Request for payment of education grant and/OR




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UNITED NATIONS NATIONS UNIES



REQUEST FOR PAYMENT OF EDUCATION GRANT AND/OR


ADVANCE AGAINST EDUCATION GRANT
INSTRUCTIONS: All applicants must complete Part I and Part II of this form. Applicants for Payment of Education Grant must complete Part III. Applicants for Advance against the Education Grant must complete Part IV. Submit original to your Human Resources Officer.
Instructions for Part III, Textbooks: Textbook expenses may be claimed only if textbooks were not provided free of charge. If so, select one option --- fixed amount or actual amount spent.
Instructions for Part IV: For each child, if a grant was paid for the previous year, this advance will automatically be paid at 100 per cent of the previous year’s grant. If you anticipate a lower grant than the previous year, indicate the lower amount in item IV (c). If no grant was paid for the previous year, or if you request a higher amount than the previous year, indicate the amount in item IV (c), and attach documentation to substantiate the amount requested.


  1. REQUEST AND CERTIFICATION

I request an advance against the education grant for the next school year      to     ; AND/OR claim the education grant for the scholastic year      to      as shown in Parts III and IV of this form. I understand that there is no obligation to make payments ahead of the schedule established by the school and that this advance will be recovered from my salary if the required documentation is not submitted.


I have disclosed all scholarship(s), bursary or similar grant(s) in respect of the child/children. I have not claimed expenses related to textbooks if textbooks were provided free of charge. I understand that, if anticipated costs on the basis of which the advance was granted become lower, I am required to notify the Organization promptly.
I certify that the statements made by me, and the information provided by me on this form and the attached documentation are true and complete to the best of my knowledge and belief; and that no other education grant is being paid in respect of the child/children for the periods indicated.

Signature of Staff Member: …………………………… Date: ………………….…

(dd/mm/yyyy)

* To print page 2, turn over this page and manual feed your printer. Please note that for the claim to be valid, it must be submitted on a double-sided form.




UNITED NATIONS



REQUEST FOR PAYMENT OF EDUCATION GRANT

AND/OR ADVANCE AGAINST THE EDUCATION GRANT

II. Staff Member: Follow instructions on page 1. Parts I and II must be completed.

Last Name of Staff Member

     

First

     

Mid. Initial  

Index No.

     

Level

    

Dept. or Div.

     

Ext.

     

Room No.

     

Type of Appointment

     

Expiry Date

     

Entrance on Duty Date

(d/m/y)      



Home Country

     

Duty Station

     

Type of U.S. Visa

     

Child’s Name

     

     

     

Date of Birth (d/m/y)

     

     

     

Name of School or University attended

     

     

     

Location of School

(City, Country)



     

     

     

Level of Instruction

(Class or Grade)



     

     

     

III. Request for Education Grant

School Year

(From – To)



Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Child attended School (From – To)

Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Actual Cost (Attach P.41 and/or other receipts)

Currency and amount

     

Currency and amount

     

Currency and amount

     

Textbook Cost: Elect one option. Read instructions on page 1.

Check box for OR Specify Amount

fixed amount

 US$      


Check box for OR Specify Amount

fixed amount

 US$      


Check box for OR Specify Amount

fixed amount

 US$      


Tuition in Mother Tongue (Attach P.41/A)

Currency and amount

     

Currency and amount

     

Currency and amount

     

Other Private Tuition

Currency and amount

     


Currency and amount

     

Currency and amount

     

IV. Request for Advance against the Education Grant


  1. School Year

(From – To)

Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Day/Month/Year – Day/Month/Year

     

Choose one (b or c)

  1. 100% of last year

(Check box)







(c) First advance / higher amount than previous year

US$      

US$      

US$      

FOR OFFICIAL USE OF OHRM


School Location

DUTY STN.  HOME CTRY  OTHER CTRY 

DUTY STN.  HOME CTRY  OTHER CTRY 

DUTY STN.  HOME CTRY  OTHER CTRY 

Admissible Cost

     

     

     

Maximum Entitlement

(if prorated)



     

     

     

Advance requested in Part IV authorized

     

     

     

Staff member entitled as above.

For the ASG, OHRM: (Print Name & SIGN)      



Date:      

FOR OFFICIAL USE OF OPPBA


Flat Sum for Board

     

     

     

Cost of Attendance

(including/excluding board)



X 75% =      

X 75% =      

X 75% =      

Total Entitlement per Child

US$      

US$      

US$      

GRAND TOTAL:      

LESS: Advance Outstanding      

Net Payment (US$):     

Examiner: OPPBA (Print name & SIGN)      



Date:      







P.45 (12-03) – E


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