10 Published on National Portal of India (india.gov.in) Government of Orissa Department of Public Grievances & Pension Administration O.C.S.(PENSION) FORM 5 DETAILS OF FAMILY [(See rule 56 (15)] Name of the Government Servant : Designation : Date of birth : Date of appointment : Details of members of my family as on Date of Name of the members Remarks Relationship with Initials of the Sl. the Officer Head of Office No. birth of family 1 2 3 4 5 6 1 2 3 4 5 6 7 8 9 I hereby undertake to keep the above particulars up-to-date by notifying to the Head of Office any addition or alternation. Place: Date: Signature of the Government Servant Family for this purpose means family as defined in clause (b) of sub-rule (17) of Rule 56 of the Orissa Services (Pension) Rules, 1992. NOTE- Wife and husband shall include respectively Judicially separated wife and husband. Published on National Portal of India (india.gov.in)
