NATIONAL CENTRE FOR RADIO ASTROPHYSICS TATA INSIITUTE OF FUNDAMENTAL RESEARCH PUNE UNIVERSITY CAMPUS, PUNE-411007

(To be filled by the staff member in duplicate and returned to the Establishment Office. Declaration in respect of family member/s made at items 6 below should be supported by some documentary evidence such as copy of ration card, marriage certificate and birth certificate/s of children, broters and sisters. Staff members becomes eligible for LTC facility only after completion of one years continuous service in the Institution.)

1. Name & Computer Code:
2. Desingation & Section:
3. Date of Birth:
4. Date of Joining:
5. PB(1/2/3/4/5)-Band Pay-Grade Pay:

6. Names of Family members:(i.e. wife/husband, children, parents, sisters and minor brothers. Pleasee see note below.)

Sr. No.	Name	Relation	Age	Monthly* income
1
2
3
4
5
6

*If dwawing pension, please mention only basic pension and attach documentary proof.

7. Name of the Home town with address    :
8. Nearest Railway Station to Home Town :
9. Name and address of nearest relative at  : 
    Home Town, phone. No. if any

Note
1. 'Family' means a Government servant's wife/husband, unmarried children or stepchildren, wholly dependent upon the Govt. servant whether they are residing with the Govt. Servant or not. Married daughters, who have been divorced, abandoned or separated from their husbands, if residing with or wholly dependant upon the Govt. servant. Unmarrried minor brothers, unmarried divorced, abandoned, separated from their husbands or windowed sisters residing with the wholly dependant on the Govt. Servant provided their parents are either not alive or are themselves wholly dependant on the Govt. Servant.
2. Income from all sources in case of each dependant should not exceed Rs. pm.