CEFA Form for GDS

PROFORMA FOR RE-IMBURSEMENT OF CHILDREN EDUCATION FACILITATION ALLOWANCE

Employee Information

CLAIM FOR THE FINANCIAL YEAR:

I hereby apply for the reimbursement of Children Education Facilitation Allowance for my child/children and relevant particulars are furnished below:

1. Name of the Employee
2. Employee Code/UID
3. Category/Post
4. Office
5. Residential Address of the Employee
6. Name of Spouse
7. If spouse is employed, State whether in Central Government, State Government, Public Sector Undertaking. (Give Details)
8. Designation, Office & Employee code Number of spouse, if spouse is employed in Department of Posts.
9. Intimate as to whether Reimbursement of CEFA/CEA/Hostel Subsidy is admissible in the Department in which the spouse is working
10. If so, whether Joint Declaration for not claiming the amount from that Department is submitted.

11. Details of all the children of the Gramin Dak Sevaks:

Sl. No.	Sequence	Name of the Child	Date of Birth	Age
1.	1st Child
2.	2nd Child
3.	3rd Child

12. Details of the children for whom CEFA is claimed:

Sl. No.	Sequence	Name	DOB	Age
1.
2.
3.

13. Academic year, Name of School/Residential School and Class in which children studied:

Details	1st Child	2nd Child	3rd Child
Name of the Child
Name of School/residential School and address
Class in which the child studied in last year

14. Academic year for which CEFA is applied for now.

15. Disability Information (if applicable)

(a) Whether the child for whom the CEFA is applied for is a disabled child: Select Yes No

(b) If yes, indicate the nature of disability:

(c) Date of disability certificate:

(d) Indicate the percentage of disability:

16. Whether the Bonafide certificate from Head of Institution is attached: Select Yes No