ZCS FORM 11B

ZAMBIA CIVIL SERVICE (LOCAL CONDITIONS)

APPLICATION FOR LEAVE (OTHER THAN SICK LEAVE)
FOR A PERIOD OF LESS THAT THIRTY DAYS

(OFFICERS IN DIVISIONS I, II and III

To be completed and forwarded in TRIPLICATE to the permanent secretary or Head of Department as early possible before the proposed date of departure.

PART I
(TO BE COMPLETED BY THE APPLICANT)

Name; ………………......……………..……………….. Ministry File No …………......……………….

Appointment ……………………...........……………… Station ………………………………………
Ministry ……………………………….....……………………...........……..……………………………..
Date of commencement of present period of qualifying service ………..................…………....20……. (a)
Service in months since (a) above at date of proposed leave………..................……………………………
Division in which service ……………...........……….. Rate of leave….........…
…..………days in a month
Leave granted since (a) above ………….........………………. days.
Leave applied for ………............…… days, the first of which is to be …….......…………………20……...
Duty to be resumed on …………………………………...............20……...
Address during leave……………………….…………..................………………………………………….
………………………………....................…………………………………500.
………….

Date ……………….....………20………. …………….................…………………

(Signature of Applicant)
PART II

(TO BE COMPLETED BY PERMANENT SECRETARY OR HEAD OF DEPARTMENT)

Leave approved ………………………..……………….days.

Signature …………………………………….………………
Designation ………………………………….………………
DATE………………………………………………….…….
 ZAMBIA POLICE SERVICE
APPLICATION FOR OCCASSIONAL LEAVE

PART A
(TO BE COMPLETED BY THE APPLICANT IN TRIPLICATE)

FULL NAMES: FILE No……………………............................................................................……….

APPOINTMENT ………………………..…….............……… STATION…………………………..…
LEAVE APPLIED FOR ……………………….………………...........……………………………......
THE FIRST OF WHICH IS TO BE …………………..……………...........…………………..……….
BALANCE IF ANY…………………………….…………………………............………………...…..
DUTY TO BE RESUMED ON ………………………………………………............………….…..…
ADDRESS DURING LEAVE …………………………………………………...........……….…..…..
SPECIAL REMARKS …………………………………………………………................….…………
………………………………………………………………............…………....…

DATE ………………….....……. 20………. SIGNATURE……........………………………..

PART B.
(TO BE COMPLETED BY THE HEAD OF THE DEPARTMENT)

LEAVE DAYS APPROVED ……………………….…………………………………..………

NAME OF APPROVING AUTHOURITY ………………..…………………………..……..
DESIGNATION ……………………………………...………………………………….………
DATE ……………………………………………………..………………………………..…….
SIGNATURE OF AUTHORISING OFFICER ………………………………………………….
 MEDICAL REPORT
Stocked by QM Stores
MEDICAL REPORT
ZAMBIA POLICE SERVICE
P.O. Box 450010
MPIKA

Date……………20……

THE MEDICAL OFFICER

…………………………………………………………………….Hospital

The bearer No. ……………….. Rank………………………. Name…………..…………………….

Has been sent to you for the following reasons: ……………………………………………………………..

….……………………………………….

……………………………………………………………………….…………………………..…….
You are requested to examine him/her thoroughly and report as below on your findings

………………………………………
Officer in Charge

I have examined the above named officer and report the following with regards to his/her disability
1. He/she is suffering from………………………………………………………………………….
2. This disability is considered serious/trivial/permanent/non-permanent
…………………………………………………………………………………………………………….
3. He/she is likely to be unfit for full operation duties for………………………………..days
4. He/she can/cannot be expected to return to full operational fitness……………………………..
5. He/she will/will not require specialist attention…………………………………………………
6. I recommend/ do not recommend that you apply for a medical board to enquire into his/her fitness
for retention in the Zambia police……………………………………………………………………
7. Any other remarks of recommendations……………………………………………………………….
………………………………………….
…………………………………………………………………………………………………………
……………………………………………………………….

HOSPITAL DATE STAMP

Doctor / Medical Officer

………………………………….
 REPUBLIC OF ZAMBIA
SUMMONS TO A WITNESS

IN THE SURBODINATE COURT of …………………………………………. Class for the

……………………………………………District ,Holden at …………………………………

THE PEOPLE

Verses

To…………………………………………………… of………………………………………..
……………………………………………………………………………………………………

You are hereby commanded in the name of the President to attend in person before this

Court at……………………………………………on the……………………………………….

…………………………………………………………………………………………………….
day of ………………………………………………20…... and so from day to day till the above cause

be tried, to testify all that you know in the said cause.

You are summoned at the instance of

Issued at……………………………the………………………………..20……….

