CLAIM FORM FOR C.E.

A : Army officers

CDA (O) A/C NO 111/111/11111
Tele : 23016876 111111/ABCD/Acct CDA (O) Golibar Maidan Pune - 1 CEA CLAIM IN R/O IC-11111A COL ABCD : FWD OF CDA (O) A/C NO 11/111/111111 1. Form I on account of Children Educational Allowance in respect of IC11111A Col ABCD (CDA (O) A/C No 11/111/11111), of unit ABCD for the period from 01 Sep 08 to 31 Mar 09 for Rs 14,000/- (Rupees fourteen thousand only) along with original School fees for the following children are forwarded herewith :Unit Address Feb 2009

(a) 7000/(b) 7000/-

Master ABC Miss XYZ

- 01 Sep 08 to 31 Mar 09 - 01 Sep 08 to 31 Mar 09 Total

- Rs - Rs - Rs

14,000/2. You are requested to remit the amount to the Officer’s Bankers at the earliest :AXIS BANK LTD SB A/C No: 000000000000

(ABCD) Col Enclosures : Allowance. 1. Form I - Proforma for Claiming Children Educational

2. Original Fees paid receipts ( Three sheets each for the period Jul – Sep 08, Oct – Dec 08 and Jan – Mar 09) of Army Public School,

Form-1

PROFORMA FOR CLAIMING CHILDREN'S EDUCATIONAL ALLOWANCE
1. Certified that my child/children mentioned below in respect of whom children educational allowance is claimed are wholly dependent upon me and I are staying with me at my present place of my posting/residence. School/College The place in which where the studying location Date of Birth Govt. thereof and servant is residence of the residing child
2 3 4

Name of child

Class in which the child is studying
5 IX

Monthly educational allowance admissible
6 Rs 1000/-

Amount of allowance claimed for the period from 01 Sept 08 to 31 Mar 09 ( 7 Months)
7

1 ABC

11 JAN 1111 ARMY PUBLIC NEW SCHOOL, DELHI

Rs 7000/-

ARMY PUBLIC

XYZ

22 FEB 2222 SCHOOL

NEW DELHI

III

Rs 1000/-

Rs7000/Total- Rs 14000/-

2. Certified that my child/children in respect of whom children's educational allowance is claimed is / are studying in the schools mentioned in column (3) which is/are recognised school(s) (Not applicable to schools run by Central / Government / State Government /Union Territory Administration / Municipal Corporation / Municipal Committee / Panchayat Samiti / Zilla Parishad).

3. Certified that :
(a) My wife is not a Central Government servant. (b)My wife is a Central Government servant and that she/ he will not claim children's educational allowance in respect of our child/children. (c)My wife is employed with _______________ (*) She is not entitled to Children's Educational Allowance in respect of our child/children. 4. Certified that during the period covered by the claim the children attended the school regularly and did not absent himself /herself /themselves from the school without proper leave for a period exceeding one month. 5. Certified that children have not been studying in the same class for more than two academic years. 6. Certified that the allowance for the period has been claimed for the first time and the amount claimed has been actually expended by me for fees etc of the school. 7. In the event of any change in the particulars given above which affect my eligibility for children's educational allowance, I undertake to intimate the same promptly and also refund excess payments, if any made. (Signature of the Government Servant) Name in block letters Designation & office UNIT ADDRESS Date FEB 2009 COL ABCD

Place of Posting

(strike out whatever is not applicable) * Employer other than Central Government to be mentioned.

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