FORM 3 ( See Rule 54 (12) ) DETAILS OF FAMILY Name of the Govt. Servant .................... Designation ....................... Date of Birth ...................... Date of appointment ...................... Details of the members of my family as on .................... Sl. No. Name of the members of family Date of Birth Relationship with the office Initials of the Head of Office Remarks. I hereby undertake to keep the above particulars up-to-date by notifying to the Head of Office any addition or alteration. Place .......... Dated the .......... Signature of Government Servant. Family for this purpose means family and defined in clause (b) of sub-rule (14) of Rule 54 of the CCS (Pension) Rules, 1972. Note : Wife and husband shall include respectively judicially separated wife and husband.