………………………………………
(Clerk of Court)
 SECTION 355 (3) CAP 88 OF THE CPC CAP 160

IN THE SURBODINATE COURT OF THE FIRST CLASS HOLDEN AT MPIKA

I ………………………………………………...............................………….of the Zambia Police having

Found ......……………….……………………………….......……………………………...
............................................................................................................................................................
Owned by……………………………………………….………….....……………………………..
............................................................................................................................................................and now
being in possession of exhibits which are subject to speedy and natural decay or which have decayed
namely ……………………………………...................………………………………………………………..
……………………………………………………………………………………………………………..
………………………………………………………………………………………..........................................
..............................................................................................................................................................................
...........................................................................................................and herby apply to the court that the said
exhibit be destroyed by order of the court.

……………………………………………..
SIGNATURE OF POLICE OFFICER
Now therefore, in pursuit to section 335 of the CPC Cap 160 having received the complaint above and
having all power as directed under the said section do herby authorise the destruction of the said exhibits
by..................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................

………………………………………
SIGNATURE OF MAGISTRATE
 FORM VSU

IN THE SURBODINATE COURT OF THE FIRST CLASS

HOLDEN AT MPIKA

THE MEDICAL OFFICER

......................................................................GOVERNMENT HOSPITAL
MPIKA.

ORDER FOR MEDICAL EXAMINATION

WHEREAS a preliminary inquiry is being held in respect of a male person by the name of
……………………………………………………………………………………………………..
The court has therefore ordered that, the said Male person be medically examined for the purpose of
ascertaining his mental capacity which in the opinion of the court is material to the proceedings before the
court.

……………………………….
MAGISTRATE

THE MAGISTRATE
This is to certify that having carried out the medical examination my findings are:
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
………………………………………………………………………………......................................................
.............................................................………

……………………………………
MEDICAL OFFICER
 CPC 32(Revised)

REPUBLIC OF ZAMBIA
WARRANT OF COMMITMENT TO UNDERGO SENTENCE OF IMPRISONMENT
{WHEREAS NO ALTERNATIVE PUNISHMENT}
(Section 307)
IN THE SUBORDINATE COURT of……………………………………………..Class
To ……………………………………………………………………………………………
WHEREAS……………………………………………..of………………………..was convicted before this
court of the offence of ( state offence with place and date)

And was sentenced to (state the punishment fully and distinctly). If it intended to backdate the sentence by
virtue of Section 37 of the Penal code care should be taken to ascertain whether the prisoner is already
serving a sentence or not).

You are required to lodge the said

In the prison of together with this warrant, in which the aforesaid

sentence shall be carried into execution according to law and for this the present warrant shall be sufficient
authority to all whom it may concern.

Dated at the day of 20……….

………………………………………….
Magistrate
 [GN No. 168 of 1961]

CPC No. 18(a)

Stocked by Govt. Printers

REPUBLIC OF ZAMBIA
In the Subordinate Court of the………………………………………………………….. Class for the
………………………………………………District, Holden at…………………………………………
Case No…………………………..20……..
THE PEOPLE
Vs
………………………………………………………
WARRANT OF COMMITMENT FOR SENTENCE
(C.P.C Section 197A & 197B)
To each and all officers of the Zambia Police and to the superintendent of the state prison at……..……..
(hereafter called the prisoner) was on the…………….day of……………………………….20…….………
Convicted by the subordinate court of the…………………class, for the………….…….……….District Holden
at………………………… for the offence of………………………………….…………..
AND it appeared to the court that on the day of the said conviction the prisoner was not less than seventeen
years of age.
AND the court was of the opinion for reasons set out in the record that greater punishment should be inflicted
in respect of the offence than this court had powers to inflict.
AND it was this day adjudged the prisoner should be committed t the high court for sentence in accordance
with the provisions of section 197A of the criminal procedure code, and the prisoner was informed of his/her rights
of appeal within fourteen days to the high court against conviction.
YOU, the said officer are hereby commanded to convey the prisoner to the prison aforesaid and there to deliver
him/her to the superintendent thereof, together with this warrant;
And you the superintendent of the said prison, are hereby commanded to receive the prisoner you’re your custody and
keep him/her until the first convenient opportunity not being less than fourteen days nor more than three months from
the date hereof when you shall have him/her before high court together with this warrant, there to be dealt with
according to law.
And for so doing this shall be your warrant.
Dated at…………………………………..this……..day of……………………20……..

…………………………………….
Magistrate
 S.C. CRIMINAL No 33
Stocked by Govt. printers

REPUBLIC OF ZAMBIA

CASE No………………………………………...........................of 20……………………

IN THE SUBORDINATE COURT of the……………………………………Class for the

………………………………………………..District, Holden at………………………….
Before……………………………on the 18th day of February 2016
At…………………………..hours in the………………………..noon.

_____________________

THE PEOPLE

Versus
RABBSON CHOLA

Tribe: NSENGA
Residential Address: ZAMBIA POSTAL SERVICES
Village: LUNDU
Chief: LUNDU
District: CHAMA
Occupation: SECURUTY ASSISTANT
Age: 56
Sex: MALE
Accused was served on……………..…………With a summon dated……………….…..20…...
Accused was arrested on ……………………Under warrant dated…….……………..…20….
Accused was arrested without warrant on 29/12/15………….……………………………….
Accused was released on bail on his own recognizance on……………………………………...

