CERTIFICATE TO BE OBTAINED FROM THE HEAD OF THE EDUCATIONAL INSTITUTION /

SCHOOL IN WHICH THE CHILD / CHILDREN OF THE GOVT EMPLOYEES IS / ARE STUDYING
Certified that Master/Kum ___________________________ S/O, D/O Shri__________________
____________________ is a bonafide regular student of class _______________ (Class to be indicated in
figures as well as in words ) of this School / Collage _________________________________________
(Name of institution with complete postal address ) during the current Academic session ___________ which
starts from __________ and finishing on _____________ (Complete date i.e. Day/Month/Year be given).
2. Master /Kumari ______________________ S/O, D/O Shri _______________________________
whose date of birth is _____________ (DOB be given in figure as per School Record) joined class _____
(Name of class) on _________ (exact date on which student joined the class) during the ________ (Session).
3. The following charges have been / are being paid by the child:-
S/ Details of charges paid/ to be paid Amount paid per Period for which Total amount paid/
No. by the student during the current month /per Qtr/ amount paid / will be paid by the
academic session. Half Yearly/ being paid From student during the
Annual basis ______ To _____ current academic
session.
1 Admission Fee
2. Tuition Fee
3. Laboratory Fee
4. Spl fee charged for
(Agriculture/electronics/Music or
any other subject)
5. Fee Charged for Practical Work
under the programme of work
experience
6. Fee paid for the use of any aid or
appliance by the Child.
7. Library Fee
8. Games / Sports Fee
9. Fee for extra curricular activities
10. Cost of Books & Note Books
(Restricted to one set)
11. Cost of uniforms (Restd to 02 sets)
12. Cost of School Shoes (Restd to one
set)
4. Whether School/Institution is recognized by State Govt or Central Govt if so state the following:
a) Recognition No. ___________________ Date _______________
b) Issuing authority ________________________________________________
(Not applicable in case Central or State Govt or Central School)
5. Date of admission of the student in the present School _______________________________
6. Certified that the above information is correct and as per records of this School/Institution.

Date :- Signature of the Head Master/

Place :- Principal School / Institution

Note :-
1. Certificate must be signed by the head of the School/Institution i.e. Head Master/Principal.
2. Score which in not applicable.
 APPLICATION FOR RE-IMBURSEMENT ITEMS ADMISSIBLE UNDER NEW CHILDREN EDUCATION
ALLOWANCE SCHEME INTRODUCED IN 6TH PAY COMMISSION
Certified that my, child / children mentioned below in respect whom children’s education allowance under new
scheme is / are claimed are wholly dependent upon me:-
Name of the Child / Children D.O.B. School / Collage in Class in which
which studying location the child is
thereof and residence of studying
the child
(1) (2) (3) (4)

Name of item applied for re-imbursement Period for which Cash Memo / Receipt Amount
amount is being No. & Date claimed
claimed
(5) (6) (7) (8)
Admission Fee
Tuition Fee
Laboratory Fee
Spl fee charged for (Agriculture / electronics /
Music or any other subject)
Fee charged for Practical Work under the
programme of work experience
Fee paid for the use of any aid or appliance by the
child
Library fee
Games / Sports fee
Fee for extra curricular activities
Cost of Books & Note Books (Restd to one set)
Cost of uniforms (Restd to two sets)
Cost of School Shoes (Restd to one set)
Note :- Items shown in column 05 can be re-imbursed under Children Education Allowance Scheme.
Original Money Receipt and Cash Memo should be attached with the application. Annual ceiling fixed for
reimbursement of CEA is Rs. 12,000/- in a academic session per child and restricted to 02 child from Nursery Class to
XII Class.
2. Certified that my child / children in respect of whom children’s education allowance is claimed under new CEA
Scheme is / are studying in the School mentioned in Column 3 which is / are recognized school (s).College (not
applicable to school run by Central Govt/State Govt/ Union Territory administration / Municipal corporation /
Municipal Committee / Panchayat Samiti / Zila Parishad).
3. Certified that:-
(i) My wife /husband is not in Central Govt. Servant.
(ii) My wife / husband is Central Government servant and that she / he will not claim children’s
educational allowance in r/o our child or children.
(iii) My wife / husband is employed with ____________________ She / He is not entitled to
children’s education allowance in r/o our child / children.
4. Certified that during the period covered by the claim the child / 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. 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 to refund excess payments, if any made.
Strike out whatever is not applicable

Date :- Signature of Govt Servent

Name _____________________
Place of Posting :- Regtl No. __________ Rank ____
Unit _______________________