Annexure ‘B’
Lucknow Division
Northern Railway
APPLICATION FOR REIMBURSEMENT OF CHILDREN EDUCATION ALLOWANCE / HOSTEL SUBSIDY FOR THE
ACADEMIC YEAR – 2024- 2025
Ref.: Railway Board Letter No. E (W) 2017/ED-2/3 Dated 12/10/2017 (RBE No. 147/2017)
1. NAME OF THE EMPLOYEE :
2. EMPLOYEE NO. & DESIGNATION :
3. PAY BILL UNIT NO./OFFICE :
4. NAME OF SPOUSE :
5. B.U. & Designation of Spouse :
Not applicable
If employed in Railways.
6. PARTICULARS OF CHILDREN : CHILD-1 CHILD-2
NAME OF THE STUDENT :
DATE OF BIRTH & CLASS :
NAME OF THE SCHOOL AND :
ADDRESS
NATURE OF CLAIM: (Tick :
Education Allowance Education Allowance
whichever is applicable)
7. Whether Bonafide Certificate :
from school is enclosed
8. HOSTEL SUBSIDY: :
Whether Bonafide Certificate
from school mentioning the Not applicable
amount of expenditure is
enclosed
9. AMOUNT CLAIMED :
TOTAL (Child-1 & Child-2) : Rs.
Certified that:
1. I have ____ alive children as per Pass Declaration whose name and date of birth are:-
A. Name ________________________ DOB __________ B. Name _______________ DOB / /
(Son / Daughter) (Son / Daughter)
2. My child / children mentioned above in respect of whom reimbursement of education expenses is claimed is
/ are wholly depended upon me.
3. My wife/husband is not a Central Government Employee.
4. My wife / husband is a Central Government Employee and that she / he will not claim reimbursement of
education expenses in respect of our child/children.
5. My child / children in respect of whom reimbursement is claimed is / are studying in recognized school.
6. (i) I hereby declare that reimbursement of Children Education Allowance has not been claimed in respect of
the child / children by a person other than me.
(ii) I hereby declare that reimbursement of Children Education expenses is claimed for my eldest two
surviving children only.
(iii) I hereby declare that the particulars mentioned above are correct to the best of my knowledge. If any
information furnished above is not correct, I am liable to be taken up under D&AR.
Signature of the controlling Signature of the forwarding official Signature of the Applicant
Officer with seal with date & Seal.
(Ref.: RBE NO. 147/2017 PC-VII No. 68 Dt. 12-10-2017)
CERTIFICATE FROM THE HEAD OF INSTITUTION/SCHOOL
(FOR REIMBURSEMENT OF CEA)
It is certified that ………………………… having, Admission No. ……. D.O.B.
………. Son/Daughter of Mr./Mrs. ………………………………………………..is a bonafide student of
this School and studied in Class Sec. Roll No……. during the previous
academic year from 1st April 24 to 31st March 25 School, namely
……………………………………………………………………………………………. vide affiliation Regd.
No. / Code ………….. and Pattern ………curriculum.
During the year Master / Kumari ______NA_________ has resided in the
residential complex (Hostel) of the school and paid an amount of `
_____NA_______/- towards boarding and lodging in the residential complex.
Place: VARANASI
Date: __ / ___ / 2025 Signature of Principal
(Affix School Stamp)
❖ Strike out whichever is not applicable.
