TNAG-0472-FCO40-537-Hong-Kong-government-policy-on-education-1974 — Page 95

CLAIM FOR BOARDING SCHOOL ALLOWANCES

(See notes overleaf BEFORE completing this Form.

Officer's full name :

FIRET CHILD

SCHOOL YEAR 19 _ / -

APPENDIX III

This Form must be completed in TRIPLICATE and in BLOCK CAPITALS)

Rank/grade:

SECOND CHILD

Department:

THIRD CHILD

FOURTH CHILD

Child's name

Date of birth

Name of School

Number of terms over which fees are payable

1. Terms for which allowance claimed giving dates

term begins and ends

2. Fees payable in respect of the term at (1)

QUALIFYING FOR BOARDING ALLOWANCE

3. Full allowance for one term

4. Grants received in respect of the term at (1)

(See E.C. 14/73, para.3(xii))

5. Total assistance in respect of the term at (1)

if allowance paid in full (Item 3 plus item 4)

6. Excess of assistance over fees payable at (2)

(Item 5 minus Item 2)

7. Net Allowance claimed (Item 3 minus Item 6)

I.

I certify that the above particulars are correct and attach supporting FORMS 0.5.A.3 herewith in respect of all allowance claimed. (Paragraph 14 of E.C. 14/73)

II. I declare that:

(a) THE FEES SHOWN ABOVE ARE THOSE QUALIFYING FOR BOARDING ALLOWANCE in accordance with paragraph 3(xv) of E,C.14/73;

(b) the circumstances under which my previous application was approved have in no way changed and the payment instructions given by me at that time are still applicable; (c) with the exception of scholarships won on a competitive basis, I am not in receipt of any other assistance for shcool fees in respect of the term which is the subject

of this claim, either from an education authority or any other public/private body;

(a) any refund of fees made by the school or the receipt of any assistance not shown above will be reported immediately by me to the Accountant General;

(e) I have received no grants or refund of fees relating to previous terms for which allowances have been claimed; and

(r) I have read Establishment Circular No. 14/73 and accept fully the conditions which govern the payment of Overseas Education Allowances,

SIGNATURE OF OFFICER

DATE

PLEASE DO NOT SIGH BEFORE READING I AND II ABOVE AND THE NOTES ON THE BACK OF THIS FORM CAREFULLY

Witness

This claim form was signed and dated in my presence on the date shown. NAME (in block letters)

RANK/GRADE

HEAD OF DEPARTMENT

---SIGNATURE

I declare that to the best of my knowledge all the details entered above are correct and the calculations of the allowances claimed at item 7 are correct.

RANK/GRADE

NAME

1

DATE

SIGNATURE

for Head of Department

TREASURY USE ONLY

ALLOWANCES PAYABLE : hot CHILD | 2nd CHILD 3rd CHILD 4th CHILD TOTAL

INITIALS

Agreed with previous application Checked by Record Card noted

DATE

0.E.A.2