CHARGE:
{1ST COUNT}
Statement of Offence: DEFILEMENT contrary to section 138 (1) of the Penal Code Chapter 87 of the laws
of Zambia as amended with Act number 15 of 2005 and Act number 12 of 2011.

Particulars of Offence: RABBSON CHOLA, on the 29th day of December 2015 at Mpika in the Mpika
District of the Muchinga Province of the Republic of Zambia, did have unlawful
carnal knowledge of BRIDGET MULENGA a girl below the age of 16 years.

.............................................................................
 Signature of Magistrate or Prosecutor

PROSECUTOR:

INTERPRETER:

CHARGE EXPLAINED TO ACCUSED:

ACCUSED WHEN CALLED UPON TO PLEAD, SAYS:

THE COURT RECORDS A PLEA OF:

 CERTIFICATE OF CONVICTION
On……………………………………………..the accused…………………………………….
Whose particulars are recorded within was sentenced as follows:
COUNT OFFENCE SENTENCE

Note- details of binding over recommendations for deportation or order for Police Supervisors must be
included. Where a conviction on more than one count or for a variety of different offences has been
obtained, the different counts or offences and sentences will be clearly indicated and it will be stated
whether sentences are consecutive concurrent. A separate Form must be used for each convicted person
_______________________________________________________________________
Rolled impression of right thumb print to
Be impressed immediately after sentence

Signature or mark of accused…………………………… _____________________________

Court seal or ………………………
Date stamp Signature of Public prosecutor

Certified correct ……………………………………...

______________________________________________________Magistrate or Clerk of court
Remarks (enter supplementary details of offence (s) for which convicted if particulars in the charge are
inadequate, e.g. method of entry in break in, weapon used in assaults, etc):
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………….................________________________________
_______________________________________
Office Isoka C.R No._____________________________________________
 ZP Form 113
Stocked by Q.M stores

ZAMBIA POLICE
Formation………………………………………………………………………………………………………

Charge against No ……………………………………………………………………………………………..

Place of offence:…...
……………………………………………………………………………………………………

Date of offence…………………………………………………………………………………………………

CHARGE

Witnesses:

[ P.T.O]

Certificates:
(a) I certify that I have this………………………… day of…………...…………… 20……… at (time)
………………………… at (place)………………………………………………...
Give to the accused a copy of this charge sheet which has been explained to him and an abstract/
summary of evidence on which it is proposed to base the charge.

Accused does/does not require witnesses to be called in his defense.

…………………………………..
 Signature of serving officer

NOTE – To be signed by a police officer not being subordinate to the accused.

(b) Accused agrees that the contents of the above certificate are correct and that the preliminaries have
been complied with.

………………………………………
Signature of officer holding Tribunal

……………………..……………….
Name and Rank in BLOCK LETTERS
(c) I wish/ or do not wish to be defended ……………………………………….
Signature of Accused

Prosecutor:

Defense:

Interpreter:

Charge read and explained to accused.

Accused when called upon to plea says…………………………………………………..…..
…………………………………………………………………………………………………………
The tribunal records a plea of:………………………………………………………

Findings:

Sentence: ……………………………………….
Signature of officer holding Tribunal

……………………………………….
Name and Rank in BLOCK LETTERS
*Delete where not applicable
+Force order reference…………………………. Date:…………………………………
 C.P.C No 15B
Stocked by Govt. Printer
REPUBLIC OF ZAMBIA
-------------------

RECOGNIZANCE TO SURRENDER AFTER REMAND

OR ADJOURNMENT
(SECTION 116 OR 205, CRIMINAL PROCEDURE CODE)
-----------------------------

In the Subordinate court of the…………………… Class for the ………………… District

Holden at ………………………………… S……………………..20………….
Whereas hereinafter called (“the
Principal party”) stand charged with*………………………………………………
Contrary to section of the Penal Code ………………….
The undersigned principal party to this recognizance hereby binds………self to perform the following
obligations:
To appear before the court at…………………….on the……………..day of……………..20……
And on any other prior or subsequent day when required by the Court to answer to the said
Charge and to be dealt with according to law.
And the said principal party, together with the undersigned sureties, hereby severally acknowledge
themselves bound to forfeit to ………………………………the sum following, viz: The said principal party
the sum of…………………………….kwacha and the said sureties the sum
of………………………………………..Kwacha each, in case the said principal party
Fails to perform the above obligation or any part thereof.

Signed) ………………………………………………………
Principal party
(Signed) ………………………………………………………..}Sureties

(Signed)………………………………………………………….

Taken before me at……………………………the………day of………………………20……..

………………………………………………
(Magistrate)
 CPC 15
REPUBLIC ZAMBIA

WARRANT OF COMMITMENT IN CUSTODY FOR TRIAL

(Criminal Procedure Code Cap 60 Section 231)

In the subordinate court of the ……………….………………….................... Class for the

………………………….………….. District, Holden at ………………….…………………

Case No ……………………………20……….

