Education Allowance Application Form

Education Allowance Application Form
Number of Children to Apply for Education Allowance
Name
First NameLast Name
Employee Number
Employment Date
MonthDayYear
Date
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Name of Spouse
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Is the Spouse Employed
Company Name
Address of Company of Spouse
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Employment Date of Spouse
MonthDayYear
Date
Has the spouse successfully availed of the benefit of education allowance with his/her employer?

Child 1 Information
Name of Child
First NameLast Name
Birthdate
MonthDayYear
Date
Gender
Name of School
Address of School
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I hereby declare that my child is attending
Tuition Fee breakdown
Rows Amount
Tuition Fee
Laboratory Fee
Admission Fee
School materials
Books and Notebooks
Miscellaneous Fees
Cost of Uniform (include shoes)
Total Tuition Fee Cost
Please attach photo copy of certificate of registration
Cancelof
Please attach photo copy of receipts if for reimbursement
Cancelof
Please provide information for purpose of your application

Rows	Amount
Tuition Fee
Laboratory Fee
Admission Fee
School materials
Books and Notebooks
Miscellaneous Fees
Cost of Uniform (include shoes)

Child 2 Information
Name of Second Child
First NameLast Name
Birthdate of Second Child
MonthDayYear
Date
Gender of Second Child
Name of School of Second Child
Address of School of Second Child
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I hereby declare that my second child is attending
Tuition Fee breakdown of Second Child
Rows Amount
Tuition Fee
Laboratory Fee
Admission Fee
School materials
Books and Notebooks
Miscellaneous Fees
Cost of Uniform (include shoes)
Total Tuition Fee Cost
Please attach photo copy of certificate of registration of Second Child
Cancelof
Please attach photo copy of receipts if for reimbursement of Second Child
Cancelof
Please provide information for purpose of your application for your Second Child

Rows	Amount
Tuition Fee
Laboratory Fee
Admission Fee
School materials
Books and Notebooks
Miscellaneous Fees
Cost of Uniform (include shoes)

Attestation
I hereby declare that the information provided by me is true and correct to the best of my knowledge. I am aware that any false information provided by me for the availing of the benefit may be treated as misconduct and may disqualify me from further availing of the benefit. I understand that any benefits I have successfully availed of from the offense may cause me to reimburse the company/organization and may hold me liable criminally and civilly under the law.
Signature
Clear
Date
MonthDayYear
Date
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Child 1 Information