Officer's full name
Child's name
Date of birth
CLAIM FOR ARREARS OF BOARDING SCHOOL ALLOWANCE
(See Notes overleaf BEFORE completing this Form. This Form must be completed in TRIPLICATE
and in BLOCK CAPITALS)
SECTION I - OFFICER
APPENDIX V
Rank/Grade :
Department :
1. From school term
term, ending (Day/Month
1st School
Name and address of school(s)
(See Note 2)
2nd School
3rd School
commencing/Tq school
1st School
to
to
to
to
2nd School
to
to
to
to
3rd School
to
to
to
to
1st School
TOTAL
TOTAL
TOTAL
TOTAL
2nd School
3rd School
Year)
of Section 1 of Forms O.E.A.3A attached)
2. Fees in respect of the
terat
ALIFYING
FOR BOARDING ALLORANCE (Col.(c) of Section I
of Forms 0.E.A. ZA attached)
3. Full allowances as per Col.(e) of
Section II of Forms 0.E.A. JA attached.
4.
the
Grants received in respect of t 14/73. para. 3(xii) and Col.(d) of section
(1).
1 of Forms O.E.A.3A attached)
5. Total assistance respect of the
terms at (1) If allowance paid in full. (Iten 3 plus item 4)
6. Excess of assistance over fees
payable at (2). (Iten 5 minus item 2)
7. Net Allowance (Item 3 minus item 6)
8. Allowances received under previous
scheme in respect of the terms at (1)
tItem
9. Arrears of allowance claimedminus item
I. I certify that the above particulars are correct and attach supporting Forms O.E.4.3A herewith in respect of all allowances
claimed. (Paragraph 20 of 3.0. 14/73).
II. I declare that :
(a) THE FEES AS SHOWN ABOVE ARE THOSE QUALIFYING FOR BOARDING ALLOWANCE in accordance with paragraph 3(xv) of E.C. 14/73;
(b) the payment instructions given in my initial/previous application are still applicable;
(c) with the exception of scholarships won on a competitive basis, all grants from education authorities or any other public/
private bodies received towards the education of the above children have been shown at item (4); and
(d) I have read Establishment Circular No. 14/73 and accept fully the conditions which govern the payment of Overseas
Education Allowances.
SIGNATURE OF OFFICER
TREASURY USE ONLY
Agreed with initial/previous application
Checked by
Record Card noted
ARREARS PAYABLE
INITIALS DATE
DATE
PLEASE DO NOT SIGN BEFORE READING I AND II ABOVE AND THE NOTES ON THE BACK OF THIS FORM CAREFULLY
1st CHILD
Witness
2nd CHILD
This claim form was signed and dated in my presence on the date shown. NAME (in block letters)
SIGNATURE
RANK/GRADE
3rd CHILD
4th CHILD
TOTAL
I declare that:
SECTION II - HEAD OF DEPARTMENT
(a) to the best of my knowledge all the above details are correct;
(b) the entries at item 3 are correct and are in accordance with the attached Forms O.E.A.34; and (c) the amounts shown at item 8 are correct. NAME
RANK/GRADE
SIGNATURE
DATE
for Head of Department
Passed to Director of Education if schools have not been approved. (See paragraph 21 of E.C. 14/73)
SECTION III – DIRECTOR OF EDUCATION
I declare that those schools named in Section I which were not shown on the officer's previous application may be considered approved schools within the
meaning of the terms governing the payment of Boarding School Allowances.
SIGNATURE
NAME
RANK/GRADE
Passed to Accountant General
O.E.A.2A
DATE
for Director of Education