FORM FOR DECLARATION FOR CHILD/CHILDREN EDUCATION ALLOWANCE

(To be filled by the School Authority)

01 Name of the student

02 Father’s name
03 Name of the School location
(Full address also mentioned.
i.e Post, Distt, State, Pin No.)

04 Whether the School is recognized by

the Govt. of education of Authority of
the jurisdiction in which the School is
situated.
05 Class in which the student is studying
06 Date of promotion to the present
Class
07 Date of Birth of the student
08 Date of Admission in the School
09 Whether the student is getting any
scholarship (if yes mentioned details)
10 Academic year of education
(mentioned date of month & Year
11 Whether the student has been
granted free boarding & lodging in
addition to tuition fee
12 Medium of teaching of Child/Children

Station

Date

Office Seal

Signature with seal

Principal/Headmaster/Head Mistress
FORM FOR RE-IMBURSMENT OF CHILDREN EDUCATION ALLOWANCE SCHEME GOI. NO.A-27012/02/2017-
TH
Estt.(AL) DATED 16.08.2017 (ALLOWANCE) (AS PER 7 CPC 2016)

It is certified that I No.___________________Rank__________Name______________________ claimed re-

imbursement of Children Education Allowance in respect of my following child/Children who is/are wholly dependent
upon me.

Sl Name of child Date of Name of Class in Total amount paid during quarter ending
no birth of the School which From_______________
child studying to_________________

01 a) Admission Fee
b) Tuition fee
c) VVN Fee
d) Exam fee
e) Special/Computer fee
f) Library fee
g) Game/Sports fee
h) Cost of Text book (1set)
i) Note book (01set)
j) Cost of Uniform (1/2)sets
k) Cost of School shoe (1pair)
l) Fee for practical work
m) Fee for Extra curricula activities
G Total

02 a) Admission Fee
b) Tuition fee
c) VVN Fee
d) Exam fee
e) Special/Computer fee
f) Library fee
g) Game/Sports fee
h) Cost of Text book (1set)
i) Note book (01set)
j) Cost of Uniform (1/2)sets
k) Cost of School shoe (1pair)
l) Fee for practical work
m) Fee for Extra curricula activities
G Total
CERTIFICATE

1. Certified that the amount as mentioned above against the name of my child/children actually been paid by me
(Original cash receipt/Counter foil of the bank vourcher is/are enclosed with my signature of its back side).

2. My wife/husband is a Central Govt. Servant but she/he will not claim reimbursement of the same.

3. Certified that my child/children in respect of whom reimbursement of above amount is being claimed is/are studying
regularly in the school mentioned against their names and the School is recognized by _______________________
University or __________________ Board of Education.

4.Certified that S/No. (a to m) has not been claimed earlier during this academic year-2017-18.

5. I undertake that if any above information, which is submitted by me is found false the amount may be recovered from
my salary please.

Signature _______________________________

Name __________________________________

CISF No._________________________________
CISF ASG Dimapur Airport