Sarkari Dak - Government Tools Portal

CEA Re-imbursement Form - Official 18 Points

CEA RE-IMBURSEMENT FORM (POINTS 1-18)

Basic Details (1-6)

1. Name of Govt. Servant

2. Personal No.

3. Designation

4. Name of Unit/Office

5. Spouse Employment (Central/State/PSU/Name)

6. Spouse Desig/Office/BU No. (If Railway)

7. Details of Children

Child	Name	DOB	Standard	School & Place
1st
2nd

8. Claim Details

Academic Year

Rate of CEA (Rs.)

1st Child Amt

2nd Child Amt

Other Info (9-15)

9. Hostel Distance (KM)

10. Prev Amt Received

12. Child Disabled?

Disability Details (Nature/Date/%)

13. Bonafide Attached?

15. Hostel Amt Claimed

Declaration (16-18)

16. Spouse Name (Sri/Smt)

Spouse Working As (Designation/Office)