FORM 3 [See rule 54 (12)] Details of Family 1. Name of the

FORM 3
[See rule 54 (12)]
Details of Family
1.
2.
3.
4.
Name of the Government servant
Designation
Date of birth
Details of the members of family as on-----------------------:
S.
No
Names of the
members of family
Date of
birth
Relationship
with the
officer
Marital
status
Remarks
(1)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
(2)
(3)
(4)
(5)
(6)
Dated
signature
of Head
of Office
(7)
I hereby undertake to keep the above particulars up-to-date by notifying to the Head of the
Office any addition or alteration.
Signature of Government servant
Place :
Date :
Note 1. – The original Form submitted by the Government. servant is to be retained. All
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 5.
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 shall indicate the date of receipt of communication regarding addition
or alteration in the family in the ‘Remarks’ column. The fact regarding disability or change of
marital status of a family member should also be indicated in the ‘Remarks’ column.
Note 4. - Wife and husband shall include judicially separated wife and husband.