we Tet TE = RM et ' pm" oN go ~ att. ~ ate FORM - 3 1 @ [See Rule 54(12)] ‘ i - DETAILS OF FAMILY ame of Government Servant RAUL ee Nal new Designation Gren plypcaih ____——— pate of Birth a) te a deze __ Date of Appointment gai = = — Details of the members of family as on Riu -2020 i i ks [SNo| ber(s) of ] Date of Birth | Relationship | Initials of | Remar! SNe] Name ot — we with the the Head member__|_of Office iT 2 3 4 5 6 DEPEWOGAT o Rontasa os]ielincs | FATHER f) oo 6 60 06! 2 Vinmatt _ fle fatan | Mechee worn 6 & & 07 8 Thereby undertake to keep the above particulars up-to-date by notifying to the Audit Officer / Head of Office any addition or alteration. Place: bydurased Date: 23-4, -2e2© “Family (for this purpose) means family as defined in clause (b) of Sub rule (14) of the Rule 54 of the CCS (Pension) Rules, 1972. Rahat Signature of the Government Servant 1. Wife in the case of a male government servant or husband in case of female government servant (wife and husband shall include respectively judicially separated husband and wife). 2.Son who has not attained the age of 25 years and unmarried daughter who has not attained the age of 25 years, including such son and daughter adopted legally before retirement. 8 copy.