Schedule-9(330)
(Relating to Sub-rule (17) of Rule 36)
Form of application for transfer
Date:
Re: Request for transfer.
To,………….
……………
Dear sir/madam,
I hereby make this application, accompanied by the relevant documents, along
with my true and factual details, for an opportunity to serve the nation being
transferred to the below-mentioned office.
Description of employee

330 Amended by Seventh Amendment.

1.
2.
3.
Attached documents:
1. Documents showing service done in the concerned office:
2. Reason for wishing to be transferred and evidence.
The contents mentioned herein are true, if proved false, I am ready to
bear punishment pursuant to laws.
Applicant:
Name, surname:
Post:
Employee code No.:

Office:

Check-list of application for transfer:

Yours sincerely,
Name, surname:
Post:
Employee code No.:
Office:

Schedule -10
(Relating to Rule 37)
To be kept by the authority empowered to transfer
Format of details relating to class wise transfer of offices under him or
her
Office :
District : Date of filling details :

Note: (1) This format is to be maintained by each office.
(2) This details shall be up-dated in every Six months.
(3) This details shall be sent to/maintained in the Ministry, operating service,
group, concerned Ministry and Department.
Preparing Officer’s – Certifying Officer’s –
Signature : Signature:
Post: Post:

Date: Date:

Schedule -11

(Relating to Sub-rule (1)

331
of Rule 38)
Description of transfer
(To be included in the personal file)
(1) Name: (6) Group:
(2) Code No. of employee: (7) Sub-group:
(3) Designation: (8) Educational qualification:
(4) Class: (9) Training:
(5) Service: (10) Other details (If any):

Note: The details as per this form shall be maintained or caused to be maintained up to
date by each Chief of the Office by duly filling it.

331 Amended by Seventh Amendment.

Preparing Officer’s – Certifying Officer’s –
Signature: Signature:
Post: Post:
Date: Date:

Schedule-11A.
332
(Relating to Clause (b) of Sub-rule (2) of Rule 38)
Format of letter of transfer
Dear sir/madam,
Pursuant to the decision of the Government of Nepal/…………, dated……..,
you are transferred as follows on the condition that the
Ministry/Secretariat/Commission/Office of your transfer or for up to the period
of………….

Mr…………..
333
Employee code No.:
Copy for information and action:
The Public Service Commission.
The Civil Employees Record Office.
The Employee Provident Fund.

332 Inserted by Second Amendment.
333 Inserted by Seventh Amendment.

Schedule- 12
(Relating to Clause (b) of Sub-rule (2) of Rule 38)334
Dispatch Letter
The Government of Nepal
……….Ministry /Department/Office
Reference number:
Mr./Ms——-
It is hereby informed that Mr./ Ms. ………………, transferred to that office,
has been given this dispatch letter with the following details and sent to attend
that office.
1. Name, surname of employee:
2. Code Number of employee:
3. Previous (a) Post: (b) Class:
(c) Service: (d) Group, sub-group:
(e) Office:
4. Transfer: (a) Date of decision: (c) Class:
(b) Post: (e) Group, sub-group:
(d) Service: (f) Office:
5. Details in regard to hand-over of charge:

334 Inserted by Second Amendment

Done Not done
6. Date of dispatch:
7. Leave utilized up to the date of dispatch order:
(a) Casual leave and festival leave …… days.
(b) Home leave …… days.
(c) Sick leave …… days.
(d) Maternity leave/maternity care leave335 …… times
(e) Study leave …… days.
(f) Extra-ordinary leave …… days.
(g)336 Leave without pay …… days.
8. Accumulated leave up to the date of dispatch letter:
(a) Home leave …… days.
(b) Sick leave …… days.
(c) Maternity leave/maternity care leave
337
…… days.
(d) Study leave …… days.
(e) Extra-ordinary leave …… days.
(f)
338
Leave without pay …… days.
8A.
339
Date of full attendance in the office:

335 Amended by Second Amendment.
336 Inserted by Seventh Amendment.
337 Amended by Second Amendment.

9. Being drawn monthly: (a) Salary (Rs.) : (b) Salary increment (Rs.):
10. Last date of payment of salary allowance:
11. Employees provident fund deduction amount:
12. Amount of payment of medical expenditure: Date :
13. Advance amount taken for daily travel allowance:
14. Starting date of salary increment:
15. Citizen Investment Fund deduction amount
16. Income tax deduction amount:
17.
340
(a) Year….month….and day…. of deposit in the fixed term life
insurance fund:
(b) Year….month….and day…. of payment of annual premium for
the fixed term life insurance fund:
18.
341
(a) Old pension scheme:
(b) Year….month…. and day….. of initial date of the new pension
scheme, and date of deposit of amount in the fund: Up to
year…..month….
19.
342
Name of festival at which festival expense is received and date and
possible month of that festival:

338 Inserted by Seventh Amendment.
339 Inserted by Seventh Amendment.
340 Inserted by Seventh Amendment.
341 Inserted by Seventh Amendment.
342 Inserted by Seventh Amendment.

20.
343
Details of payment of infant care allowance to the employee:
Copy to:
The Civil Employees Record Office, Harihar Bhawan.
The Employee Provident Fund, Tridevi Marg, Thamel.
Mr./Ms. ………… (concerned employee) : You are hereby requested to attend
the office to which you have been transferred.
344
The……………. (name and address of the organization where amount is
deposited with as per the new pension scheme.

