Schedule LIII-Form No.351 (New) O.C. S.(PENSION) FORM 5 [(See rule 56 (15)] DETAILS OF FAMILY Name of the Government Servant Designation Date of birth Date of appointment : : : : Details of members of my family as on ......... Sl. No. Name of the members of family Date of birth Relationship with the Officer Initials of the Head of Office Remarks 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: Signature of the Government Servant Date: *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.
