CLAIM FORM FOR C.E.A : Army officers

CDA (O) A/C NO 111/111/11111

Tele : 23016876 Unit Address

111111/ABCD/Acct Feb 2009

CDA (O)Golibar MaidanPune - 1

CEA CLAIM IN R/O IC-11111A COL ABCD : FWD OFCDA (O) A/C NO 11/111/111111

1. Form I on account of Children Educational Allowance in respect of IC-11111A 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 :-

(a) Master ABC - 01 Sep 08 to 31 Mar 09 - Rs 7000/-

(b) Miss XYZ - 01 Sep 08 to 31 Mar 09 - Rs 7000/-

Total - Rs 14,000/-

2. You are requested to remit the amount to the Officer’s Bankers at the earliest :-

AXIS BANK LTDSB A/C No: 000000000000

(ABCD)Col

Enclosures : 1. Form I - Proforma for Claiming Children Educational Allowance.

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.

Name of child

Date of Birth

School/College in which studying location thereof and residence of the child

The place where the Govt. servant is residing

Class in which the child is studying

Monthly educational allowance admissible

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

1 2 3 4 5 6 7

ABC

XYZ

11 JAN 1111

22 FEB 2222

ARMY PUBLIC SCHOOL,

ARMY PUBLIC SCHOOL

NEW DELHI

NEW DELHI

IX

III

Rs 1000/-

Rs 1000/-

Rs 7000/-

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 COL ABCD

Designation & office UNIT ADDRESS Date FEB 2009

Place of Posting

(strike out whatever is not applicable)

* Employer other than Central Government to be mentioned.