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Family Composition Certificate Template

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emergencychubl
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2K views1 page

Family Composition Certificate Template

Uploaded by

emergencychubl
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FAMILY COMPOSITION CERTIFICATE

NAME OF THE EMPLOYEE


1. TICKET NO
(CAPITAL LETTERS)

2. [Link]. / EMP. NO. SHOP/OFFICE

3. DESIGNATION DATE OF BIRTH

DATE OF
4. RATE OF PAY AND GRADE PAY
APPOINTMENT

DETAILS OF FAMILY MEMBERS


SL. REMARKS DECLARATION
NAME RELATIONS DOB AADHAR NO.
NO HP/MR ETC
[Link] FATHER IS ALIVE /
1.
NOT ALIVE
2. I hereby declare that all the
mentioned family members in
FCC are residing with me & are
2. wholly dependent upon me. All
the members mentioned are
not availing Railway Pass/PTOs
from any other sources
3. All the information furnished
are true to the best of my
knowledge and in case any
3.
information furnished is found
false. I shall be liable to be
taken up under DAR.
4. -------------------DO---------------

WITNESS - 01: WITNESS-02 :


SIGNATURE: SIGNATURE :
OFFICE: OFFICE:

SIGNATURE OF THE IMMEDIATE SUPERVISOR


NAME: SIGNATURE OF EMPLOYEE
DESIGNATION /SEAL/DATE: DATE

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