343 Inserted by Seventh Amendment.
344 Inserted by Seventh Amendment.

Schedule-12A.345
(Relating to Rule 63A.)
Format of bond executed by a civil employee who goes for
study/training/tour upon being nominated by the Government of Nepal
(This bond must be submitted along with the application made for approval of
the study leave with pay/deputation)
Whereas, I……………………………………………,serving in the post of
………………………..Ministry/Commission/Secretariat/Department/Office have,
vide the decision of the Government of Nepal (…….level), dated………….,
been nominated for study/ training/study tour on —————-, to be held from
…………to …………..in …………( country), and in pursuance of the
nomination, I am going to take part in the said programme in the near future;
Now, therefore, I have submitted the following bond pursuant to Section 40D.
of the Civil Service Act, 2049 (With Amendment).
(a) I shall attend the organization operating the study/training/tour within
the specified date in order to take part in the study/training/programme.
(b) I shall fully observe the policies/rules/codes of conduct specified by the
body providing scholarship and operating the programme throughout
the period of the study/training/programme.
(c) I shall return to the home country immediately on expiration of the prior
approved period of the study/training/tour and attend the body in which
I have lien and compulsorily serve for up to the period as referred to in
Section 40(c) of the Civil Service Act, 2049(…) (As Amended).

345 Inserted by Seventh Amendment.

(d) If I fail to attend the body in which I have lien within the time-limit as
referred to the rules immediately upon completion of the study/training/
tour or fail to serve for up to the period as referred to in Section 40(c) of
the Civil Service Act, 2049 (…) (As Amended), I fully consent that the
Government of Nepal may recover from me, as government dues, all
amounts equivalent to the salary, allowance and other economic
facilities obtained by me during the period of the study/training/tour and
air fare obtained to go to and come from the said programme,
scholarship and other economic facilities received from the donor
agency from the salary, allowance, pension or gratuity receivable by me
from the Government of Nepal and the employee provident fund and
citizen investment fund held in my name, amount receivable by me in
lieu of my accumulated home leave and sick leave, amount receivable
by me for medical expenses, insurance amount accrued with joint
investment of the Government of Nepal and of me and any movable and
immovable property in my name within Nepal, pursuant to Section
40(d2) of the Civil Service Act, 2049(…).
Official causing bond to be executed: Civil employee making bond:
Signature: Signature:
Name: Name:
Post: Post:
Office: Office:
Date: Date:

346 Inserted by Seventh Amendment.
Official causing bond to be executed: Civil employee making bond:
Signature: Signature:
Name: Name:
Post: Post:
Office: Office:
Date: Date:

Schedule-12C.347
(Relating to Rule 63A.)
Format of bond to be executed by a civil employee in the course of
requesting for extra-ordinary leave to serve in a national and
international organization/ institution
(This bond must be submitted along with the application made for approval of
extra-ordinary leave)
Whereas, I————–,serving in the post of …………………………………..
Ministry/Commission/Secretariat/Department/Office have, vide the decision of
the Government of Nepal (….level), dated………., obtained prior approval to
serve in ……..organization/institution from …………to …………..;
Now, therefore, I hereby make this request for the extra-ordinary lever to
service in the said organization/institution for the said period. If the leave is
approved, I shall attend the body in which I have lien immediately on the
expiration of the period of leave, and shall, upon returning from the leave,
compulsorily serve for the period equal to the period of my leave.
Official causing bond to be executed: Civil employee making bond:
Signature: Signature:
Name: Name:
Post: Post:
Office: Office:
Date: Date:

347 Inserted by Seventh Amendment.

Schedule -13
(Relating to Sub-rule (1) of Rule 64)
Application of Leave
Government of Nepal
……… Office

348 Inserted by Seventh Amendment.
349 Amended by Seventh Amendment

For use by the Personnel Administration Section

Personnel Administration Section

Schedule-14
(Relating to Sub-rule (2) of Rule 69)
Description of leave and medical expenses

351 Amended by Seventh Amendment.

Schedule-15 (352)
(Relating to Sub-rule (1) of the Rule 78)

Work performance evaluation form of non-gazetted and classless civil
employees
Guidelines for filling the work performance evaluation form:
1. This form shall have to be filled every fiscal year (on the basis of work carried out from the 1st day of the month of Shrawan to the last day of the month of Ashadh (July 15 to July 14)).

2. The work performance evaluation form has been divided into the following three sections:

Section a: Details and achievements of the work performed.
Section b: Evaluation of the level of work performance.
Section c: Evaluation of the review committee.

3. The concerned civil employee shall fill all subjects, goals and achievements in the columns specified as to be filled by the employee, under the details of work as prescribed in Section (a). In so filling the work performed by the employee, he or she shall fill from the works specified in his or her job description and included in the annual action
plan. The employee shall also attach copies of his or her job description and approved annual action plan. A maximum five works covering, to the extend possible, all works carried out by him or her within the Seventh day of Shrwan each year shall have to be mentioned in brief. The annual work performance evaluation form filled in pursuant to Rule 78B., also putting name, signature and date thereon, shall have to be registered and . submitted to the supervisor within the specified time or where it has to be sent by post, it has to be sent to the supervisor for evaluation by a registered post within the specified time.

4. After receiving the form filled in by the concerned civil employee, the supervisor shall make comments taking into account the achievements filled in by the employee, in the columns specified as to be filled and commented by the supervisor as set forth in Section (a). On the basis of achievements of works as filled in by the civil employee and comments, the supervisor shall fill the portion “Evaluation of Supervisor” of Section .

(b). In so making evaluation, the supervisor shall examine whether the employee has presented the description of the achievements of works specified in his her job description and included in the annual action plan and make evaluation on that basis. Upon so making evaluation, the supervisor shall so submit the work performance evaluation form, also putting his or her name, post, signature and date on it, to the reviewer that the reviewer can receive it within the last day of the month of Shrwan.

5. The reviewer shall fill the portion “Evaluation of Reviewer” of Section (b) on the basis of Section (a) of the form received from the supervisor, within the Fifteen day of the month of Bhadra each year. The reviewer shall so submit the work performance evaluation form so filled, also putting his or her name, post, signature and date on it, as the review   committee can receive it.