To each and all Police Officers of Zambia Police and to the Superintendent/Officer-in-Charge of the
Government Prison at ………………………………………. And to any Prison Officer into whose hands
this warrant shall come

WHEREAS ……………………………………………..……….. (Hereinafter called the accused) Appeared

this day before this court charged with …………………………………….

AND WHEREAS, the said court, after due inquiry committed the accused for trial at the next session of the
high Court for the ……………………….………………… Province and Remanded him in custody.

NOW THEREFORE YOU said Police officer, are hereby commended to convey the accused to the said
Prison and there deliver the accused to the Superintendent/Officer-in-Charge thereof together with his
warrant, and you the Superintendent/Officer-in-Charge of the said Prison are hereby commanded to receive
the accused into your custody and to keep the accused until delivered in due course of law.

Dated at…………………………………….the …………….. Day of …………………..20…….

……………………………………
MAGISTRATE
 REPUBLIC OF ZAMBIA

WARRANT WHERE WITNESS HAS NOT OBEYED SUMMONS

In the subordinate court …………………………………….. Class, Holden at

………………………………… District, for …………….……………………….

THE PEOPLE

Vs

To ………………………………..Police Office, and the other

officers………………………………………..………was commanded to appear before this
court at ………………………. On the……………….. Day of …………………….………
20….…., and subsequent days, to testify what he knew in the above cause, but he has not
appeared according to the said summons and has not excused his failure.

Therefore, you are hereby commanded in the name of the President to apprehend and to
bring and have the said……………………………………………………
Before this Court at …………………………………………… on the……………
Day of ………………………….. 20……..

Issued at ……………………the ……………….day of …………….……20……

………………………………………..
MAGISTRATE
 REPUBLIC OF ZAMBIA
WARRANT OF COMMITMENT ON REMAND

In the subordinate court of the………………………………..…………………….Class for the

………………………….District Holden at…………………..on the……………………day of
……………………………..……………2017
To…………………………………………………Police Officer and other officers. You are commanded to
lodge……………………………………………………………...…..who is accused of the offence of
……………………………………………………………………………………………………
……………………………………………………………………………………………………
In the prisons at………………………………………there to be remanded by the officer in charge of the
prison at…………………until the………..day of……………………..2017
At 09:00hrs in the forenoon when we shall have the said…...…………………………………….
Before the court at ……………………………...……………………………..…………………..

Dated at………………………………… this……………day of……………….2017

………………………………………………..
Magistrate

-------------------------------------------------------------------------------------------------------------------
REPUBLIC OF ZAMBIA
WARRANT OF COMMITMENT ON REMAND

In the subordinate court of the17…………………………………………………....Class for the

………………..……….District Holden at……….….…..…..on the……….……….……day of.
……………………………………2017
To………………………………………Police Officer and other officers. You are commanded
to lodge………………………….……………………..who is accused of the offence of
……………………………………………………………………………………………………
In the prisons at……………….………………there to be remanded by the officer in charge of the prison
at……………………………until the …………..day of…………….………..2017
At 09:00hrs in the forenoon when we shall have the said………………………………….
Before the court at ………………………………………………………...…………………..

Dated at………………………… this……………day of………………….20…………

…………………………………………..
Magistrate
 FORM VSU 1
IN THE SUBORDINATE COURT OF THE FIRST CLASS HOLDEN AT MPIKA

THE MEDICAL OFFICER

…………………………………………..GOVERNMENT HOSPITAL
MPIKA.

ORDER FOR THE MEDICAL EXAMINATION

WHEREAS a preliminary inquiry is being held in respect of a Juvenile person by the name of

……………………………………………………………………………………………………………………………
………………………………………………………………………………………..…
The court has therefore ordered that, the said Juvenile person be medically examined for the purpose of ascertaining
her/his age which in the opinion of the court is material to the
Proceedings before the court.

………………………………….
MAGISTRATE

THE MAGISTRATE

This is to certify that having carried out the medical examinations, my findings are
……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

………………………………….
MEDICAL OFFICER
 CPC No. 12
Stocked by Govt. Printers
REPUBLIC OF ZAMBIA

PRELIMINARY INQUIRY No…………………………S…………………….of 20……

DESPOSITION OF WITNESSES ON INVESTIGATIONS

BEFORE COMMITMENT
[CPC : SS 222-236, part VIII, Cap 160]
IN THE SUBORDINATE COURT of the…………………………………………Class for the
……………………………………District, Holden at…………………………………………..
at …………hours in the……………………………………noon.

THE STATE versus……………………………………………………………………………...

