APPLICATION FOR REIMBURSEMENT OF TUTION FEE Sl No Name of Child/Children Date of School in Birth which studying Monthly tution fee

actually payable. Tuition fee actually paid from

Form 2 Amount of reimbursement claimed

1. Certified that the child/children mentioned above in respect of whom reimbursement of tution fee is claimed is/are wholly dependent upon me.

2. Certified that the tution fee indicated against the child /each of the children had actually been paid by me vide certificate(s) from the institution(s) attached.

3. Certified that:(i) My wife/husband is not a central government servant.

(ii) My wife/husband is a Central Govt Servant and her/his pay does not exceed Rs.. p.m,but she/he will not respect of our child /children and claim reimbursement of tution fee in

(iii)

My

wife/husband

is is not

employed entitled to

with..She/he

reimbursement of tution fees in respect of our child/childrenEmployer other than Ventral Govt to be mentioned.

4. Certified that the child/children mentioned has/have not been studying in the same class for more than two years.

5. Certified that I or my wife/husband have/has not claimed and will not claim the childrens educational allowance in respect of the child /children mentioned above.

6.In the event of any change in the particulars given which above which affect my eligibility for reimbursement of tution fees,I undertake to intimate the same promptly and also to refund excess payments, if any ,made.

Signature of the Govt.Servent: Name in Block Letters: Designation & Office:

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