6. If, in relation to the work performance evaluation forms submitted to the review committee, the review committee is not satisfied with the evaluation of the supervisor or reviewer or both, it may seek clarification from the reviewer or supervisor or send it back for reconsideration, along with the grounds for re-evaluation. In relation to the work performance evaluation forms so sent, the supervisor and the reviewer shall make re-   evaluation or set out rationale, reason, if is not necessary to amend the evaluation made before, and submit the same to the review committee within Three days after the receipt of the forms by the supervisor and the reviewer. If the work performance valuation forms so submitted again do not contain reasonable reason or marks are not also amended, the review committee shall make comments on this matter and write to the  concerned body to record such supervisor and reviewer and reconsider their work performance evaluation.

7. The review committee shall evaluate the work performance evaluation   forms submitted also on the basis of the evaluation made by the reviewer and the supervisor and forward them to the Public Service Commission and the secretariat of the promotion committee within the last day of the month of Bhadra each year.

8. In respect of a civil employee who has worked under the supervision of more than one supervisor for one period, one who is the supervisor at the end of that person shall fill this form for the whole period.

9. In registering the work performance evaluation form after the period as referred to in Sub-section (6a) of Section 24A. of the Act, it has to be registered within the current financial year. The review committee shall reduce one mark in the work performance evaluation form so registered.

10. Where any civil employee has filled in the work performance evaluation form in time as required to be submitted within the specified time, and the work performance evaluation form already registered with the office is destroyed due to fire or similar other divine calamity or natural disaster, the incumbent evaluator shall, with the approval of the pertinent Ministry, send the work performance evaluation form filled in by such a civil employee, accompanied also by the cause of its destroy and evidence thereof, back to the employee to again fill in the work performance
evaluation form. The evaluator shall mention the reason for re-evaluation  in, and also attach the evidence with, the work performance evaluation form so evaluated.

11. In the course of evaluating the work performance of civil employees, the supervisor shall make evaluation on the following basis:

(a) To give a maximum of excellent grade marks, without giving most excellent grade marks, for one appropriate segment out of the four segments (cost, time, quantity and quality), to a civil employee who remains absent for more that Thirty consecutive days without getting a leave approved or without making an application for leave,

(b) To give a maximum of excellent grade marks, without giving most excellent grade marks, on the ground relating to the overall quality of work, to a civil employee who has been awarded the punishment of censure or withholding of grade or promotion in respect of the year in which he or she has been awarded that punishment,

(c) In cases, except where a civil employee has obtained certification by the Funds and Accounts Controller Office
that a circumstance beyond his or her control has arisen in relation to any advance obtained by him or her, where the
civil employee has not been able to settle the advance within Six months, subject to the laws in force relating for
financial administration and settlement of advances, to give a maximum of excellent grade marks, without giving most excellent grade marks, on the ground relating to the overall quality of work, to such an employee.

(d) Where a civil employee holding the post of Chief of Office or Head of Department or chief of project has not been able   to achieve Fifty percent goal or result throughout the year despite the sanction of funds and approval of programs during the first four monthly period of a fiscal year, to give a maximum of excellent grade marks, without giving most excellent grade marks, on the ground relating to the overall  quality of work, to such an employee,

(e) The goal of business to be performed by a civil employee holding a post other than the post of Chief of Office shall
be determined by a collective meeting of employees within the first four monthly period of each year. In making
evaluation of a civil employee who fails to achieve Fifty percent goal so determined, to give a maximum of excellent
grade marks, without giving most excellent grade marks, on the ground relating to the overall quantity of work as
referred to in Clause (d), to such an employee, Provided that, if the goal specified in Clauses (d) and (e) could not be achieved due to other reason than that of the concerned employee, the marks shall not be decreased.

(f) If there is any evidence that any civil employee has done an undisciplined act, to give a maximum of excellent grade marks, without giving most excellent grade marks, on the ground relating to the overall quantity of work,

(g) To give a maximum of excellent grade marks, without giving most excellent grade marks, on any one of the two grounds relating to the overall quantity and quality of work to a civil employee who does not fill up the half-yearly work performance evaluation form within the time-limit as referred to in Sub-rule (2) of Rule 78B. and a civil
employee who does not evaluate the yearly and half yearly work performance.

12. Where, in reducing marks on the grounds as referred to in serial number 11, marks are to be reduced in relation to the same civil employee on more than One ground, it shall not be required to reduce marks on more than Two grounds out of the Four grounds in One year.

13. If it appears that marks have not been reduced accordingly despite the existence of the reasons as referred to in serial number 11, One mark shall be reduced in the evaluation of the work performance
of such an evaluator.

14. Even if marks are to be reduced pursuant to serial number 11, there shall be attached documents accompanied by clear reasons for the same.

15. In making work performance evaluation, the work performance evaluator shall make such evaluation by clearly writing marks in such column of the work performance form as specified for the purpose of giving marks

Format of Work performance evaluation form of non-gazetted and classless civil employees
Office where details are submitted to:
Registration No.:
Date:
Name of employee: Code of employee:
Period of evaluation: From….. To…….
1. Post 2. Class: 3. Service:
4. Group: 5. Sub-group:
6. Name of the Office:
7. Date of appointment to the current post:
8. Offices transferred to during this period of evaluation:
Serially:
9. Date of submission to the supervisor:
Part-A
Details of Work Performed
Works of which
targets specified
and not
specified
Details to
be filled by
employee
Quantity Cost Time Quality
(a)
(b)
(c)
(d)
(e)
Other works
done at one’s
own initiative
(a)
(b)
If any work could not be performed, the reason thereof:
Works
(a)
(b)
(c)
(d)
Signature of
employee:
Reasons
(a)
(b)
(c)
(d)
Attempted to
resolve
(a)
(b)
(c)
(d)
Date:
Comment of
supervisor:
(a) Rationale of
reason:
Correct
Incorrect
(b) Attempt made
to resolve reason:
Correct
Incorrect
Signature of
Supervisor:
Date:
Note: (1) Possible attempt shall be made to fill the grounds specified for the works of which targets are specified, namely quantity, cost, time and quality).
(2) While filling the details of works of which targets are not specified, the civil employee shall point out the quantity, cost and time, to the extent possible.

