I, Sh./Smt. working as in the department/office of requested to reimburse the Education Allowance of my child.
It is certified that :
1. My son/daughter date of birth Aged years (5 to 20 years) is a student of class (Nursery to 10+2) in the school which is aided/approved by Haryana/Central Govt.
2. I have actually incurred an expenditure of more than Rs. 750/- p.m. for his/her tuition fee and other related expenditure (books, uniform, school shoes etc.) for his/her education during the months of in the academic year of .
3 My wife/husband is not working in any State/Central Govt. Deptt./Organization Wholly/partially owned/controlled by State/Central Govt. extending the scheme of Education Allowance.
Sanctioned
HOD
Signature____________________
Name
Designation