PROFORMA FOR REIMBURSEMENT

OFCHILDREN EDUCATION
ALLOWANCE

CLAIM FOR THE ACADEMIC YEAR: 2020-21

I hereby apply for the reimbursement of Children Education Allowance for my

child / children and relevant particulars are furnished below:-

1. Name of the Govt. Servant : Shri Bhagwati Prasad B. Sharma

2. Designation : TGT

3. Name of Department Directorate of Education

4. If Spouse is employed, state : Yes

whether inCentral Govt., PSU, State
Govt. (give details with name of the
Spouse)
5. Designation, Office & B.U. No. of : NA
spouse, if spouse is employed in
Railway

6. Details of the child / children for whom CEA / Hostel Subsidy claimed:-
Sequence Name of child DOB Standard Name & Place of
(A.Y.2020-21) the School /
Institution
1 Child Harsh B. Sharma 04/05/2006
st
IX BAPS SVM,Athal
DNH.

7.Re-imbursement ofExpenditure: -

Sequence Period Rate of CEA Amount Remarks

(Rs) claimed

1st Child April-20 to @ 2250/- PM 27000.00 Self-attested copy of

May-21 Certificate of Head of
Institution and Result is
attached herewith

Total amount claimedRs 27,000.00

1
 8 Distance of Hostel of child from residence of employee (in NA
case Hostel Subsidy)
9 Amount of CEA already received up to previous quarter NIL
10 The Academic year for which CEA is applied now 2020-21
11 (a) Whether the child for whom the CEA is applied for is a NO
disabled child
(b) If yes, indicate the nature ofdisability NA
(c) Date of disabilitycertificate NA
(d) Indicate the percentage of disability NA
12 Whether the Bonafide certificate from Head of Institution YES
has been attached
13 For Hostel Subsidy, the Bonafide certificate from NA
mentioning the amount is attached
14 If Yes at Item No. 13, Amount claimed for Hostel Subsidy NA

15 Certified that my wife is a HouseWife

16 Certified that my child in respect of whom re-imbursement of Children

Education Allowance is applied is studying in the School / Jr. College which
is recognized and affiliated to Board of Education /University.

17 Certified that I am claiming the CEA in respect of my one eldest surviving

children only, the information furnished above are complete and correct and
I have not suppressed any relevant information. In the event of any change in
the particulars given above which affect my eligibility for reimbursement of
Children Education Allowance, I undertake to intimate the same promptly
and also to refund excess payments if any made. Further, I am aware that if
at any stage the information / documents furnished above is found to be
false, I am liable for disciplinaryaction.

Date: / /2020
Place:Silvassa
(Signature of GovtServant)

Name: Bhagwati Prasad B. Sharma

Desi. : TGT

2
 Authority vide Government of India Ministry of
PersonalP.G and Department of Personal &Training New
Delhi
Order No. A-27102/02/2017-Estt. (AL) 16 August 2017
(This order shall be effective from 01 Jul 2017)

CERTIFICATE FROM THE HEAD OF INSTITUTION /SCHOOL

(FOR REIMBURSEMENT CEA)

RefNo………………Date: / /2021.

It is certified that Harsh B. Sharma having Admission

No.SL0854D.O.B.04/05/2006Son ofBhagwati Prasad B. Sharma was

studying inClass IX section B Roll No.14 during the previous Academic

Year from 2020 to 2021 School namely BAPS Swaminarayan

VidyaMandir, Athal vide affiliation Reg.No.3030002 and pattern

Central Board Of Secondary Education.

Seal & Signature of Principal

Place:Silvassa.
Date:- / /2021.

3
 Authority vide Government of India Ministry of
PersonalP.G
and Department of Personal &Training New Delhi
Order No. A-27102/02/2017-Estt. (AL) 16 August 2017
(This order shall be effective from 01 Jul 2017)

SELF DECLARATION

I ,Bhagwati Prasad B. Sharma,TGT GHSS(T)HM Silvassa,working

under Directorate of Education, Dadra & NagarHaveli,Silvassa do hereby

certify that my Son Harsh B. SharmaStudied inClass IX Section B Roll No.14

during Previous Academic Year 2020-2021inBAPS Swaminarayan

Vidyamandir,Silvassa.

In the event of any change in the particulars given above which affect

my eligibility for Children Education Allowance. I undertake to intimate the

same promptly and refund excess payment, if any made to me.

Signature of Govt Servant

Name:BhagwatiPrasad Sharma
TGT

Date: / /2021

4
Place:Silvassa.

5
 CERTIFICATE

This is to certify that I have ONE living children and I claimed for MY
children who is wholly dependent upon me.
Certified that
1. My wife is a HouseWife
2. In the event of any change in the particulars given above which effect My
eligibility for reimbursement of Children Education Allowance, I under take
to intimate the same promptly and also to refund excess payments if any
made.

(Bhagwati Prasad B. Sharma)

TGT

.
6
 From: Bhagwati Prasad B. Sharma,
TGT,
GHSS(T)HM, Silvassa.

Date: / /2021

To,
The Director of Education,
Dadra & Nagar Haveli,
Silvassa

Sub:Regarding Reimbursement of Children Education Allowance.

Respected Madam,

Please refer Office Memorandum No.A-27012/02/2017-Esstt.(AL) dated 16th

August, 2017 from Govt.of India Ministry of personal Public Grievance& Pension
(Dept. of Personal & Training) New Delhi regardingReimbursement of Children
Education Allowance. In this connection I am submitting herewith form and
certificate of Head of Institution for the period 2020-21 in respect of my SonHarsh
B. Sharma, studied in std. IX in the year 2020-21 at BAPS Swaminarayan
Vidyamandir,Athal.
Kindly Reimburse the Children Education Allowance as early as possible.

Thanking You.
Yours faithfully

(Bhagwati Prasad B. Sharma)

7
 Encl:
1. Form
2. Certificate of Head of Institution
3. Self-Declaration
Copy respectfully submitted through HM, GHSS T HM, for kind information and
necessary action please.