Part-B
Evaluation of supervisor and reviewer

Date of submission to the supervisor:

Date of submission to the reviewer:
Evaluation of supervisor Evaluation of Reviewer
Standard Most
excellent
Excellent Normal Low Most
excellent
Excellent Normal Low
Standard of work
performance
(on the basis of job
description)
Marks 6.25 5.25 4.25 3.25 2.5 2 1.5 1
1. Overall quantity
of work
performed.
2. Overall cost of
work
performed.
3. Overall time of
work
performed
4. Overall quality
of work
performed
Total:
Marks obtained
Full marks
Marks obtained
Full marks
Reason to be set
out for giving
more than 95
percent and
less than 75
percent marks.
Name of Suprevisor:
Employee code:
Signature:
Date:
Name of Reviewer:
Employee code:
Signature:
Date:
If it is not possible to evaluate the cost, the marks set aside for this may be distributed to the rest three grounds proportionately. If description cannot be accommodated in any column, it shall be set forth in a separate sheet an
certified and attached. The supervisor and the reviewer shall make evaluation, on the grounds specified in Section 24A. of the Civil Service Act and the Civil Service Regulation and submit the forms to the reviewer or review committee within the period as referred to in Rule 78B. of the Civil Service Regulation. Reason is to be set out clearly for giving more than 95 percent and less than 75 percent marks pursuant to Sub-rule (7) of Section 24A. of the Civil Service Act, and less than 75 marks are given, information thereof shall be given to the concerned civil employee, and if the employee makes any comments, the form shall be accompanied also by such comments and submitted to the review committee. The Competent Authority shall take departmental action against the evaluator who uses tipex over the marks obtained.

Part-C
Evaluation by the review committee
Name of employee: Post: Class:
Date of submission to the review committee:
Standard Most
excellent
Excellent
Normal Low
Personal quality and conduct
Marks 1 0.75 0.50 0.25
(a) For non-gazetted
employees
(1) Knowledge of subject
matter and skills
(2) Ability to maintain
secrecy.
(3) Ability to act as per
direction
(4) Attendance, time and
discipline
(5) Honesty and morality
Full marks
Total marks obtained
Marks
Standard Most
excellent
Excellent
Normal Low
(b) For classless employees Marks 1 0.75 0.50 0.25
(1) Knowledge of subject
matter and skills

(2) Ability to act as per
direction
(3) Interest in work, and
enthusiasm
(4) Obedience and discipline
(5) Vigilance and promptness
Full marks
Total marks obtained
Marks
Review committee officials’:
Name Post Employee code Signature Total marks secured
1. In figure:
2. In words:

Date:
Note: If the review committee is to give more than 95 percent and less than 75 percent marks pursuant to Sub-section (7) of Section 24A. of the Civil Service Act, clear reason shall be assigned for the same.

Schedule-15A.353
(Relating to Sub-rule (1) of Rule 78)

Semi-annual and annual work performance evaluation form of gazetted
civil employees

Guidelines for filling the work performance evaluation form:

1. The semi-annual work performance form of this Schedule shall have to
be filled on the basis of every semi-annual period and the annual work
performance evaluation form shall have to be filled on the basis of every
fiscal year (on the basis of work carried out from the 1st day of the
month of Shrawan to the last day of the month of Ashadh (July 15 to
July 14).

2. The work performance evaluation form has been divided into the
following three sections:

Section a: Semi-annual work performance evaluation form.
Section b: Annual work performance evaluation form (evaluation by
the supervisor and the reviewer)
Section c: Evaluation by the review committee.

3. The concerned civil employee shall fill all columns from 1 to 4 specified
as to be filled by the employee, as prescribed in Section (a).

Works haveto be mentioned in short in a manner to cover all works performed by
him or her in the specified period, to the extent possible. The works so
mentioned as to have been performed by the employee have to be
included in his or her job description and in the annual action plan.
Generally, works which are not included in the job description and the
action plan and which are included in the job description and action
plan of another post shall not be filled. The form so filled, also putting
name, signature and date thereon, shall have to be registered with the
concerned office for the purpose of submitting to the specified
supervisor, within Seven days of the expiration of every period. In
submitting such a form, the employee shall also attach copies of his or
her job description and approved annual action plan. In evaluating the
semi-annual work performance evaluation form so filled by the gazetted
employee, the supervisor shall examine whether the works mentioned as
performed by the concerned civil employee are included in his or her
job description and approved action plan and the employee has
presented the description of the achievements of works specified in his
or her job description and included in the annual action plan, and shall
return it, along with his or her feedbacks to the concerned employee
within another Seven days. The annual work performance evaluation
form filled in pursuant to Rule 78B., mentioning the works performed
by the concerned employee, within the Seventh day of the month of
Shrwan each year, also putting name, signature and date thereon, shall
have to be registered for evaluation and submitted to the supervisor
within the specified time or where it has to be sent by post, it has to be
sent to the supervisor for evaluation by a registered post within the
specified time. On the basis of the semi-annual work performance
evaluation form filled in by the civil employee, the supervisor shall fill
in the portion “Evaluation of Supervisor” of Section (b) for annual work
performance evaluation within the last day of the month of Shrwan each
year.

