7th CPC Children Education Allowance: Guidelines and Sample of Claim Form, School Certificate Form, Self Declaration Form

CEA : Proforma for reimbursement 

PROFORMA FOR RE-IMBURESMENT OF CHILDREN EDUCATION ALLOWANCE

I hereby apply for the reimbursement of Children Education Allowance /
Hostel-Subsidy for

my child / children and relevant particulars are furnished below:- 

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.

(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.

(Signature of Govt Servant)

Name: ……………………………

Rank : ……………………………

P.No.: ……………………………

II

COUNTERSIGNED

Authority vide Government of India Ministry of Personal P.G and
Department of Personal &Training New Delhi Order No.
A-27102[02[2017-Estt. (AL) 16 August 2017

(This order shall be effective from 01 Jul 2017)

CERTIFICATE FROM THE HEAD OF INSTITUTION / SCHOOL

(FOR REIMBURSMENT CEA)

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 2017 to 2018 School / Institution, namely
____________________________________________________________vide
affiliation Regd No. /

Code ______________________________ and pattern ____________________
Curriculum.

Signature of principal

(Affix School Stamp) 

CEA : Self Declaration to be submitted by the Govt. Servant

SELF DECLARATION

 

I Service No. _____________ Rank ________________ Name
______________________________

of Unit ICGS Samarth do hereby certify that my Son
/ Daughter namely_________________________________ Studied
in Class ________ Sec _______________ Roll No.__________________ during
Previous Academic Year 2017-2018 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.

Signature of Govt Servant

Name: ____________________

Rank: _____________________

P.No. _____________________