Tribe……………………………………. Residential Address……………………...
Village………………………………….. Chief……………………………………..
District………………………………….. Postal Address…………………………...
Age……………………………………… Sex……………………………………….
Occupation………………………………………………
Accused was arrested on……………………………………..under warrant dated………………………..
Accused was arrested without warrant on ………………………………………………………

CHARGE:
[If space insufficient, continue overleaf]
Statement of Offence:

Particulars of Offence

……………….…………………………………………………….
SIGNATURE OF MAGISTRATE OR PUBLIC PROSECUTOR

Prosecutor:

For the accused:

 CPC No. 18
20m-K703-70p/f
Stocked by govt. printers
REPUBLIC OF ZAMBIA

WARRANT OF COMMITMENT
[ON DEFAULT OF DISTRESS OR OF PAYMENT ORDERED]

IN THE SUBORDINATE COURT of the………………………………………Class for the

…………………………………….District, Holden at……………………………………on the
………………..Day of………………………..20………….
To:……………………………………………………………………………………………….

WHEREAS………………………………………………….of………………………………..
……………………………………………………………………………………………………
…………………………………………………………………………………………………...
Was on the…………….day of…………………………..20……………convicted before this
Court of the offence of*……………………………………………………………………….
And was ordered to pay forth with (or on or before the………………………………………day
of………………………..20…..) K………………………. and the said has not been satisfied.
This is to command you to lodge the said……………………………………………………….
In the state prison at…………………………….together with this warrant, in which prison the
Said………………………………………………………shall be imprisoned(with hard labour)
For the space of……………………………………………………...…..unless the said sums
{with K……………………………….for cost of distress} be sooner paid
………………………………………………………………………..………………………….
…………………………………………………………………………………………………...

Dated at……………..………………the……………day of……………………….20………..

………………………………..
Magistrate
 REPUBLIC OF ZAMBIA

INQUISITION ORDINANCE CHAPTER 216

…………………………………………………………………………………………………………………

……………………………………………………………………………………………

Take the oath and say that, I do not wish the Postmortem to be conducted on the body of

……………………………………………….………………… who died as a result of a traffic accident

which occurred on ……………..……………………..……… at ………….…………. Hours along …..

…………….…………………………………………………………………………………………

………………………………………………..………………………………………………………….

…………………………………………………………………..……………………………………….

The reason being that this is in accordance with our religion and traditional belief.

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………….…………………………………………………………………….……………

…………………………………………..

SIGNATURE OF RELATIVES

Take to day this ……………………of …………………………………………….20………...

…………………………………………..
 SIGNATURE OF MAGISTRATE

REPUBLIC OF ZAMBIA

INQUEST ORDINANCE CHAPTER 21

DR..................................................................................................................................................
I HAVE TODAY PERFORMED A POSTMORTEM EXAMINATION ON THE BODY OF
……….........................................................................................................................
…………………………………………………………………………………………….
THE CAUSE OF THE DEATH
WAS ...........................................................................................................................................................
............................................................................................................................................................
..............................................................................................................................................................................
...........................................................................................................................................
I AM UNABLE TO CERTIFY THE CAUSE OF THE DEATH………………………………….……….
........................................................................................................................................................................
..............................................................................................................................................................................
........................................................................................................................................................................

SIGNATURE.........................................................

CORONER.................................................................................................................................... MPIKA
THE BODY OF..............................................................................................................................
THE DECEASED IS NO LONGER REQUIRED FOR POLICE INVESTIGATIONS AND MAY BE
BURIED.
SIGNED...................................................
RANK......................................................
STATION................................................
DATE......................................................
BURIAL AUTHORIZED

DATE...................................................
SIGNATURE............................................
 REPUBLIC OF ZAMBIA

CORONER’S FORM

ORDER FOR POSTMORTEM EXAMINATION (Section 14 Inquest Act Cap 216)

TO Dr:....................................................................................................................................................

……………………………………………………………………………………………

Whereas I am credibly informed that one………………………………………………………

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

Died in circumstances which may require the holding of an inquest act. You are hereby authorized and

required to take a postmortem on the body of the said…………………………..

…………………………………………………………………………………………………....

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

Which will be delivered to me by…………………………………………………………………

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

And to make a report to me thereon. Given under my hand at……………………………………..

…………………………………………………………………………..………………………..

This day ........................................ of ......................................................................... 20.............

......................................................
CORONER
 EVIDENCE
Zambia Police Service Case Number: ______________________________________________________

Item Number: __________________________________________________________________________

Date of Collection:_______________________ Time of Collection:________________________

Collected By:___________________________ Badge Number:__________________________

Description of Enclosed Evidence_________________________________________________________

_______________________________________________________________________________________________

_____________________________________________________________________________

Location Where Collected:_______________________________________________________________

_______________________________________________________________________________________________

_____________________________________________________________________________

Type of Offence:________________________________________________________________________

Victim’s Full Name:_____________________________________________________________________

Suspect’s Full Name:____________________________________________________________________

Evidence bag sealed by:_______________________________ Badge No:________________________

