR THE FINANCIAL YEAR:-


    I hereby apply for the reimbursement of Children Education Allowance for my child/children and relevant
    particulars are furnished below:-
    1. Name of the Employee
    2. P.F. No./Employee No.
    3. Designation
    4. Office & Bill Unit No.
    5. Name of Spouse
    6. If spouse is employed, State Whether in Central Govt.,
    PSU, State Govt. (give details)
    7. Designation, Office & B.U. No. of Spouse, if spouse is
    employed in Railway:

    8. Details of all the children of the Employee:-


    Sl. No. Sequence Name DOB Age
    st
    1. 1 Child
    2. 2nd Child
    3. 3rd Child

    9. Details of all the children for whom CEA/Hostel subsidy claimed :


    Sl. No. Sequence Name DOB Age
    1.
    2.

    10. Academic year, Name of School/Residential School and Class in which children studied:
    st nd
    1 Child 2 Child

    11. Distance of Hostel of Child from residence of employee (in case Hostel Subsidy is claimed)….
    12. Amount of CEA/Hostel Subsidy already received up to previous quarter:…………………………………
    13. The Academic year for which CEA/Hostel Subsidy is applied now:…………………………………………….
    14. (a) Whether the child for whom the CEA/Hostel Subsidy is applied for is a disabled child: YES/NO
    (b) If yes, indicate the nature of disability :
    (c) Date of disability Certificate.
    (d) Indicate the percentage of disability:
    15. Whether the Bonafide certificate from Head of Institution has been attached: Yes/No.
    16. For Hostel Subsidy, the Bonafide certificate from mentioning the amount is attached: Yes/No

    Contd….P/2
    -:2:-

    17. If Yes at Item No. 16, Amount claimed for Hostel Subsidy…………………………………………

    18. (i) Certified that the Fee/amount indicate above had actually been paid by me.

    (ii) Certified that my Wife /husband is /is not a Central Government Servant.

    (iii) Certified that my husband /wife 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 mentioned above.

    (iv) 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.

    19. Certified that my child in respect of whom reimbursement of Children Education Allowance is applied is
    studying in the School/Jr. College which is recognized and affiliated to board of Education/University.

    20. 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.

    Signature:
    Name:
    Design & Station
    Working Under:
    Date:
    The family composition of the claimant has been verified from the official records such as pass
    Declaration /Register etc and found correct.

    Date:

    Signature of Sr. Subordinate


    With office seal and stamp

    FOR OFFICE USE ONLY

    Sl. Name of staff P.F. No. CEA Amount Hostel Subsidy Total
    No Amount if any

    Forwarded to : Sr. DFM/CKP for vetting and early return.

    Bill Clerk/OS Bill Compiling


    officer
    SELF-DECLARATION

    I Force No ……………………………Rank…………………….Name……………………………………………….of Unit


    ………………………………………………….do hereby certify that my Son/Daughter Namely
    …………………………………….was studied in class…………………………Sec….………….Roll
    No………………………………………………During the previous academic year……………………………………….in
    …………………………………………………………………………………….school.

    In the event of any change in the particulars given above which affect my eligibility for
    Children Education Allowance. I undertake to intimate the same promptly and refund
    excess payment, if any made to me.

    PLACE:-
    DATE :- Signature

    NAME:-
    F/NO:-
    RANK:-
    UNIT:-
    Authority vide Government of India
    Ministry of personnel, P.G and Pensions Department of Personal & Training New Delhi,
    Order No. No.A-27012/02/2017-Estt.(AL)16 August,2017.
    (This order shall be effective from 1st july , 2017)

    CERTIFICATE FROM THE HEAD OF INSTITUTION/SCHOOL


    (FOR REIMBURSEMENT OF CEA)
    Ref. No. Date:-

    It is certified that master/Kumari ………………………………………………………………….having

    admission No………………………………D.O.B…………………………………...…..Son/Daughter

    of Mr/Mrs…………………………………………………………………………………………………………..was

    studying in class…………………sec ………..…..Roll No…………..………........during the previous

    academic year from …………………………..to………………………………………school/institution,

    namely…………………………………………………………………………………........vide affiliation regd.

    No./Code……………………………………..and pattern…………………………….………….curriculum.

    Place :-
    Date :-

    Signature of Principal
    (Affix School Stamp)

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