4. After making such evaluation, the supervisor shall, putting his or her
name, post, signature and date on it, submit the work performance
evaluation form to the reviewer so that the reviewer can receive it.

5. The reviewer shall fill the portion “Evaluation of Reviewer” of Section
(c) on the basis of the annual work performance evaluation form
received from the supervisor, within the Fifteen day of the month of
Bhadra each year. The reviewer shall submit the work performance
evaluation form so filled, also putting his or her name, signature and
date on it, to the review committee.

6. If, in relation to the work performance evaluation forms submitted to the
review committee, the review committee is not satisfied with the
evaluation of the supervisor or the reviewer or both, it may seek
clarification from the reviewer or supervisor or send it back for
reconsideration, along with the grounds for re-evaluation. In relation to
the work performance evaluation forms so sent, the supervisor and the
reviewer shall make re-evaluation or set out rationale, reason, if is not
necessary to amend the evaluation made before, and submit the same to
the review committee within Three days after the receipt of the forms by
the supervisor and the reviewer. If the work performance evaluation
forms so submitted again do not contain reasonable reason or marks are
not also amended, the review committee shall make comments on this
matter and write to the concerned body to record such supervisor and
reviewer and reconsider their work performance evaluation.

7. The review committee shall evaluate the annual work performance
evaluation forms submitted also on the basis of the evaluation made by
the reviewer and the supervisor and forward them to the Public Service
Commission and the secretariat of the promotion committee within the
last day of the month of Bhadra each year.

8. In respect of a civil employee who has worked under the supervision of
more than one supervisor for one period, one who is the supervisor at
the end of that person shall fill this form for the whole period.

9. In registering the work performance evaluation form after the period as
referred to in Sub-section (6a) of Section 24A. of the Act, it has to be
registered within the current financial year. The review committee shall
reduce one mark in the work performance evaluation form so registered.
10. Where any civil employee has filled in the work performance evaluation
form in time as required to be submitted within the specified time, and
the work performance evaluation form already registered with the office
is destroyed due to fire or similar other divine calamity or natural
disaster, the incumbent evaluator shall, along with the recommendation
of the pertinent Ministry, send the work performance evaluation form
filled in by such a civil employee, accompanied also by the cause of its
destroy and evidence thereof, to the Ministry of General Administration
for approval, and upon receipt of approval from the Ministry of General
Administration , the incumbent evaluator shall cause the concerned
employee to again fill in the work performance evaluation form,
accompanied by the evidence. The evaluator shall mention the reason
for re-evaluation in, and also attach the evidence with, the work
performance evaluation form so evaluated.

11. In the course of evaluating the work performance of civil employees, the
supervisor shall make evaluation on the following basis:

(a) To give a maximum of excellent grade marks, without giving most
excellent grade marks, for one appropriate segment out of the
four segments (cost, time, quantity and quality), to a civil
employee who remains absent for more that Thirty consecutive
days without getting a leave approved or without making an
application for leave,

(b) To give a maximum of excellent grade marks, without giving most
excellent grade marks, on the ground relating to the overall
quality of work, to a civil employee who has been awarded the
punishment of censure or withholding of grade or promotion in
respect of the year in which he or she has been awarded that
punishment,

(c) In cases, except where a civil employee has obtained certification
by the Funds and Accounts Controller Office that a circumstance
beyond his or her control has arisen in relation to any advance
obtained by him or her, where the civil employee has not been
able to settle the advance within Six months, subject to the laws
in force relating for financial administration and settlement of
advances, to give a maximum of excellent grade marks, without
giving most excellent grade marks, on the ground relating to the
overall quality of work, to such an employee.

(d) Where a civil employee holding the post of Chief of Office or
Head of Department or chief of project has not been able to
achieve Fifty percent goal or result throughout the year despite
the sanction of funds and approval of programmes during the first
four monthly period of a fiscal year, to give a maximum of
excellent grade marks, without giving most excellent grade marks,
on the ground relating to the overall quality of work, to such an
employee,

(e) The goal of business to be performed by a civil employee holding
a post other than the post of Chief of Office shall be determined
by a collective meeting of employees within the first four
monthly period of each year. In making evaluation of a civil
employee who fails to achieve Fifty percent goal so determined,
to give a maximum of excellent grade marks, without giving most
excellent grade marks, on the ground relating to the overall
quantity of work as referred to in Clause (d), to such an
employee,Provided that, if the goal specified in Clauses (d) and (e)
could not be achieved due to other reason than that of the
concerned employee, the marks shall not be decreased.

(f) If there is any evidence that any civil employee has done an
undisciplined act, to give a maximum of excellent grade marks,
without giving most excellent grade marks, on the ground relating
to the overall quantity of work,

(g) To give a maximum of excellent grade marks, without giving most
excellent grade marks, on any one of the two grounds relating to
the overall quantity and quality of work to a civil employee who
does not fill up the half-yearly work performance evaluation form
within the time-limit as referred to in Sub-rule (2) of Rule 78B.
and a civil employee who does not evaluate the yearly and half
yearly work performance.

12. Where, in reducing marks on the grounds as referred to in serial number
11, marks are to be reduced in relation to the same civil employee on
more than One ground, it shall not be required to reduce marks on more
than Two grounds out of the Four grounds in One year.

13. If it appears that marks have not been reduced accordingly despite the
existence of the reasons as referred to in serial number 11, One mark
shall be reduced in the evaluation of the work performance of such an
evaluator.

14. Even if marks are to be reduced pursuant to serial number 11, there
shall be attached documents accompanied by clear reasons for the same.

