V.P-15,000/1-2000
1. Name of the child _________________________ 2. Date of last claim____________
3. Period for which reimbursed was 4. Period to which claim
Claimed______________________ pertains.__________________
|
No. |
Name of the Child |
School in which studying (State or a Govt. added School). |
Class for which claim preferred |
Class in which studying |
Monthly tuition fee paid actually (receipts attached) |
Amt.of Govt. Scholarship if any. |
Amt. Of Scholarship sources |
Amt of reimbursement claimed (to Restricted fees as by the authority) |
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
|
|
|
|
|
|
|
|
|
|
Certified that my child/ children mentioned above in respect of whom reimbursement of tuition fees is/are studying in the school mentioned in column 3 Which is /are recognized school and the tuition fees Indicated against which have actually been paid me.
Certified that my wife/husband is not in the Govt. Service and that n imbursement would have claimed by her/him and also the pay drawn by her/him does not exceed Rs. 1200/- p.m (Pre-revised).
My wife/husband is employed with ___________________________________ She/He is note entitled to reimbursement of tuition fees in respect of children. She/He is entitled to reimbursement of tuition fees in respects of children as follows:-
(2)
Certified that I have not claimed and will not claim to children educational allowance under the Ministry of Finance, O.M. No. 10 (H). Estt. (Spl.,)/ 60 dt. 30.1.60 & 30.1.62 in respect of the children mentioned over-leaf (Strike out if not applicable).
Dated__________________________ SIGNATURE OF GOVT. SERVANT
Name__________________________
Designation_____________________
Branch/Deptt.____________________
VERIFICATION FROM SCHOOL AUTHORITIES:
1.
Name of the
School :_______________________________________
2.
Certified
that __________________son/daughter of Shri_________________ is a bonafied
student of class________ of this School. Certified that he/she has not been
studying for more than two academic Years in this class.________.
3.
Certified
that He/She is mot in receipt of Govt. or non-Govt, Scholarship
4.
Certified
that this is recognized school under the Directorate of Education,
5.
Certified
that _____________________-son/daughter of Shri________________________ has
paid tuition fee/science fee at the rate of Rs._____________________/- &
Rs. ______________________________/- pm. respectively for class_________for the
period w.e.f
N.B.: (The certificate without stamp of the school be considered as
invalid certificate)
PRINCIPAL OF THE SCHOOL