Professional Documents
Culture Documents
, PROFORNf,
whichisr:egisteredandAffiliatedvideReg.No....,.
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s.R. EDUCAT
Date of Birth
Class in which studied-in the
Previous Academic year
Education Allowancel
:
Nature of claim: I I
Education Allowance
(Tick whichever is applicable) Hostel Subsidy I
-.-:-:.--r
i Hostelsubsidy
Ulgb_Eg__chi! i i
Disabled Child
5(a)
eXIffen Education Allow
Whether Bonafide certificate from I;i iY.Sl-*-r
i.-_+-_.r
school is enclosed (Yes/No) nl_-1 *Ig.- -:
OR
Hostel Subsidy:
E'l --l
5(b)
Whenever Bonafide certificate fror
lY';'l--_t
school mentioning the amount of
expenditure is enclosed.(Yes/N0) - bil:_l
Certified thaU (Tick which euer is applicable)
tses is claimed
is/arewholly depended upon me.
|] My Spouse is a Central Govt, Employee and that helshe will not claim reimbursemenl of educaiion
expenses in respect of oer WardAtVards.
t. I hereby declar:e that reimbursement of ChildrEn Education Altowance has not been ctaimed in respect of the
child lchildren by a person other than me.
2. I hereby declare that reimbursement of Children Education expense$ is clairned for my eldest two surviving
children only
Ihereby declare that the particulars mentioned above are correct to the best of my knowledge. lf any information furnished
above is not correct, I am liable to be taken up under D&AR.
! declare that the folloning members particulars given by me are true and correct up to the
best of my knor.rledge, if any false declaration DAR action may be initiated against me
Narne:...
PF No:..
Fcirvarded to:
Certified that the above Particulars submitted by the employee are veritied"
and feund correct.