Form No. 3 - Details of Family & Nomination Forms

:FORM NO.-3:

{See Rules 54 (12)}

:DETAILS OF FAMILY:

1. Name of the Govt. Servant

2. Designation

3. Date of Birth

4. Date of appointment

5. Details of family members as On

Sl.No.	Name of members of "Family"	Date of Birth	Relationship with official	Initial of Head of Office	Remarks

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

Place

Dated

SIGNATURE OF THE GOVT. SERVANT

* Family for this purpose means:-

(a) Wife, in the case of male government servant.
(b) Husband, in the case of a female government servant.
(c) Son's below 25 years of age and unmarried daughters below 25 years of age;

Including such son or daughter adopted legally before retirement.

NOTE: Wife and husband shall include respectively judicially separated wife and husband.

FORM - I

NOMINATION FOR DEATH CUM RETIREMENT GRATUITY

When the Government servant has a family and wishes to nominate one member or more than one member thereof.

I hereby nominate the person/persons mentioned below who is/are members(s) of my family, and confer on him/them the right to receive, to the extent specified below, any gratuity that may be sanctioned by the Central Government in the event of my death to the extent specified below, any gratuity which having become admissible terms on retirement may remain unpaid at my death:-

Original nominee(s)				Alternate nominee(s)
Name & address of nominee/nominees	Relationship with Govt. Servant	Age	Amount or share gratuity payable each*	Name, address, relationship & age of person to whom right conferred shall pass if nominee predeceases Govt. Servant	Amount or share of gratuity payable to each**

* This column should be filled in so to cover the whole amount of the gratuity.

** The amount share of gratuity shown in this column should cover whole share payable to original nominee(s)

This nomination supersedes the nomination made by me earlier on which stands cancelled.

Dated this day of 20 at

Witness to Signature:

Signature of Government Servant

(To be filled by the Head of Office / Audit Officer)

Signature of Head of Office / Audit Officer:

Nomination by:

Designation:

Office:

Dated:

Designation:

NOMINATION FOR FAMILY PENSION

I hereby nominate the persons who are members of my family to receive in the order shown below the family pension which may be granted by Government in the event of my death after completion of qualifying service:-

Name & Address of nominee	Relationship with official	Age	Whether married or unmarried

This nomination supersedes the nomination made by me earlier on which stands cancelled.

Dated this day of 20

Witness of Signature:

Signature of Government Servant

(To be filled in by Head of Office in case of Non-Gazetted Officer)

Nomination by:

Designation:

Office:

Date:

Signature of Head Of Office

(Acknowledging the receipt of Nomination Form by Head of Office)

To,

Shri/Smt.

In acknowledging the receipt of your nomination dated / Cancellation dated of nomination made earlier, in respect of gratuity/pension, I am to state that it has been duly placed on record.

Place:

Dated:

Signature of Head of Office

Designation:

Guide to Form No. 3 (Details of Family), Gratuity & Family Pension Nomination

Form No. 3 under Rule 54 (12) of the Central Civil Services (CCS) Pension Rules, 1972 is a mandatory statutory document submitted by Central Government employees, Defense personnel, and CAPF jawans upon joining service. It records official family details and facilitates valid nominations for Death-cum-Retirement Gratuity (DCRG) and Family Pension.

Maintaining an updated Form No. 3 in your official Service Book ensures immediate settlement of pensionary benefits and gratuity claims to eligible family members without legal or administrative hurdles in the event of unforeseen contingencies.

Page-by-Page Filling Instructions

Page 1: Details of Family (Form No. 3)

Government Servant Particulars: Fill in your full official name, designation, date of birth, date of appointment, and the current date of declaration.
Family Members Table: List dependent family members including spouse, sons below 25 years, and unmarried daughters below 25 years (including legally adopted children before retirement).
Definition Note: Under CCS Pension Rules, spouse includes judicially separated husband or wife. Married daughters and sons above 25 years are generally excluded unless suffering from permanent disability.

Page 2: Nomination for Death-cum-Retirement Gratuity (Form - I)

Original Nominees: Specify nominee names, exact addresses, relationship with the employee, age, and percentage share of gratuity payable to each member (totaling 100%).
Alternate Nominees: Nominate alternate individuals to whom the right shall pass if the primary nominee predeceases the employee.
Attestation & Witness: Must be signed in the presence of two independent witnesses and counter-signed by the Head of Office (HOO).

Page 3: Family Pension Nomination & Official Acknowledgement

Order of Entitlement: Nominate family members to receive Family Pension in sequential priority order in case of death during service or post-retirement.
Head of Office Receipt: Ensure the lower portion (Acknowledgement slip) is signed, stamped, and officially recorded in your Service Book by the Head of Office / Audit Officer.

Mandatory Checklist of Documents & Strict Guidelines

Family Photograph: Combined joint family photograph affixed on the designated space of Form 3.
Identity Proofs: Self-attested identity proof copies (e.g. valid identity cards) of all listed family members.
Inclusion of Spouse (Wife's Name): Official Marriage Certificate is mandatory along with an updated government identity document reflecting the changed surname/name post-marriage.
Inclusion of Child: Official Birth Certificate issued by the Municipal Corporation / Registrar of Births.
Dependent Parents: Valid Income Certificate and Dependency Certificate with official seal and signature of the competent revenue authority (Tehsildar).
Critical Rule on Name & DOB Matching: Always enter the exact Name and Date of Birth as recorded on the identity documents. If there is any discrepancy between the identity document and official Service Book entries, explicitly mention it in your forwarding application requesting necessary correction as per the identity document.