CHAIN OF CUSTODY

From To Date
 ZAMBIA POLICE
REPORT OF MEDICAL EXAMINATION
FOR RAPE/DEFILEMENT CASES
(TO BE COMPLETED IN TRIPLICATE)
1. Doctors full names…………………………………………………………………………......
Hospital…………………………………….Address……………………………………….
….Phone……………………. Ward…………………….Date……..…………….Time…………
2. Name of Abused person…………………………………………....Age………………............
Residential Address…………………………………………………………...………………..
3. Referred by Police Officer’s No………………Rank…………….……Cell Phone…………...
Name…………………………Formation………………….OB No…………………………...
4. Name of Nurse Present at Examination Time………………………..………………………..
His / Her Signature…………………………….…..Ward…………………...………………..
5. Consent must be obtained from: Parent / Guardian. i.e. Verbal/Written
6. External Examination
a) Condition and Appearance of clothes……………………………………………..…………...
b) Identification marks or other evidence……………………………………………..…………..
c) Condition of inner garments……………………………………………………………..……..
d) Has victim previous sexual experience…………………………………………………..……..
e) Did the victim take drugs or alcohol at time of crime………………………...………………..
7. Internal Examination:
a) Condition of hymen in defilement…………………………………………….………………..
b) Body injuries (Bruises, Bites) ……………………………………………….………………
8. Doctors Opinion:
a) The Findings are consistent with the alleged circumstances.
b) The Findings are not consistent with the alleged circumstances
Other Remarks
…………………………………………………………………………………………………………………
………………………………………………………………….........................................................
Signature of Doctor……………………..……………Police Officer…………………………………...
 IDENTIFICATION PARADE REPORT
1. Parade held at ............................... on........... day of ...........................2006 at ............. hours
2. Names or Name of suspects
(a) .............................................................................................................................................
(b) .............................................................................................................................................
(c) .............................................................................................................................................
(d) .............................................................................................................................................
(e) .............................................................................................................................................
3 Members of Parade
1................................................................. 2.......................................................................
3 .................................................................. 4........................................................................
5 .................................................................. 6........................................................................
7 .................................................................. 8........................................................................
9 ................................................................... 10......................................................................
4 Suspect told his rights........................................................................................................................
(a) Friend or Lawyer present......................................................................................................
(b) Objection to any member of the parade.................................................................................
5 Accused asked to take up his position
6 Position taken (between numbers .........................................................................................................)
7 Name/Names of identifying Witnesses: - (1) ..................................................................................
(2) ....................................................................................
(3) .....................................................................................
(4) ......................................................................................
(5) .......................................................................................
Explanation given......................... Identifies/Fails to identify Remarks....................................................
8 Accused asked if they want to change position of parade
No. 1 ......................................................................................................................................................
No.2 ...........................................................................................................................................................
No.3 ......................................................................................................................................................
No.4 ......................................................................................................................................................
No.5 ......................................................................................................................................................
9 The accused asked if he/they is/are satisfied with the way the parade was conducted..............................
10 Parade dismissed at........................................................ hours.
11 Accused/s handed over to No...................... Rank.............................Name...............................................
 ZAMBIA POLICE

INVESTIGATION DIARY

DATE/TIME ENTRY REPORT REFERENCE

NO. NO.
 ZP FORM 197
STOCKED BY POLICE QUARTERMASTER
z
REPUBLIC OF ZAMBIA
APPLICATION FORM
NOTICE TO HOLD ASSEMBLIES, MEETINGS AND
PROCESSIONS IN PUBLIC PLACES
PART A – TO BE COMPLETED BY AN APPLICANT
(your attention is drawn to the Notice overleaf)
1................................................................................................................................................
Representing.............................................................................................................................
Society/Association……………………................................... Apply for permission to hold
An Assembly/Public Meeting/Procession ………....................................................................
...................................................................................................................................................
At (Public Place) or along route (procession)..........................................................................
The objects of and reasons for the Assembly/Public Meeting/Procession
are...................................................................................................................................................
...................................................................................................................................................
List of Speakers........................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
Date ....................................20…............ Signed...................................................
Applicant

PART B – TO BE COMPLETED BY THE REGULATING OFFICER

COMMENTS: ...............................................................................................................................................
...
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
…………………………………………
Regulating Officer
PART C – TO BE COMPLETED IN THE OFFICE OF THE REGULATING OFFICER
I acknowledge that I fully understand the above conditions attaching to the permit and I agree to ensure
compliance with them.
DATE................................................... APPLICANT......................................................
 Z P Form 82
Stocked by Govt Stores
Original to be retained by Police
Duplicate to be supplied to Principal Party
ZAMBIA POLICE

POLICE BOND OR RECOGNIZANCE

WHEREAS.......................................................................................................................................................................................
Has been arrested this.................................................. Day of .............................................................................................. 20….......
At ............................................................................ for (offence).........................................................................................................
................................................................................................................................................................................................................
The undersigned principal party to this recognizance hereby binds himself/herself to perform the following obligations:
To appear before the....................................................................... Court at (place)......................................................................
........................................................................................ on the ............................... day of .................................................................
20............ at ............................... hours in the ....................................................... noon, and on any other or subsequent day when required
by the Court to answer to the said charge and to be dealt with according to law.

