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Proforma For Re-Imbursement of Children Education Allowance/Hostel Subsidy For The Academic Year:-2022-2023

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sirohimanojkumar1981
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186 views

Proforma For Re-Imbursement of Children Education Allowance/Hostel Subsidy For The Academic Year:-2022-2023

Uploaded by

sirohimanojkumar1981
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Annexure ‘A’

PROFORMA FOR RE-IMBURSEMENT OF CHILDREN EDUCATION


ALLOWANCE/HOSTEL SUBSIDY FOR THE ACADEMIC YEAR:-2022-2023

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 : Manoj Kumar


2 P.F. No./Employee No. :
3 Designation : Senior Accountant
4 Present Department/Office : Telecommunication
5 Name of Spouse : Sheetal Sirohi
6 If spouse is employed, State :
whether in Central Govt., PSU,
State Govt. (give details) NA
7 Name, Designation and Office :
address of the Spouse. NA
8. Details of the children for whom CEA/Hostel Subsidy claimed:

Sl. Sequence Name DOB Age


No.
1 1ST Child Shivank Sirohi 25.07.2012 12 Years
2 2nd Child Vaibhavi Sirohi 27.06.2014 10 Years
9. Name of School / Residential School and Class in which children studied:

1st Child. 2nd Child


Army Public School, Army Public School,
Sunjwan, Sunjwan,
10. Jammu. Jammu.

Class 6Th Class 4th

Distance of Hostel of child from residence of employee (in case Hostel Subsidy is
claimed) ___ NA _________.

11. The Academic year for which CEA /Hostel Subsidy is applied now: 2023-24

12. (a) Whether the child for whom the CEA is applied for is a disabled child: …..NO

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

(c) Date of disability certificate. …………………NA

(d) Indicate the percentage of disability…….NA


13. Whether the bonafide certificate from Head of Institution has been attached Yes.

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………………. NA

16. (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:…………NA……… is presently working


as : ……NA ……… in …………………NA……………………….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.

17. 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.

18. 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: Manoj Kumar
Design: SA
Date: 08-04-2023

The details of child/children for whom the present claim is submitted by the official has
been verified from the official records and found correct.

Signature of Administrative Authority

with office stamp.


Authority vide Government of India,
Ministry of Personnel, P.G. and Pension Department of Personnel & Training,
New Delhi,
Order No. A-27012/02/2017-Estt. (AL) 16 August 2016
(This order shall be take effective from 1st July 2017)

CERTIFICATE FROM THE HEAD OF THE INSTITUTION/SCHOOL


(For reimbursement of CEA)
Ref No.
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 School Principal

(Affix School Stamp)


Authority vide Government of India,
Ministry of Personnel, P.G. and Pension Department of Personnel & Training,
New Delhi,
Order No. A-27012/02/2017-Estt.(AL) 16 August 2016
(This order shall be taken effective from 1st July 2017)

CERTIFICATE FROM THE HEAD OF THE INSTITUTION/SCHOOL


(For reimbursement of CEA)
Ref No.

It is certified that Master Shivank Sirohi, having Admission No. 1829, D.O.B. 25 Jul

2012, Son of Mr. Manoj Kumar was studying in Class 6th, Sec B, Roll No. 16, during the

previous academic year from 2023 to 2024. School / Institution Namely APS

SUNJUWAN vide affiliation Regd. No. / Code 780023 and pattern CBSE curriculum.

Place:- Jammu
Date:- Signature of School Principal

(Affix School Stamp)


Authority vide Government of India,
Ministry of Personnel, P.G. and Pension Department of Personnel & Training,
New Delhi,
Order No. A-27012/02/2017-Estt.(AL) 16 August 2016
(This order shall be taken effective from 1st July 2017)

CERTIFICATE FROM THE HEAD OF THE INSTITUTION/SCHOOL


(For reimbursement of CEA)
Ref No.

It is certified that Kumari Vaibhavi Sirohi having Admission No. 1830, D.O.B. 27 Jun

2014, Daughter of Mr. Manoj Kumar was studying in Class 4th, Sec B, Roll No. 12

during the previous Academic year from 2023 to 2024. School / Institution Namely APS

SUNJUWAN vide affiliation Regd. No. / Code 780023 and pattern CBSE curriculum.

Place:- Jammu
Date:- Signature of School Principal

(Affix School Stamp)

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