फ़ॉर्म नंबर 3 (परिवार का विवरण), ग्रेच्युटी एवं फैमिली पेंशन नामांकन मार्गदर्शिका

केंद्रीय सिविल सेवा (CCS) पेंशन नियम, 1972 के नियम 54 (12) के तहत Form No. 3 एक अति आवश्यक वैधानिक फॉर्म है। यह फॉर्म केंद्रीय सरकारी कर्मचारियों, सेना और अर्धसैनिक बलों (CRPF, BSF, ITBP, CISF, SSB) के कर्मचारियों द्वारा सेवा में शामिल होते समय और परिवार में बदलाव होने पर भरा जाता है। यह फॉर्म ग्रेच्युटी (DCRG) और फैमिली पेंशन के सही नामांकित व्यक्तियों का ब्यौरा दर्ज करता है।

फॉर्म भरने के मुख्य चरण और नियम

पेज 1: परिवार का ब्यौरा (Form No. 3)

कर्मचारी का विवरण: अपना पूरा नाम, पद (Designation), जन्म तिथि और नियुक्ति तिथि (Date of Appointment) दर्ज करें।
परिवार के सदस्यों की सूची: पत्नी/पति, 25 वर्ष से कम आयु के पुत्र तथा 25 वर्ष से कम आयु की अविवाहित पुत्रियों (गोद ली गई संतान सहित) का नाम, जन्म तिथि और संबंध दर्ज करें।

पेज 2: ग्रेच्युटी नामांकन (Form - I)

मूल नामित व्यक्ति (Original Nominees): नामांकित परिजनों का नाम, पता, संबंध, आयु और प्रतिशत हिस्सा (Share of Gratuity) भरें।
वैकल्पिक नामांकन (Alternate Nominee): यदि मूल नॉमिनी की मृत्यु कर्मचारी से पहले हो जाती है, तो अधिकार किसे मिलेगा उसका ब्यौरा दर्ज करें।
गवाह (Witness): दो गवाहों के हस्ताक्षर करवाएँ और अपने कार्यालयाध्यक्ष (Head of Office) से सत्यापित करवाएँ।

पेज 3: पारिवारिक पेंशन नामांकन एवं पावती (Acknowledgement)

पेंशन क्रम: मृत्यु की स्थिति में फैमिली पेंशन प्राप्त करने वाले सदस्यों को प्राथमिकता क्रम में दर्ज करें।
पावती रसीद: फॉर्म जमा करने के बाद निचले भाग (Acknowledgement Slip) पर कार्यालयाध्यक्ष के हस्ताक्षर एवं मुहर लगवाकर अपनी सर्विस बुक (Service Book) में दर्ज करवाएँ।

आवश्यक दस्तावेज़ों की चेकलिस्ट एवं महत्वपूर्ण दिशा-निर्देश

फैमिली फोटो: परिवार के सभी सदस्यों का संयुक्त (फैमिली) फोटो निर्धारित स्थान पर संलग्न करें।
पहचान पत्र प्रति: परिवार के सभी सदस्यों के वैध पहचान पत्र (जैसे आधार कार्ड) की स्व-प्रमाणित प्रति।
पत्नी (Wife) का नाम जोड़ना: यदि पत्नी का नाम जोड़ना है, तो मैरिज सर्टिफिकेट अनिवार्य है और पहचान पत्र (आधार कार्ड) में नाम परिवर्तित/अपडेटेड होना चाहिए।
बच्चे का नाम जोड़ना: जिस बच्चे का नाम दर्ज कराना है, उसका सक्षम प्राधिकारी द्वारा जारी आधिकारिक जन्म प्रमाण पत्र (Birth Certificate) संलग्न करें।
माता-पिता का नाम: माता-पिता के लिए आय प्रमाण पत्र (Income Certificate) तथा आश्रित प्रमाण पत्र (Dependency Certificate) संलग्न करें, जिस पर तहसीलदार की मुहर एवं हस्ताक्षर होना अनिवार्य है।
नाम और जन्म तिथि का मिलान (अति महत्वपूर्ण): फॉर्म भरते समय पहचान पत्र (आधार कार्ड) में दर्ज नाम और जन्म तिथि ही भरें। यदि पहचान पत्र और सेवा पंजीका (Service Book) के विवरण में कोई भिन्नता है, तो अपने आवेदन पत्र (Application) में इसका स्पष्ट उल्लेख करें कि पहचान पत्र में दर्ज नाम तथा जन्म तिथि के अनुसार सेवा पंजीका में सुधार किया जाए।

अक्सर पूछे जाने वाले प्रश्न (FAQs)

Q1: क्या विवाह या बच्चे के जन्म के बाद फ़ॉर्म नंबर 3 को अपडेट करना जरूरी है?
A: हाँ, परिवार में किसी भी नए सदस्य के जुड़ने (विवाह/बच्चे का जन्म) या बदलाव होने पर तुरंत नया Form 3 भरकर कार्यालयाध्यक्ष को देना अनिवार्य है।

Q2: क्या 25 वर्ष से अधिक आयु के पुत्र या विवाहित पुत्री को इसमें शामिल किया जा सकता है?
A: सामान्यतः नहीं। केवल तब शामिल किया जा सकता है जब वे स्थायी रूप से शारीरिक या मानसिक विकलांगता से ग्रस्त हों और आय का कोई साधन न हो।