FORM 3 DETAILS OF FAMILY SEE RULE 53 (12)

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1 FORM 3 DETAILS OF FAMILY SEE RULE 53 (12) Name of the Government Servant Designation Date of Birth Date of appointment Details of the members of my family as on : S/No. Name of the members of family Date of Birth Relationship with the Government Servant

2 NOMINATION FOR FINANCIAL ASSISTANCE OUT OF BSF BEN FUND I, No. Rank Name I hereby nominate the person/ persons mentioned below and confer on them the right to receive the Financial Assistance from BSF Ben Fund that may be sanctioned by the Govt in the event of my death. or Unmarried Name and Address of Relationship and age Note :- The Government servant should draw lines across blank space below the last entry to prevent the insertion of any name after he has signed.

3 NOMINATION FOR GENERAL PROVIDENT FUND (FIRST SCHEDULED RULES 5 (3) ) I hereby nominate the person/ persons mentioned below who are members of my family to receive in the order shown below the Non-contributory family pension which may be granted by the Central Government in the event of my death. or Unmarried Name and Address of Relationship and age Note :- The Government servant should draw lines across blank space below the last entry to prevent the insertion of any name after he has signed.

4 FORM I { SEE RULE 53 (1A)} 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/her 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 while in service and the right to receive on my death to the extent specified below, any gratuity which having become admissible to me on retirement may remain up paid at my death. Name and Addrsss of Nominee/ Nominees Relationship with the Govt Servant DOB/ Age Amount or share of Gratuity payable to each Name, address and age of person/ persons if any, to whom the right conferred on the shall pass in the event of predeceasing the Govt servant or the dying and the death of the Govt servant before receiving payment gratuity. Amount or share of gratuity payable to Note: (i) The Government Servant shall draw lines across the blank the last entry to Prevent the insertion of my name after he has signed. (ii) Strike our which is not applicable Signature of two witness: -

5 NOMINATION FOR SEEMA PRAHARI BEEMA YOZANA BORDER MEN Authority : FHQ BSF O/No. 34/64/93-Adm/BSF/Dated 18 th Aug 1993 No.. Rank Name... I hereby nominate the person/ persons mentioned below who are members of my family to receive in the order shown below the Non-contributory family pension which may be granted by the Central Government in the event of my death. or Un-married Relationship and age. Note: The Government servant should draw lines across blank space below the last entry made to prevent the insertion of any name after he has signed.

6 NOMINATION FOR BENEFITS UNDER THE CENTRAL GOVERNMENT EMPLOYEES GROUP INSURANCE SCHEME When the Govt servant has family and wishes to nominate one member or more than one member thereof:- I hereby nominate the person/ persons mentioned below who are members of my family to receive in the order shown below the Non-contributory family pension which may be granted by the Central Government in the event of my death. Relationship DOB/ Age Whether married or Un-married Relationship and age. Note: The Government servant should draw lines across blank space below the last entry made to Prevent the insertion of any name after he has signed. ** Strike out which is not applicable. Signature of two witness: -

7 NOMINATION OF NON-CONTRIBUTORY FAMILY PENSION I, No.. Rank Name... I hereby nominate the person/ persons mentioned below who are members of my family to receive in the order shown below the Non-contributory family pension which may be granted by the Central Government in the event of my death. or Un-married Relationship and age. Note: The Government servant should draw lines across blank space below the last entry made to Prevent the insertion of any name after he has signed.