Family Details form

Employee Name ARELLA RAJESH Bhadratha Number 134849

Gender Male Designation PC
Date of Birth 23-Jul-1989 Date of Appointment 01-Feb-2012
Unit Name TSSP 4 Battalion Date of Retirement 31-Jul-2050

Father Mother Spouse

Name Arella Sambaiah Name Arella Sulochana Name Arella Ramya

Date of Birth 08-Jun-1970 Date of Birth 26-Sep-1973 Date of Birth 08-Nov-1993
Gender Male Gender FeMale Gender Female

Dependent Yes Dependent Yes Dependent Yes

Children-1 Children-2 Children-3

Name ARELLA SNEHANASH Name ARELLA SURYANASH Name Not Provided

Date of Birth 08-Dec-2018 Date of Birth 31-Aug-2021 Date of Birth Not Provided
Gender Male Gender Male Gender Not Provided

Dependent Yes Dependent Yes Dependent Not Provided

I, hereby declare that my Father Sambaiah, my Mother Sulochana, my Spouse Ramya, my Son /
Daughter SNEHANASH , SURYANASH , is wholly dependent upon me, He/ she is not having any
other source of income.

Note: Please sign this form and attach the Aadhar card details of self and family members, attest
the signature & seal of Unit officer/ AO and submit to Bhadratha office.

Signature of the Member

Unit Office Use Only

His/Her Parents are not govt employee/Govt.Pensioneer/ incometax Payer or Assessee

Verified the above Declaration Form with the records and found to be correct. Forward to the
secretary.Bhadratha

Attested Signature of the Unit Officer

(with seal and date)