15. In making work performance evaluation, the work performance
evaluator shall make such evaluation by clearly write marks in such
column of the work performance form as specified for the purpose of
giving marks

Part-A

Format of semi-annual work performance evaluation form of
gazetted civil employees
1. First semi-annual work performance evaluation form
Period of evaluation: From the month of Shrwan of year…. to the
last day of the month of Poush
Office where details are submitted to: Registration No.: Date:
Name of employee: Code of employee
Post and Class:
Service:
Group or Sub-group:
Name of the Office presently in service:
Date of appointment to the current post:
Offices transferred to during this period of evaluation (Serially):
Date of submission to the supervisor:

Signature of the employee: Date:

Note:
(1) The concerned civil employee shall fill the actual details up to columns
1, 2, 3 and 4 of the above form for the first semi-annual evaluation and
register it with the concerned office for the purpose of submitting it to
the supervisor within the Seventh day of the month of Magha every
year.
(2) A minimum of Five works have to be mentioned in the description of the
works performed.

(3) Works mentioned have to correspond to the objectives of the
organization and the job description of the post.
(4) For any work of which annual target cannot be specified at the
beginning, the works performed throughout the year shall be considered
to be the annual target.
(5) The supervisor shall make evaluation of the semi-annual evaluation form
submitted to him or her within Seven days and provide a copy of the
evaluation form to the concerned civil employee.
(6) If it is not possible to evaluate the time, evaluation shall be made by
making analysis also on the basis of the overall quantity achieved. If
description cannot be accommodated in any column, it shall be set forth
in a separate sheet and certified and attached.
(7) Evaluation shall be made by writing the marks in the column specified
for the purpose of giving marks.

Format of semi-annual work performance evaluation
form of gazetted civil employees
2. Second semi-annual work performance evaluation form
Period of evaluation: From the month of Magha of year…. to the
last day of the month of Ashadh
Office where details are submitted to: Registration No.: Date:
Name of employee: Code of employee
Post and Class:
Service:
Group or Sub-group:
Name of the Office presently in service:
Date of appointment to the current post:
Offices transferred to during this period of evaluation (Serially):
Date of submission to the supervisor:

Signature of the employee: Date:

Note:
(1) The concerned civil employee shall fill the actual details up to columns
1, 2, 3 and 4 of the above form for the second semi-annual evaluation
and register it with the concerned office for the purpose of submitting it
to the supervisor within the Seventh day of the month of Magha every
year.
(2) A minimum of Five works have to be mentioned in the description of the
works performed.

(3) Works mentioned have to correspond to the objectives of the
organization and the job description of the post.
(4) For any work of which annual target cannot be specified at the
beginning, the works performed throughout the year shall be considered
to be the annual target.
(5) The supervisor shall make evaluation of the semi-annual evaluation form
submitted to him or her within Seven days and provide a copy of the
evaluation form to the concerned civil employee.
(6) If it is not possible to evaluate the time, evaluation shall be made by
making analysis also on the basis of the overall quantity achieved. If
description cannot be accommodated in any column, it shall be set forth
in a separate sheet and certified and attached.
(7) Evaluation shall be made by writing the marks in the column specified
for the purpose of giving marks.

Part-B
Format of annual work performance evaluation form of
gazetted civil employees
Period of evaluation: Financial year:……..From the month of Shrwan to the
last day of the month of Ashadh
Office where details are submitted to: Registration No.: Date:
Name of employee: Code of employee
Post and Class:
Service:
Group or Sub-group:
Name of the Office presently in service:
Date of appointment to the current post:
Offices transferred to during this period of evaluation (Serially):
Date of submission to the supervisor:

Signature of the employee: Date:

Note:
(1) The concerned employee shall fill the actual details up to columns 1, 2,
3 and 4 of the above form for the annual evaluation and register it with
his or her office for the purpose of submitting it to the supervisor within
the Seventh day of the month of Shrwan every year.
(2) A minimum of Five works have to be mentioned in the description of the
works performed.

(3) Works mentioned have to correspond to the objectives of the
organization and the job description of the post.
(4) For any work of which annual target cannot be specified at the
beginning, the works performed throughout the year shall be considered
to be the annual target.

Evaluation by supervisor and reviewer
Date of submission to the supervisor: Date of submission to the reviewer:

If it is not possible to evaluate the time, evaluation shall be made by making
analysis also on the basis of the overall quantity achieved. If description cannot
be accommodated in any column, it shall be set forth in a separate sheet and
certified and attached. The supervisor and the reviewer shall make evaluation,
on the grounds specified in Section 24A. of the Civil Service Act and Rule 78
of the Civil Service Regulation and submit the forms to the reviewer or review
committee within the period as referred to in Rule 78B. of the Civil Service
Regulation. Reason is to be set out clearly for giving more than Ninety Five
percent and less than Seventy Five percent marks pursuant to Sub-rule (7) of
Section 24A. of the Civil Service Act. The Competent Authority shall take
departmental action against the evaluator who uses tipex over the marks
obtained.
Note:
(1) The supervisor shall, based on the semi-annual evaluation forms filled
by the civil employee, evaluate the annual work performance evaluation
form of the gazette civil employee and so submit that the reviewer
receives it within the month of Shrwan.
(2) The reviewer shall evaluate the annual work performance evaluation
form of the employee submitted to him or her and so submit that the
review committee receives it within the Fifteenth day of the month of
Bhadra.
(3) Reason is to be set out clearly for giving more than 95 percent and less
than 75 percent marks by the supervisor or reviewer for the work
performance evaluation to be made annually; and where less than 75
marks are given, information thereof shall be given to the concerned
civil employee, and if the employee makes any comments, the form shall
be accompanied also by such comments and submitted to the review
committee.

