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From 1 to AO 15/90


1. Certify that my child ShnV Kumari ______________________ .(Name of the student) ,

is studying in _________________________________________ (Name of School)
was admitted to hostel of the school on_____________________ (Certificate from the
Head of the School attached)

2. Certified that-

(a) My wife/husband is / is not a Govt service, is / is not drawing hostel subsidy in respect of
my child/ children

(b) The total number of children in respect of whom the Hostel Subsidy and children's
educational allowance have been claimed does not exceed three
(c) The child or children in respect of whom the Hostel Subsidy is claimed is / is not in receipt
of Scholarship which covers the Hostel expenses

(d) I undertake to inform my Employer forthwith in the event of my withdrawing the child
from the hostel and also in the event of there being any change in the particulars mentioned

(e) I undertake to produce the receipt for the payment of the Hostel Charges
at the time of preferring my initial claim and thereafter in the month of
________________ & _____________________ every year


Signature of the Claimant

Name in Block letters
Designation & Office
From 5 to AO 15/90


...................................... School/College

(Name of the School and place) (Particulars of

boarders admitted to the Hostel)

1 Name of Boarder __________ '_: __________ [ ______________________

2. Name of Parent ________________________________________________

3. Class to which admitted _________________________________________

4. Class in which now studying ________ - _________: __________________

5 Date of admission in the Hostel _________________________________

6 Period during the year for which the child or children to stay in the hostel

From ____________________ • to, _______________ . ______________ ■



7 The vacation of the school is from _____________________ to________________

and Hostel Charges of Rs _____________________ have been received for this period

Signature of Principal/Headmaster
Seal of the School

From 3 to AO 15/90


1. This is to certify that Shn/Kumari ________________________________________

(Name of the student) Son/Daughter of _____________ ' ____________________
(Name of the Government servant) (Regimental No. Rank and Unit) and employee of
the Ministry/Office of ________________________ is studying in
______________________________ (Name of School) in Primary/ Secondary/
Secondary Class __________________ . (Class and / Section) ________
since ______________________ (Date of joining the School) His/her date of birth
according to
the school record is ________________________ .
2. Certified that this school is recognized by the Education Department /Education
authorities of the state of __________________________ .

(Principal/Head of School)
Seal of the School
Fnrm 4 to AO 5/90

__________________________________School/ College

(Name and location of the institution)

X Certified that she/kumari __________________Son/daughter of

shri/Smt______________________________________ passed out from
class_________________________________ He /She had paid tuition
fee for the period from_____________________________ to as per details
given below -
1. Tuition fee
2. Science fee
3. Music fee
X Certified that she/kumari __________________ is at present a student of
class_______________ since _______________________and paid tuition fee for the period
for Apr ___________to Jul__________________ as per details given bellow.
1. Tuition fee
2. Science
3. Music fee
X Certified that this is a School/college run by central Govt./state Govt./ union territory
Administration/ Municipal corporation/ Municipal committee/ Panchayat Samiti /Zilla Parisad.
Certified that this is a School/college recognized by the educational authority of
_______________________________ State/ Union territory Administration.

Principal/ Headmaster/Headmistress
Date (stamp of institution)
X Strike out whatever is not applicable
Note : Certificate from the head of the institute should be furnished in the month of
___________ and _____________ every year covering the periods as shown below.

Month of the Certificate Period to be covered by the Certificate

Fnrm 5 to AO 5/90