And the said principal party together with the undersigned sureties hereby acknowledge himself/her severally acknowledge themselves
bound to forfeit to the government of the Republic of Zambia the sum(s) following, viz.: the said principal party the sum
of ..................................................................................................................................................................... and the said sureties the sum
of ...................................................................................................................................................................................... each, in case the said
principal party fails to perform the above obligation or any part thereof.*

Signed........................................................................................................
PRINCIPAL PARTY

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

Signed Sureties
..................................................................................

Taken before me at ……….........................................................................................................................................................................

the........................................................ day of ..................................................................................................................... 20................

..............................................................................................
OFFICER IN CHARGE

Details of additional conditions.................................................................................................................................................................

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

* Delete words in italics if no sureties required.

If sureties taken, delete words ‘hereby acknowledges himself’ only
 CONFIDENTIAL ZP Form 14
Stocked by QM Stores
20m G544 3/76 S
ZAMBIA POLICE

RECOMMENDATION FOR APPOINTMENT TO CID

PART I

NO. RANK NAME

STATION……………………………………………………………………………………
Date and place of birth……………………………… ………………………………
Where educated and standard reached (other ranks only)…………………………………………….
Date attested……………………………. Date detached as aide……………………………………
Period served under officer completing this report……………………………………………………
Nature of and manner in which duties performed……………………………………………………..
Duties engaged upon during three years immediately prior to appointment as an aide:………………
…………………………………………………………………………………………………………
In possession civilian driving license: Yes/No. Classes...............................
Force authority to drive: Yes/No.
Ability to write reports:………………………………………………………………………………..
Languages: own………………………………………………………………………………………..
Fluent in………………………………………………………………………………………………..
Knowledge of…………………………………………………………………………………………..
Signature:......................................................
Date ..................................... 20........... Appointment:.................................................

PART II

Personal characteristics and general remarks on suitability for appointment to cid including observations upon officer’s
judgment and sense of responsibility
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………

Signature.....................................................

Date ..................................... 20........... Appointment...............................................

[PTO
CONFIDENTIAL
 PART III – To be completed by D.C.I.O.
Remarks
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
………………………………………..………..

Signature:......................................................

Date ........................................ 200............. Appointment:......................................................

PART IV – To be completed by Officer Commanding Division

……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………

Signature:...........................................................
Date...................................... 20…............. Appointment:.....................................................

PART V – To be completed by Assistant Commissioner CID

Signature:........................................................

Date .................................... 200............. Appointment:................................................

PART VI

Approved/not approved

Date......................................... 200........... ...............................................................

 ZAMBIA POLICE
STOCKED BY Q.M. Stores
3mpds c501 12/81 T/R2

Page No……………….

Statement of (full name) …………….………………………………… Sex/Age………………..…………………………….

Residential address…………………………………………………………………………………………………………………….
Business address………………………………………………………………………………………….............................................
Occupation ………………………………… Nationality or tribe……………………………………………………………………
Village ……………………………………Chief……………………….District……………………………………………………..
Passport/Identity Document No …………………….Issued at …………………Date………………...
 ZAMBIA POLICE SERVICE

ANTI-STOCK THEFT TEAM.

APPLICATION TO BUY AND TRANSFER STOCK

PART A

1. APPLICANTS NAME (FULL NAMES)………….……………………………………………

2. RESIDENTIAL ADDRESS………………………….…..……………………….……………..
3. BUSINESS ADDRESS………………….……………………………………….…………….
4. OCCUPATION……………………….………….. IDENTITY/NRC No……………………….
5. ISSUING OFFICER (NAME)…………………………….RANK……………...……….……...

PART B
1. BOUGHT FROM (FULL NAMES)……………….……………………………………………...
2. RESIDENTIAL ADDRESS…………………………..…………………………………………..
3. OCCUPATION……………………….….……. IDENTITY/NRC No………………………….
4. VILLAGE………………………….CHIEF…………….…………….DISTRICT………………
5. BRAND MARK (IF ANY)…………………………..…………………………………………...
6. NAMES OF VILLAGE HEADMAN…………………..………………………………………...
7. SIGNATURE OF VILLAGE HEADMAN………………………..……………………………...

DESCRIPTION OF STOCK
BULLS…………………………….OXEN…………..…………….COWS……………………………..
GOATS……………………………SHEEP………………..………PIGS……………………………….
PLACE BOUGHT………………………………….. SITUATED AT………………...…………………

PART D
1. BY ROAD/RAIL……………………..…………………………………………………………..
2. REGISTRATION NUMBER OF THE MOTOR VEHICLE………….....………………………
3. TOTAL NUMBER OF CATTLE CARRIED……………………………..…………………….
4. NAME OF DRIVER……………………………………………………………..……………….
 5. TRAVELLING FROM……………………….………TO…………………….…………………
6. SIGNATURE OF OWNER/TRANSPORTER…………………………..……………………….

PART E

CERTIFICATE/VETERINARY OF HEALTH INSPECTOR

I certify that I have checked the above stock and found them to be correct/free from disease and fit to be transferred to
any place. I issue herewith stock movement permit from my area.

SIGNATURE OF VETERINARY OFFICER…………………………………………………..