Part-C
Evaluation by the review committee
Date of submission to the review committee:
To give the mark of the same level if agreed with the evaluation made by the
supervisor and the reviewer, and in the other cases, to make evaluation by
setting out remarks:
Name of employee: Post: Class:

Review committee officials’:

Name Post Employee code Signature Total marks obtained
1. In figure:
2. In words:
3.
Note:
(1) The review committee shall evaluate the work performance evaluation
forms so received by the committee and forward them to the Public
Service Commission and the secretariat of the promotion committee
within the last day of the month of Bhadra.
(2) If the review committee is to give more than Ninety Five percent and
less than Seventy Five percent marks to any civil employee for the work
performance evaluation, clear reasons shall be assigned for the same.
The Competent Authority shall take departmental action against the
evaluator who uses tipex over the marks obtained.

Schedule -16
(Relating to Sub-rule (2) of Rule 80)

Details of geographical regions

“Category A”

1. Taplejung of Mechi Zone
2. All area of Sankhuwasaba of Sagarmatha Zone except southern area
including Num.
3. Solukhumbu of Sagarmatha Zone
4. Janakpur Zone, Lamabagar and Rolwaling area of Dolkha District
5. Bagmati Zone, Singhar area north to Setibas of Dhading District
6. Manang and Larke area north to Sridibas of Gorkha District
7. Mustang District other than southern area from Tukuche and Dhorpatan
area of northern Baglung of Dhawalagiri Zone
8. Rolpa and Rukum of Rapti Zone
9. Humla, Jumla, Mugu, Kalikot and Dolpa of Karnali zone
10. Jajarkot of Bheri Zone
11. Bajhang and Bajura of Seti Zone

12. Darchula of Mahakali Zone

“Category B”

1. Panchthar of Mechi Zone
2. Bhojpur, Terathum and sourthern area of Sankhuwasabha including
Num.
3. Okhaldhunga and Khotang of Sagarmatha Zone
4. Janakpur Zone, remaining area of Dolkha District except, Lamabagar
and Rolwaling area, Ramechhap
5. North area than Ramchhe of Rasuwa District of Bagmati Zone
6. North area to Khudi of Lamjung of Gandaki Zone
7. Aarghakhanchi and Gulmi of Lumbini Zone
8. Southern area of Myagdi, Parbat, Mustang District from Tukuche and
Dhorpatan area of northern Baglung and Ratamate Village located at
Tara Gaun Village Development Committee of Baglung District situated
at south of Niskot Hill of Myagdi District and Baglung District other
than eastern part of north-south latitude of Gulmi District.
9. Salyan and Pyuthan of Rapati Zone
10. Doti and Aacham of Seti Zone
11. Dadeldhura and Baitadi of Mahakali Zone
12. Dailekh of Bheri Zone

“Category C”

1. Ilam of Mechi Zone
2. Dhankuta of Koshi zone
3. Udayapur of Sagarmatha Zone
4. Sindhuli of Janakpur Zone
5. Sindhupalchowk and remaining areas of Dhading District other than
Singher area of north of Setibas and south area including Ramchhe of
Rasuwa District of Bagmati Zone.
6. Tanahun, Syangja and remaining Gorkha other than north area of Lakre
of Sirdibas and remaining part other than northern area of Khudi of
Lamjung District of Gandaki Zone
7. Palpa District Lumbini Zone
8. Remaining part of Baglung District located at east of north south
latitude touching Gulmi District extending from Ratamata Village
located at Tara Village Development Committee, Baglung District,
situated at south from Niskot hill of Myagdi District.
9. Dang of Rapati Zone
10. Bardiya and Surkhet of Bheri Zone
11. Kailali of Seti Zone
12. Kanchanpur of Mahakali Zone

“Category D”

1. Jhapa of Mechi Zone
2. Morang and Sunsari of Mechi Zone
3. Saptari and Siraha of Sagarmatha Zone
4. Dhanusha, Mahottari and Sarlahi of Janakpur Zone
5. Nuwakot and Kavrepalanchowk of Bagmati Zone
6. Bara, Parsa, Rautahat, Chitwan and Makawanpur of Narayani Zone
7. Kaski of Gandaki Zone
8. Rupandehi, Nawalparasi and Kapilvastu of Lumbini zone
9. Banke of Bheri Zone.
10.Kathmandu, Bhaktapur and Patan of Bagmati Zone

“Category E“355……

Format of Decision of the Departmental Punishment
Form of punishment order decision
Made … … … … … … by Mr./Ms…… …… …… ……of …
… ……… … … Office/Department/Ministry /Commission/ Secretariat
While conducting an enquiry/causing to conduct an enquiry by Mr.
… … … … … …(employee code number)356…., working in the post of
… … … … … …in the ………………Office/Department/Ministry
/Commission/ Secretariat, clarification submitted by him or her in respect of
the clarification demanding to produce within … … days has been given to Mr.
… … … … … … to submit defense in accordance with Sub-section (1) of
Section 66 of the Civil Service Act, 2049 (—–), the statement of defense,
proof and evidence submitted by him or her have not been found satisfactory
due to … … … … reasons. Therefore, a clarification has been demanded in
accordance with Section —–of the Act stating that why should not be taken an
action to … … … … … offence in accordance with clause … … … … … of
Section —of the Act, … … … days have been given to furnish proof, evidence
or any other reasons for not taking an action, it has been found that he has
submitted a clarification stating … … … … … In this connection, the
documents, proof and evidence collected and also considering the submitted
clarification, it has been found from … … … … proof and evidence that Mr.
… … … … … … has committed the offence in accordance with sub-section
… … … … … of section … … … … … of the Act, hence, … … … …
offence in accordance with Clause … … … of the Section 59 of the Act has
been proposed and … … … … … as per the advice of … … … office of the
Public Service Commission in accordance with clause … … of clause (—) of
Section 59 of the Act, therefore, the order of decision of punishment has been
made in accordance with Clause (–) of Section 71 of the Act against
Mr./Ms.… … … … …
In case of dissatisfaction with this order, an appeal may be to … … … within
the time limit as referred to in Clause (d) of Rule 114.
Signature:
Date:

