Free form template · Word

Education Assistance Request

An education assistance request form is used by an employee to seek company sponsorship or reimbursement of fees for a degree, diploma or certification relevant to their role. It captures course details, job relevance, cost, study leave needs and the employee's acknowledgement of any service commitment and repayment terms.

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[Company Logo][Company Name]

EDUCATION ASSISTANCE REQUEST

Company:: [Company Name]
Request No.:: [Reference Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Department
Date of Joining
Reporting Manager
Last Performance Rating

Course Details

Course Name
Institution / Certifying Body
Mode: Part-time / Online / Weekend / Full-time
Start Date
Duration
Exam / Semester Schedule

Relevance to Role

How the course supports my current role
Skills I will apply at work
Manager's comments

Cost and Support Requested

Fee Component	Amount (₹)	Due Date
Admission / Registration	[Amount]	[DD/MM/YYYY]
Semester / Course Fee	[Amount]	[DD/MM/YYYY]
Exam Fee	[Amount]	[DD/MM/YYYY]
Total	[Amount]

Amount Requested: ₹[Amount]
Disbursement: Paid to Institution / Reimbursed on Passing Each Semester
Study / Exam Leave Requested (days)

Acknowledgement

I understand that assistance, if approved, is subject to the education assistance policy. I agree to submit fee receipts and results, and to serve the company for [Number] months after completion. If I resign or am separated for misconduct before that, I agree to repay a pro-rata amount as set out in the separate agreement, which may be recovered from my dues.

Employee
[Employee Name]
Date: [Date]

Recommended by
[Reporting Manager]
Date: [Date]

Approved by
[HR Name]
Amount Approved: ₹[Amount]

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What this template includes

Course, institution, mode and duration
Relevance to current or future role
Fee breakup and amount requested
Disbursement method: upfront or reimbursement on passing
Study and exam leave needs
Service commitment and pro-rata repayment acknowledgement

When to use it

An employee wants to pursue a part-time MBA or professional course
A role needs a specific certification the company will fund
Annual learning budget allocation for higher studies
Requests for children's education assistance where policy provides it

How to customise this template

1Set eligibility, such as minimum service and performance rating
2Insert your sponsorship cap per year
3State the service commitment period and pro-rata repayment rule, if any
4Add a children's education section if offered

HR tips

Make any service commitment reasonable and explained before enrolment
Reimburse in instalments tied to semester results
Keep a separate signed bond if repayment terms are significant
Agree study leave with the manager upfront

Service commitment and repayment clauses should be reasonable and reviewed by a legal adviser before use.

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Frequently asked questions

Will my company pay for my MBA?+

Some companies sponsor or reimburse fees for job-relevant courses under an education assistance policy, often with eligibility criteria and a service commitment.

Do I have to repay education assistance if I leave?+

If the policy has a service commitment, you may need to repay a pro-rata amount when leaving early, as stated in the agreement you sign.

Is study leave given for exams?+

Many education assistance policies allow a few days of exam leave. The request form lets you ask for it.

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[Company Logo][Company Name]
COUNSELLING ASSISTANCE REQUEST
Company:
[Company Name]
Request Date:
[Date]
Confidential Contact:
[HR Name]
This form is seen only by [HR Name] for scheduling. It is not placed in your personnel file. If you need urgent help now, call [Helpline Number].
Your Details
Employee Name
Employee ID
Work Location
Mobile Number
Preferred Language
Session Preference
Counsellor: In-house [Counsellor Name] / Empanelled Partner [Partner Name] / No preference
Mode: In person / Phone / Video
Urgency: Today / This week / Flexible
Preferred Days and Times
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[Company Logo][Company Name]
INSURANCE CLAIM ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Priority:
Urgent (in hospital) / Normal
Employee and Policy
Employee Name
Employee ID
Department
Mobile Number
Policy Type: Group Health / Group Personal Accident / Group Term Life
Patient / Insured Member Name
TPA / Insurer Claim Number
Nature of Assistance Needed
- Cashless approval pending
- Reimbursement claim delayed
- Claim rejected, request review
- Claim partly settled / deductions unclear
- Document query from TPA
- Other: [Details]
Claim Summary
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Counsellor: In-house [Counsellor Name] / Empanelled Partner [Partner Name] / No preference
Mode: In person / Phone / Video
Urgency: Today / This week / Flexible
Preferred Days and Times

[Company Logo][Company Name]

REQUEST FOR ADDITION OF MEMBERS

Ref. No.:: [Reference Number]
Date:: [Date]

To,
[Insurer / Broker Name]
[Address]

Subject: Addition of members under Policy No. [Policy Number] – [Company Name]

Dear Sir/Madam,

Please add the following members to our group policy(ies) with effect from the dates mentioned below. Kindly adjust the applicable premium against our CD Account No. [Account Number] and share the endorsement copy and e-cards at the earliest.

