ANNEXURE - II

RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2013-14 - VERIFICATION FORMAT -I
District:
School Name and Address
No. of Children Admitted in 2013 - 14:
No. of Children Admitted in 2013 - 14 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied / Studying Amount to be

Class If 'Yes' Actual Claimed by the
Name of the Child Father Name admited in Whether Fee Fee Collected School for the
2013-14 collected from Rs. class in 2020-21
the child for the (Refer Fee
SI class in 2020-21? Committee order)
No 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 Yes/No Rs.
1
2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School

3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is made and neccesary certificates
have been received from the parents/schools to this effect.

4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that effect have been obtained
from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in the audit, entire amount will
be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED

District Educational Officer

 ANNEXURE - II
RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2014-15 - VERIFICATION FORMAT -II
District:
School Name and Address
No. of Children Admitted in 2014 - 15:
No. of Children Admitted in 2014 - 15 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied / Studying Amount to be

If 'Yes' Actual Claimed by the
Name of the Child Father Name Class admited
Whether Fee Fee Collected School for the
in 2014-15
collected from Rs. class in 2020-21
the child for the (Refer Fee
class in 2020-21? Committee order)
SI No 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 Yes/No Rs.
1
2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School

3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is made and neccesary certificates
have been received from the parents/schools to this effect.

4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that effect have been obtained
from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in the audit, entire amount
will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED

District Educational Officer

 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2015-16 - VERIFICATION FORMAT -III
District:
School Name and Address
No. of Children Admitted in 2015 - 16:
No. of Children Admitted in 2015 - 16 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied / Studying Amount to be

Class Claimed by the
SI No Name of Child Father Name admited in Whether Fee School for the
2015-16 collected from the class in 2020-21
child for the class (Refer Fee
in 2020-21? If 'Yes' Actual Fee Committee order)
2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 Yes/No Collected Rs. Rs.
1
2
3
4

Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is made
and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that
effect have been obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in
the audit, entire amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED
District Educational Officer
 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2016-17 - VERIFICATION FORMAT -IV
District:
School Name and Address
No. of Children Admitted in 2016 - 17:
No. of Children Admitted in 2016- 17 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class If 'Yes' Actual

SI No Name of Child Father Name admited in Class Studied / Studying Whether Fee Fee Collected Amount to be
2016-17 collected from Rs. Claimed by the
the child for the School for the class in
class in 2020-21? 2020-21 (Refer Fee
2016-17 2017-18 2018-19 2019-20 2020-21 Yes/No Committee order) Rs.
1
2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is made
and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that
effect have been obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in
the audit, entire amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED
District Educational Officer
 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2017-18 - VERIFICATION FORMAT -V
District:
School Name and Address
No. of Children Admitted in 2017 - 18:
No. of Children Admitted in 2017- 18 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied /studying

Class
SI Whether Fee If 'Yes' Actual Fee
Name of Child Father Name admited in
No collected from Collected Rs. Amount to be Claimed by
2017-18
the child for the the School for the class in
class in 2020-21? 2020-21 (Refer Fee
2017-18 2018-19 2019-20 2020-21 Yes/No Committee order) Rs.

2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is
made and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to
that effect have been obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in
the audit, entire amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED
District Educational Officer
 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR -2018-19 - VERIFICATION FORMAT -VI
District:
School Name and Address
No. of Children Admitted in 2018 - 19:
No. of Children Admitted in 2018- 19 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied /studying

Class
SI Whether Fee If 'Yes' Actual Fee
Name of Child Father Name admited in
No collected from Collected Rs. Amount to be Claimed by
2018-19
2018-19 2019-20 2020-21 the child for the the School for the class in
class in 2020-21? 2020-21 (Refer Fee
Yes/No Committee order) Rs.

2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is
made and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to
that effect have been obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in
the audit, entire amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED
District Educational Officer
 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR 2019-20 - VERIFICATION FORMAT -VII
District:
School Name and Address
No. of Children Admitted in 2019-20:
No. of Children Admitted in 2019- 20 and continued in 2020-21
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order

Class Studied /studying

Class
SI Name of Child Father Name admited in Whether Fee If 'Yes' Actual Fee
No collected from Collected Rs. Amount to be Claimed by
2019-20
2019-20 2020-21 the child for the the School for the class in
class in 2020-21? 2020-21 (Refer Fee
Yes/No Committee order) Rs.

2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is
made and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that effect have been
obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in the audit, entire
amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

Supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED
District Educational Officer
 RTE- REIMBURSEMENT CLAIM FOR THE STUDENTS ADMITTED IN THE YEAR 2020-21 - VERIFICATION FORMAT -VIII
District:
School Name and Address
No. of Children Admitted in 2020-21:
* Fee Fixed by the Committee for 2020-21: LKG - UKG: Rs I-V:Rs VI-VIII:Rs.
*If the school has not obained Fee Fixation order for 2020-21, Mention the amount as per 2019-20 fixation order
Class Studied
/studying
Class
SI Whether Fee If 'Yes' Actual Fee
Name of Child Father Name admited in
No collected from Collected Rs. Amount to be Claimed by
2020-21
2020-21 the child for the the School for the class in
class in 2020-21? 2020-21 (Refer Fee
Yes/No Committee order) Rs.

2
3
4
Total
Certificate
1) Certified that the above details are verified with the records and ascertained that the details are true.
2) Certified that the children are actually studying in the School
3) Certified that no fee has been collected on behalf of the children admitted under RTE Act from Parents/ Guardian or from any one for whom the claim is
made and neccesary certificates have been received from the parents/schools to this effect.
4) Certified that the fee collected from the parents on behalf of the children admitted under RTE Act have been refunded to the parents and the certificate to that effect have
been obtained from the parents / schools.
5) Certified that management of the school have given an undertaking that if the reimbursement claim is found to be false or incorrect at any stage or objected in the audit,
entire amount will be refunded to the Government in one lump sum.
6)Certified that the claim made by the management is correct.
RECOMMNDATION OF THE COMMITTEE

supp Resource Teacher Assistant Elementry Educational Officer Headmaster

COUNTER SIGNED

District Educational Officer