Schedule- 1
Sheet-roll Form of the Employee
(Relating to sub-rule (1) of Rule 6)
1. Name of the employee:
2. Date of birth:
3. Date of completion of 58 years of age:
4. Address:
5. Name of husband/wife if married:
6. Name of father:
7. Name of mother:
8. Name of grandfather:
9. Post of first appointment:
10. Date of first appointment:
11. Office of present assignment:
12. To be mentioned the chronological date of details of service from the  present post (in the last day of Asar 2064 (July 16, 2007) to the post of  first appointment:
13. Date of completion of 5 years from the date of promotion to the post of  special class if assigned in the said post
The aforementioned contents are true and correct. I hereby sign stating that I  shall bear and pay in accordance with the law in case of being proved my false details or intentional concealing of fact.
Signature of the employee: Signature of the certifying official:
Thumb-impressions Date:
Signature of the Secretary:
Date:
(Seal of the Office)