FORM – 3

{See Rule 54 (12) and Rule 54 of CCS (Pension) Rules}

 

1.

Name of Govt.servant            :

 

2.

Designation:

 

3.

Date of Birth:

 

4.

Date of appointment:

 

5.

Details of the member of family as on:

 

 

Sl.No.

Name of the member of family

Date of Brith

Relationship with the Official

Initial of the Head of Office

Remarks

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby undertake to keep the above particulars up-to-date by notifying the Head of Office any addition or alteration.

 

 

 

Dated Aizawl, the 14th March, 2012

 

 

 

Signature of Govt.Servant

 

 

* Family for the purpose means family as defined in clause (b) of sub-rule (14) of Rule 54 of the CCS (Pension) Rules, 1972