(SEE RULES 54(12)
Details of Family
Name of the Government Servant ...
Designation Date of Birth Date of appointment
* Details of the members of My family *as on .
I hereby undertake to keep the above particulars up-to-date notifying to the Account Officer/Head of office any addition or alternation.
Signature of the Govt. Servant
*Family for this purpose means:-
a) Wife in the case of a male Govt. servant
b) Husband in the case of female Govt. servant
c) Sons below 21 years of age and unmarried daughters below
24 years of age including such sons or daughter adopted legally before retirement.
NOTE: Wife husband shall include respectively judicially separated wife and husband.