FORM – 3

(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………………………………….……………………………

 

S.No.

Name of the member of family

Date of birth-age

Relationship with the officer

Initials of the head of office

Remarks

1

2

3

4

5

6

  

 

 

 

 

 

 

 

 

                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

Place:

Date:

 

*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.