Pension Requisition Form
To,
The Director General,
Civil Employees Record Office.
Whereas, I am going to retire/have retired from the civil service for the
following reason from date……………..,
Now, therefore, I have set out the details relating to my service and necessary
details as follows:
To mention the reason for retirement, mention the mark(×)
(a) Retirement from age limit:
(b)
(c)
I have served for Twenty years or more pursuant to Section 37(1) of the Civil
Service Act, 2049(….). I have, therefore, filled up and sent this form for the
preparation of the pension authorization.
1. Name, surname:
1A.Employee code number:
2. Permanent address (district, VDC/Municipality, as well):
3. Age to complete on the date of retirement: Year ….Month……Day
4. Designation on the date of retirement:
5. Office in service when retired:
6. Office of initial recruitment and date of recruitment:
7. Testamentary heir’s:
(a) Name, surname:
(b) Address (district, VDC/Municipality, as well):
(c) Relation (set out relationship):
Address where the letter of authorization is to be sent by the Civil Employees
Record Office:
Signature:
Date:

Format of certificate to be given to recipient of civil service award
Government of Nepal
(Crest)
Mr./Ms………….
………………….
The Government of Nepal has awarded ………most excellent/excellent/civil
service award of financial year………………for having
performed……………… in the post of……………. of the Civil Service of the
Government of Nepal.
The Government of Nepal expects special contribution from you even in the
future.
…………. ……………… ……………..
Secretary Chief Secretary Minister
Min of General Admin Government of Nepal /Minister of State
General Admin

Format of application to be made for the registration of trade union of
civil service
To,
The Department of Labor and Employment Promotion.
Whereas, the executive committee has authorized me to register the trade union
of civil employees pursuant to Clause (b) of Sub-section (2) of Section 53 of
the Civil Service Act, 2049 (…);
Now, therefore, I have made this application, accompanied also by the
documents set forth in Sub-rule (3) of Rule 117A. of the Civil Service
Regulation, 2050(…), for the registration of the trade union of civil employees.
Sincerely,
(On behalf of ….trade union)

Employee’s name and code number361:
Name: Office where to statement is submitted:
Class and post :
Office: Name:
Address:
(a) Immovable property (house, land)

(b) Cash, jewels, gold, silver etc.

(c) Statement of Shares and the Bank Balance

(d) Details of loan / mortgage borrowed and given

(e) Details of loan or mortgage, if any lent or undertaken:

I hereby sign covenanting that the above-mentioned details are true and correct
to the best of my knowledge and information.
Name and post:
Date:
Note :
1. In cases where the property is increased or decreased after submission of
this statement, such details have to be submitted in a sealed envelope to
the concerned body.
2. This statement shall not be used for other purposes except for legal
proceedings to be undertaken as per law against the government
employee. No person other than the concerned official shall be allowed
to see this Statement. This Statement shall be maintained as confidential
without publication.

Format of identify card of civil employee
Front
Government of Nepal
(Crest)
Photograph
Name:
Designation:
Citizenship number:
Blood group:
Code number:
Reserve
Certifying official’s signature: Employee’s signature:
Designation:
Name:
Designation:
Office:


Note:
(1) The employee identity card’s length shall be 9 cm and breadth 5.5 cm.
(2) The employee identity card shall be in white paper.
(3) On the front side of the employee identity card, the words “Government
of Nepal” shall be written in 12 font letters, the name of the concerned
office in 14 font letters, the name of employee in 18 font letters, and
designation and citizenship number below the designation in 16 font
letters.
(4) The crest of the Government of Nepal shall be printed in red on the
upper part of the front side of the employee identity card, and an auto
size photo shall be glued on the lower part in the right hand side.
(5) Code number shall be written in 14 font letters on the lower part of the
reverse side of the identity card, and below it shall be the signature of
the certifying official on the right hand side and employee’s signature on
the left hand side.
(6) There shall be written the name of employee, name of office and
designation of employee in 14 font letters on the lower part in the
reverse side of the identity card.
(7) There shall be written a notice in 12 fonts in the rest part of the reverse
side of the identity card that” if any one finds this identity care, one is
requested to hand over it to the concerned Office, District
Administration Office or Police Office”.
(8) The offices under a Ministry and Department shall mention only the
name of their respective offices.
(9) The Chief of Office or the officer responsible for personnel
administration, as authorized by him or her, shall certify the identity
card.
(10) The employee identity card shall be put in a plastic (transparent) cover
and be put on in such a manner as to fall one Bitta lower in the left
chest and as to be clearly conspicuous to other persons.
(11) In distributing the employee identity cards, they shall be distributed at
the expense of the concerned office for the first, and if another card is to
be obtained because of loss or torn out, the employee shall obtain it at
his or her own expense. The details of obtaining another identity card
because of loss or torn out shall be recorded and amount received from
him or her shall be credited to the revenue. Provided that if an employee
is transferred, promoted or designated as acting, the concerned office
itself shall provide the employee identity card.
(12) The employees of all government and semi-government offices shall
compulsorily put on the employee identity card while entering into and
serving in the office, and use it in other places as per necessity.
(13) The concerned Chief of Office shall be responsible for using and causing
to be used the employee identity card. The Chief of Office may not
allow any employee who does not so put on the employee identity card
or does not obtain it to enter into the office or may take action against
such employee to maintain discipline.
(14) If any employee relieves of service, he or she shall immediately return
his or her identity card to his or her office

(Source: Nepal Law Commission)

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