Reimbursement of Tuition
Fees
Certified that the children mentioned below in respect of whom reimbursement of
tuition fees is claimed is / are wholly dependent on me and is reading in
recognized institution.
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Name of the Child
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Date of Birth
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School in which studying
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Class in which studying
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Monthly tuition fees actually payable
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Tuition actually paid from
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Amount of Reimbursement claimed
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1
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2
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3
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4
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5
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6
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7
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Certified that the tuition fees indicated against the child / each of the
children & actually been paid by me (Cash receipt / counterfoils of the
bank credit vouchers to be attached with the initial claim).
Certified that:-
I. My wife / husband is
not a central govt. servant.
II.
My wife / husband is a central govt. servant, but she or he will not claim
reimbursement of tuition fee in respect of our child / children.
III.
My wife / husband is employed with _______________. She / he is not entitled to
reimbursement of tuition fees in respect of our child / children.
Certified that during the period covered by this claim the child / children
attended the school (s) regularly and did not absent himself / herself from the
school(s) without proper leave for a period exceeding one month.
Certified that I/my wife/husband have/has not claimed and will not claim the
children’s educational allowance in respect of the children mentioned above.
Certified that my child/children in respect of whom reimbursement of tuition
fees is claimed is/are studying in the school which is/are recognized school
(not applicable to schools run by state/central govt./union territory
admn./municipal corp./municipal committees/Panchayat Samiti/Zilla Parishad).
In the event of any change is the particulars above which effect my eligibility
for reimbursement of tuition fees I undertake to intimate the same promptly and
also to refund excess payment if any made.
Enclosure: - As above
all original receipt
Signature of the Government Servant
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