cg';"rL@

lgod $ sf] pklgod -!_ ;Fu ;DalGwt

g]kfn OlGhlgol/ kl/ifb\

sfof{no k|of]hgsf] nflu xfn;fn} lvlrPsf]
kf;kf]6{ ;fOhsf]
jif{ dlxgf ut]
btf{ g+= kmf]6f] tyf kmf]6f]
ldlt / kmd{df kg{] u/L
ju{ M
b:tvt

gfd btf{sf] nflu b/vf:t

g]kfn OlGhlgol/ kl/ifb\
sf7df8f}+
g]kfn OlGhlgol/ kl/ifb\ P]g, @)%% sf] bkmf !@ / g]kfn OlGhlgol/ kl/ifb\ lgodfjnL, @)%& sf] lgod $
adf]lhd OlGhlgol/ ;]jfJoj;fo ug{ g]kfn OlGhlgol/ kl/ifb\df gfd btf{ u/fpg b]xfo adf]lhdsf] ljj/0f vf]nL
b/vf:t k]z u/]sf] 5' .
!= k'/f gfd / y/ M =========================================================================================================================================================
NAME (IN BLOCK LETTERS) : =========================================================================================================================

@= hGd ldlt M -lj=;+=_================================================================ -O{=;+=_ =============================================================

#= cfdfsf] gfd M=================================================================================================================================================
$= afa'sf] gfd M===================================================================================================================================================
%= afh]sf] gfd M==================================================================================================================================================
^= gful/stf g+= M ===============================================================================================================================================
&= :yfoL 7]ufgf M=================================================================================================================================================
c~rn ======================================= lhNnf M========================== uf=lj=;= gu/kflnsf M =======================================
j8f g+= ========================== 6f]n M ======================================= ufpF M ==================================================================
kmf]g g+= ========================================================= Od]n M ====================================================================================
*= c:yfoL 7]ufgf M==============================================================================================================================================
c~rn======================================= lhNnf M========================== uf=lj=;= gu/kflnsf M ========================================
j8f g+= ========================== 6f]n M ======================================= ufpF M ==================================================================
kmf]g g+= ========================================================= Od]n M ====================================================================================
(= kqfrf/ ug{] 7]ufgf M
!)= s'g} ;+3, ;+:yf jf sfof{nodf sfo{/t eP ;f] ;+3, ;+:yf jf sfof{nosf]
s_ gfd =======================================================================================================================================================
v_ 7]ufgf ====================================================================================================================================================
u_ kb ===========================================================================================================================================================
!!= xfn btf{ x'g rfx]sf] btf{sf] ju{ M ======================================================================================================================
1. Name ( IN BLOCK LETTERS) .....................................................................................

2. Date Of Birth (B.S.).................................................... ( A.D.) .........................................

3. Father's Name ..................................................................................................................

4. Grand father's Name .......................................................................................................

5. If married, Husband or Wife's Name ............................................................................

6. Citizenship ........................................................................................................................

7. Permanent Addresses:

Zone....................... District............................. V.D.C. / Municipality ..............................

Ward No.................. Tole..............................................

Village....................................................

Phone......................................................... Email ...........................................................

8. Temporary Addresses

Zone....................... District............................. V.D.C. / Municipality ..............................

Ward No.................. Tole..............................................

Village....................................................

Phone......................................................... Email ...........................................................

9. Postal Address ..................................................................................................................

10. if engage (posted) in any organization/ office name & address of the organization/ office

..................................................................................................................................

11. Category (to be registered) .............................................................................................

12. Registered in professional Organization if any

a. Name of Organization .....................................................................................................

b. Membership No. & Date .................................................................................................

!@= z}lIfs of]Uotf jf pkflwsf] ljj/0f M
qm=;+= k|fKt u/]sf] z}lIfs of]Uotf cWoog ;+:yfg ;fn >]0fL s}lkmot

1=

2=

3=

4=

5=

l;kmfl/z ug{]sf] M
!= gfd M
x:tfIf/ M ;b:otf g+= M

@= gfd M
x:tfIf/ M ;b:otf g+= M

pk/f]Qm n]lvP adf]lhdsf] ljj/0f 7Ls ;fFrf] 5 . em'7f 7x/] sfg"g adf]lhd ;xF'nf, a'emfpFnf .

cf}+7f 5fk
bfofF afofF

b/vf:tjfnfsf]
x:tfIf/ M
k"/f gfd, y/ M
ldlt M

b|i6Jo M
!= b/vf:tjfnfn] b/vf:t;fy kf;kf]6{ ;fOhsf] tLgk|lt kmf]6f],c6f] ;fOhsf] Psk|lt kmf]6f], gful/stf,
6fG;lqmK6 jf ;f] ;/xsf] z}lIfs of]Uotf jf pkflwsf] k|dfl0ft k|ltlnlkx? ;d]t ;+nUg u/L k]z
ug{'kg{] 5 .
@= gfd btf{sf] nflu b/vf:t lbFbf kl/ifb\df b'O{ hgf btf{jfnf OlGhlgo/sf] l;kmfl/z k]; ug{'kg{]5 .
 g]kfn OlGhlgol/ kl/ifb\
NEPAL ENGINEERING COUNCIL
cg';"lr^
Annex-6
-lgod !! sf] pklgod $ ;Fu ;DalGwt_
(Relating to sub-Rule 4 of Rule 11)

k|lt1fkq
d =================================================================================================n] g]kfn
OlGhlgol/ kl/ifb\ P]g, @)%% ;f] sf] lgodfjnL Pj+ cGo k|rlnt sfg'gsf] clwgdf /xL
OlGhlgo/sf] x}l;otn] cfkm"n] kfngf ug{" kg{] ;a} sfd / st{Jo OdfGbf/Lk"j{s kfngf ug{]
k|lt1f ub{5' . g]kfn OlGhlgol/ kl/ifb\ P]g,lgodfjnL, ljlgod tyf k]zfut cfr/0f /
cGo k|rlnt sfg'gn] lglb{i6 u/]sf] OlGhlgo/sf] sfd, st{Jo / cfrf/ ;+lxtf ljkl/t sfd
u/]df sfg'g adf]lhd sf/jfxL x'g d]/f] dGh'/L 5 .
x:tfIf/ M
gfd M
7]ufgf M
ldlt M
Oath

I .............................................................. hereby promise to perform

all duties honestly as required to follow as an Engineer pursuant to the Nepal
Engineering Council Act, 2055 related Rules and other prevailing laws. I
agree to follow all the functions, duties and ethics as determined by the Nepal
Engineering Council Act, Rules, Byelaw and professional ethics and other
prevailing laws.

Signature:
Name :
Address :
Date :
 g]kfn OlGhlgol/ kl/ifb\
NEPAL ENGINEERING COUNCIL
Name : ...........................................................................................................

Application No : ............................................ Subject :...............................

Name of College :...........................................................................................

Name of University:......................................................................................

Passed year :...................................................................................................

Mark ( ) Document Submited For office use only

1. Citizenship c c
2. SLC (or equivalent) c c
i. marksheet c c
ii. Character c c
3. ISC (or equivalent) c c
i. Transcript c c
ii. Character c c
4. BE (or equivalent) c c
i. Transcript c c
ii. Character c c
iii. Provisional/ Degree c c
5. oath singd c c

............................ ............................
Applicant sign Checked by