SELF DECLARATION FOR REIMBURSMENT OF CHILDREN EDUCATION ALLOWANCE (CEA)

SELF DECLARATION FOR REIMBURSEMENT OF CHILDREN EDUCATION ALLOWANCE (CEA)

In accordance with relevant Govt. Finance Department OMs (Haryana Govt. Ref: 4/5/2009-5FR dt. 18/6/2009 and subsequent clarifications).

I. General Employee Details

Name:

Designation:

Name of Working Place/Station:

Date of last claim:

Period for which reimbursement was claimed:

Period to which present claim pertains:

II. Particulars of Children (Max 2 Children)

Sr. No.	Particulars	Particulars of 1st Child	Particulars of 2nd Child

Total Amount Claimed (INR)

Detail of Present Claim (In Words)

III. Certificate / Spouse Declaration

1. I certify that my child/children mentioned at S No 1 of the table in respect of whom reimbursement is claimed is/are studying in the school mentioned at SNO 3 of the table in respect and the reimbursement claimed S No 5 of the table have actually been paid by me.

2. Spouse Employment Status My wife / husband is not a Govt. servant. My wife / husband is in Govt. service and no reimbursement has been claimed & would be claimed in future by her/him. My wife/husband is employed with an organization (not entitled to CEA). My spouse is in Govt. Service and has claimed/will claim reimbursement. (Not Recommended)

Spouse's Department / Organization

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