FORM 3
[Sce rule 54 (12)]
Details of Family
1 Name of the Government servant
2 Designation
3 Date ofbirth
4 Details of the members of family as on-
Marital Remarks Dated
S. Names of the Date of Relationship
birth with the status signature
No members of family of Head
officer
of Office
(5) (6) (7)
(1) (2) (3) (4)
|1.
2.
3
4.
5
6
8
9.
10.
by notifying to the Head of the
i
Ihereby undertake to keep the above particulars up-to-date
Office any addition or alteration.
Signature of Government servant
Date :
Place:
is to be retained. AI
Note 1. - The original Form submitted by the Government. servant
additions/alterations are to be recorded in this Form under the signature of Head of Office in Col
7. No new Form will substitute the original Form. However, the retiring Government. servant
should submit the details of family afresh along with Form S.
Note 2. - The details of spouse, all children and parents (whether eligible for family pension or
not) and disabled siblings (brothers and sisters) may be given.
Note 3.- The Head of Office shallindicate the date of receipt of communication regarding addition
or alteration in the family in the 'Remarks' column. The fact regarding disability or change of
'Remarks' column.
marital status of a family mnember should also be indicated in the
and husband.
Note 4. - Wife and husband shallinclude judicially separated wife
