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94250-94495
FORM3 Padam Shree Traders, UJJa
rn Mo.

\ {See Rule 47 (12)}

Detail o f Family
... ... ... ... ... ... •

Name of Government Ser

vent ... ... ... M. cl;
!'.·... .' Y.'J
\(
r,, h
... .S... ... ... .. .
... ... ...

. •····
... ... .LCl.b.... Qt !-f
iin o{_J,. .... ......................
Designa~on
... ... ... ... .. • · · · · ·
J.~.{ .~.~./. /. t { ... ... ... ... ... ... ...

~1. i.~.{ r
... ... .
Date of Birth
... ... ... ... ... ... .. .
... ... ...~.
.CJ Z. 1... ... ... ... ... ...
Date of appointment ... ... . . . .
on . . . . . . . . . . . .. . . .. . . . . .
of my family as . . .. .... . . . . . . . . . . . . .
Datails of the members Remark
Initials of the Head of
s Name of the Date of Re latio nsh ip with the
the Office
No. mambers of family birth Government SeNent
6
5
3 4
1 2 A

A l~ h r~~cp~ ~Jo~ [I 2.. F-C\-Hwr ~l

Ct> l b / ( ~,v (otnuY'

:2 o~ \l fa ~~ f½r· 'L
04 r)

cer/ head of
notrfyng to the Audit offi
II 1here by under
office any addition of alte
ration.
tak e to kee the abo ve particulars u~ to date by

Servant
Signature of Government
......½ } ~ ..... .... ..
Place .....
.......................... ..
Date the .... Lo./~'t.../i!:~.~1• ?(_

ans-
Family for this purpose me
ent Servant.
case of a male Governm
(a) Wife or wives in the
t.
e of Government Servan
(b) Husband, in the cas
retirement one
arried daughters before
en years of age and unm
(c) Sons below eighte ent.
d legally before retirem
h son or darghter adopte
years of age include suc J "
and husband.
ly incdicially separates wife
I
I Note : Wife and husban
d sha ll inc lud ed respec tive
office/ Audit Officer)
o f'\\I\ 2
(to be filled in by ,"t-ad of V
I ·-A
~·

Datails of Family lR 'fll

I Filed by .........................
......... ..
TR-t-.icf>'l~~ ~ -R if ie
....
'3\T\i't;r

..........
Eesignation .................... Date
•••••••••••••••••••••••···········
·····
Office .................... ....
••••••••••••••••••••••··············· Designation .....