You are on page 1of 6

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 Maidan
Pune - 1

CEA CLAIM IN R/O IC-11111A COL ABCD : FWD OF


CDA (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 LTD


SB 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.
School/College
The place
in which Class in Monthly Amount of allowance
where the
Name of studying location which the educational claimed for the period
Date of Birth Govt.
child thereof and child is allowance from 01 Sept 08 to 31
servant is
residence of the studying admissible Mar 09 ( 7 Months)
residing
child

1 2 3 4 5 6 7

ABC 11 JAN 1111 ARMY PUBLIC NEW IX Rs 1000/-


SCHOOL, DELHI
Rs 7000/-

ARMY PUBLIC
XYZ
22 FEB 2222 SCHOOL NEW III Rs 1000/- Rs7000/-
DELHI

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.

You might also like