You are on page 1of 3

tter head the It

Addr esp should b'e written cleaflu-\

, PROFORNf,

It is certified that MasterlBab'y/Kum... '!':""" j,"""':i"'

,Has Studied in Class'.."...."..' ..See"'""':"' 'during the previous


academic year From ....to .......... ...in this schoor/rnstitution

whichisr:egisteredandAffiliatedvideReg.No....,.

During the year Master/Baby/Mr.Ms""""""""","'


and paid an
has Resided in the residential Complex (Hostel) of the school

amount of Rs.........:.'.'...'.' ..'..(Rupess" " " " :'

towards Boarding and Lodging in the residential complex.

(strike out if it is not applicable)

fSe-al_l
I with I

i oate I

Signature:of the Head of the


-
lnstitutionlSchool.
c.

\
s.R. EDUCAT

Ref: Railway Board's letter No.E{w) z}1TlED.zl3 dated lz.l0.z01t


(RtsE N0.147i2017& pBC N0_191/2017)

1 Name of the employee

t, Employee F,f No & Designation

Bill Unit & $tation of the eniployee


4. Farticulars of Children chitd.l chitd.2
Name of ihe Student

Date of Birth
Class in which studied-in the
Previous Academic year

Name of the $chool


and Address:

Education Allowancel
:

Nature of claim: I I
Education Allowance
(Tick whichever is applicable) Hostel Subsidy I
-.-:-:.--r
i Hostelsubsidy
Ulgb_Eg__chi! i i
Disabled Child

5(a)
eXIffen Education Allow
Whether Bonafide certificate from I;i iY.Sl-*-r
i.-_+-_.r
school is enclosed (Yes/No) nl_-1 *Ig.- -:
OR
Hostel Subsidy:
E'l --l
5(b)
Whenever Bonafide certificate fror
lY';'l--_t
school mentioning the amount of
expenditure is enclosed.(Yes/N0) - bil:_l
Certified thaU (Tick which euer is applicable)

tses is claimed
is/arewholly depended upon me.

i] &ly $pduse is not a CentralGovernment Employee.

|] My Spouse is a Central Govt, Employee and that helshe will not claim reimbursemenl of educaiion
expenses in respect of oer WardAtVards.

n Mychild/children inrespectofwhomreimbursement isclaimedislarestudyinginrecognizedschool.

t. I hereby declar:e that reimbursement of ChildrEn Education Altowance has not been ctaimed in respect of the
child lchildren by a person other than me.

2. I hereby declare that reimbursement of Children Education expense$ is clairned for my eldest two surviving
children only

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

{$ignature of the emPloYee}

Signature of the forwarding Official


Erlcic:;:: re for-Chl ldrens Ed ucat;o n Al i orva n ce.
'' lt is iurther declared that ihe chikl i Children mentioned atrove is / ai-e my eldesi
sunring child / chiidreri only. This nrll prove according to ttre order ol DOB inclicated in the
Famiiy Ccmposition for ihe privilege pass Account I am aware that my claim is permissible
only fcr the [w'o eldesi surviving child / children only. I have not witliully sugrpiessed or
rnisrepresented any facts on this aspect"_

Signature o-f tlre employee

FAhlrLY |{EHBERS PARTICULARS

! declare that the folloning members particulars given by me are true and correct up to the
best of my knor.rledge, if any false declaration DAR action may be initiated against me

The tibove particulars suknitted in c.onnrrction with Reimbursement of


Chitd fen Education Allowance

Signature Of the Employee

Narne:...

PF No:..
Fcirvarded to:

Certified that the above Particulars submitted by the employee are veritied"
and feund correct.

Signatute of the Supervisory fficial


Concerned--
Name & Design