Rule 3 — CCS

Details of Family

3. Central Government Employees Group Insurance Scheme, 1980 made by Shri/Smt./Kumari.....................................

Designation.......................................... Office.......................................... (Strike out which nomination is not received)

Verified that the nomination

(s) made by the Government servant is/are in accordance with the provisions of the Name, Signature and Designation of Head of Office/authorised Gazetted Officer with seal

Date of receipt......................................... The receiving officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his/her death.

The receiving officer shall put his/her dated signature on both pages of this Form. [See rules 50 (15), 57, 58, 59, 60, 62, 74, 79 and 80]

3. The Head of Office shall indicate the date of receipt of communication regarding addition or alteration in the

3. Three copies of Joint photograph with spouse or, if it is not possible to submit joint photograph with spouse, separate photographs of self and spouse, along with three copies of photograph of the member or members of the family whose names are to be included in the Pension Payment Order as a co-authorised family pensioner. (Photographs to be attested by Head of Office). 4. Form 4 Details of Family. 5. Undertaking in Format 9 for refunding any excess payment made by the pension disbursing bank. 6. Nomination for Gratuity, Central Government Employees' Group Insurance Scheme and General Provident Fund in Common Nomination Form Form 3. 7. Nomination for arrears of pension and commuted value of pension (if applied for commutation of pension) in common nomination form - Form A. 8. Undertaking in Format 1 ( applicable for those who served in Security-related or Intelligence Organizations referred to in rule 7 of the Central Civil Services (Pension) Rules, 2021). 9. Form for submitting details under Anubhav (optional). 10. Form of option for availing Medical facilities of Central Government Health Scheme or Fixed Medical Allowance after retirement 11. Photocopy of the first page of Pass Book of the Bank Account in which the pension is to be credited or any other bank document showing the name and account details of Account Holder

3. In case the claimant is/are minor or suffering from disorder or disability of mind, including mental retardation, details of guardian:

Name Date of birth (DD/MM/YYYY) Aadhaar No.* (Voluntary) Relationship with the minor/mentally disabled Relationship with the deceased/missing Govt. Servant Postal address