Emp ID	Member Name	Relationship	Date of Birth	Gender	Effective Date	Policies (GMC/GTL/GPA)	Sum Insured (₹)
[Employee ID]	[Employee Name]	Self	[DD/MM/YYYY]	[M/F]	[Date of Joining]	[GMC, GTL, GPA]	[Amount]
[Employee ID]	[Member Name]	Spouse	[DD/MM/YYYY]	[M/F]	[DD/MM/YYYY]	[GMC]	[Amount]
[Employee ID]	[Member Name]	Child	[DD/MM/YYYY]	[M/F]	[DD/MM/YYYY]	[GMC]	[Amount]
[Employee ID]	[Employee Name]	Self	[DD/MM/YYYY]	[M/F]	[Date of Joining]	[GMC, GTL]	[Amount]

Summary

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Employee Insurance Addition Request

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[Company Logo][Company Name]

REQUEST FOR DELETION OF MEMBERS

Ref. No.:: [Reference Number]
Date:: [Date]

To,
[Insurer / Broker Name]
[Address]

Subject: Deletion of members from Policy No. [Policy Number] – [Company Name]

Dear Sir/Madam,

We request you to delete the following members from our group policy(ies) with effect from the dates stated. Kindly deactivate their e-cards and credit any refundable premium to our CD Account No. [Account Number].

Emp ID	Member Name	Relationship	Deletion Date	Reason	Claim Pending (Y/N)
[Employee ID]	[Employee Name]	Self + Family	[Last Working Day]	Resignation	[Y/N]
[Employee ID]	[Employee Name]	Self	[Last Working Day]	Termination / Retirement	[Y/N]
[Employee ID]	[Member Name]	Child	[DD/MM/YYYY]	Age limit crossed	[Y/N]
[Employee ID]	[Member Name]	Spouse	[DD/MM/YYYY]	No longer eligible	[Y/N]

Where a claim is marked as pending, please continue processing it for treatment taken during the period of cover. Employee [Employee Name] has requested information on portability or conversion; kindly contact them at [Mobile / Email].

Letter · Word

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[Company Logo][Company Name]
EMPLOYEE ASSISTANCE PROGRAMME (EAP) REQUEST FORM
Company:
[Company Name]
EAP Provider:
[Provider Name]
24x7 Helpline:
[Phone Number]
Date:
[Date]
Confidentiality: Your request goes to [Provider Name]. The company receives only anonymous, aggregated usage data. Information is shared only with your consent or where there is a serious risk to safety. If you are in immediate danger, call [Emergency Number] or go to the nearest hospital.
Who Needs Support
Name of Person Seeking Support
Relationship to Employee: Self / Spouse / Child / Parent
Employee ID (for eligibility check only)
City
Type of Support
- Emotional wellbeing and counselling
- Work stress or relationship at work
- Family or relationship concerns
- Legal information and guidance
- Financial and debt guidance
- Childcare or eldercare information
- Grief or critical incident support
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Name of Person Seeking Support
Relationship to Employee: Self / Spouse / Child / Parent
Employee ID (for eligibility check only)
City

[Company Logo][Company Name]

COMPANY TRANSPORT / CAB REQUEST

Company:: [Company Name]
Request No.:: [Reference Number]
Date of Request:: [Date]

Requester

Employee Name
Employee ID
Department
Mobile Number
Cost Centre / Project Code

Trip Details

Trip Type: Late-night Drop / Client Visit / Airport-Station Transfer / Site Visit / Holiday Working / Other
Business Reason
Date of Travel
Pickup Time
Pickup Location
Drop Location
One-way / Return
Number of Passengers
Vehicle Type: Hatchback / Sedan / SUV / Tempo Traveller

Passenger List (if more than one)

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Company Transport Request

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[Company Logo][Company Name]
MEAL CARD SERVICE REQUEST
Company:
[Company Name]
Vendor:
[Vendor Name]
Request No.:
[Reference Number]
Date:
[Date]
Employee Details
Employee Name (as on card)
Employee ID
Department
Registered Mobile Number
Email ID
Request Type
- New card (enrolled but not received)
- Replacement: lost / stolen / damaged
- Block card
- Unblock card
- Switch from physical to digital
- Update registered mobile number
Card Details
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Meal Card Request Form
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[Company Logo][Company Name]
EMPLOYEE WELFARE ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Handling:
Confidential
Applicant
Employee Name (or family member applying on behalf)
Employee ID
Department
Years of Service
Mobile Number
Nature of Hardship
- Medical emergency (self or dependant)
- Death in the family
- Natural calamity / fire / accident to property
- Other serious hardship: [Details]
Details of Need
Form · Word
Employee Welfare Assistance Form
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Employee Name
Employee ID
Work Location
Mobile Number
Preferred Language

Employee Name (as on card)
Employee ID
Department
Registered Mobile Number
Email ID

Employee Name (or family member applying on behalf)
Employee ID
Department
Years of Service
Mobile Number

Education Assistance Request

Preview of the form

Employee Details

Course Details

Relevance to Role

Cost and Support Requested

Acknowledgement

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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