NAME…………………………………………………………….……

CERTIFICATE OF POLICE OFFICER

I hereby certify that I have checked the particulars of the above stock and found them to be correct/not correct.
CHECKED BY: RANK………………………… NAME……………………………………

DATE……………………………20…….. PLACE……………………………….

PART G
PARTICULARS OF SELLER/BRAND ETC
NAME OF SELLER VILLAGE CHIEF DISTRICT TYPE/ SIGN
COLOUR
 CS Form B26
Stocked by Govt Printer

REPUBLIC OF ZAMBIA
FORM OF VITAL STATISTICS
(General Orders No. 10)
1. Name of Officer in full…………………...............................………………………………………………………..
2. Date of birth…………………………..................................……………………………………………………………
3. Place of Birth…………………………….................................………………………………………………………..
4. Nationality of Parents: Father….………...............….………… Mother:………..........………….………...
5. Religion………………………………………..................................………..………………………………………..…
6. Title of Appointment…………………..............................………………....……………………….………………
7. Date of Marriage………...............….………… Date of Birth of Wife…………...........……………………….
Maiden and Christian names of Wife……............................……………………………………..……….…...
8. Children:
S/ DATE OF BIRTH NAMES SEX REMARKS
No
1
2
3
4
5
6
7
9. (To be completed by married women only)
Name of Husband in full………………………………...............………………………..………………………………….……
Address of Husband…………………………………………….............………………..…………………….....................
…………………………………………………..............……………..……………………………………...…
Husband’s Present occupation…………………………………….............…….………………....................................

10. Names and addresses of parents and/or other relations or friends whom you would wish to be notified in the
event of serious illness or other emergency.
(a) Name:........................................................................................................................................
Address………..............…………………………………………………………………………………………………………
Relationship (if any)…………..............……………………………………..…………………….……………………...
(b) Name ……………………………………...............………………………………………………….……………………..…..
Address………………………………………...............………………………………………….……………….…………...
Relationship (if any)……………………...............…………………………………………………………………………
 Date……….……...….........……….……20….…..… Signature…….......……………………………………
NOTE: The Permanent Secretary (Personnel) must be informed of any amendment to the details given above if it
becomes necessary.

TENANCY AGREEMENT RELATING TO PLOT / SHOP / HOUSE No………………………….

...............................................................................................................................................................
This agreement is between ………………………………......…………..………………(Land lord)
and ………………………………………………………......………………..…………… (Tenant).
1. Premises situated at Plot/House No …………………......……………………………………………
2. The location of the House is in a Commercial/Medium/High/Low cost area.
3. The Plot/House is fenced with ……………………...………………….………………….…………..
4. The House/Plot is fully electrified and roofed with Asbestos / Iron sheets.

CONDITIONS
5. The tenant will pay K…………………………....……..…….as rental per month and will
Pay K…………….…………...…….... as rent in advance for …....….…………… months.
6. The period of agreement shall be from …………....……….. To………….………………..
Thereafter further period of tenancy may be reviewed.
7. The tenant shall not sublet the premises.
8. That the damages and breakages not subject to tear and wear and which are attributed to the
negligence of the tenant shall be made well by the tenant.
9. That the Landlord undertakes to keep the premises in good state of repair and replace all furnishings
and fittings which become unserviceable as a result of tear and wear.
10. That water and electricity are paid for by the occupant/tenant.
11. This agreement may be terminated by either party by giving a notice of three (3) months before
termination.
12. That the tenant is entitled to maximum freedom.
13. That there should be no interference by Landlord or abrupt changes in the contract.
14. That payment is made in full and very prompt on due date.
15. That the tenant shall keep the premises clean and tidy.

SIGNED …………………………………………………….………………….. Landlord

SIGNED ………………………………………………….…………………….. Tenant
SIGNED ……………………………………………………………………….. Witness

Tel: 021-4-560219 In reply please quote

Fax: 021-4-560219 No. ZPNI/S/3/1
REPUBLIC OF ZAMBIA
ZAMBIA POLICE SERVICE
ISOKA POLICE STATION
P.O. BOX 440006 – ISOKA
Date:17th March,2011.

The Secretary,
Z.P.T.C SOC. LTD,
P.O BOX 30011,
LUSAKA.

RE: WITHDRAWS BY NO.39546 W/CONST.CHIBWE, NO.1842 TYPIST

PHYLLIS MUSWEMA AND NO. 39828 W/CONST. MWILA PRISCOVIA.

Reference is made to the above captioned subject and find attached withdraw slips
tendered in by No. 39546 W/CONST CHIBWE JANET whose NRC # IS 226139/31/1 and
NO. 1842 Typist MUSWEMA PHYLLIS whose NRC # IS 233999/33/1 as well as NO.
39828 W/CONST MWILA PRISCOVIA, both based at this formation who have authorized
NO. 29826 D/SGT MWENYA, NRC # 237687/43/1 to withdraw money on their behalf.
Any assistance rendered to the duo in this regard will be highly appreciated.

LANGENI K.
OFFICER-IN-CHARGE

Tel:021-4-560219 In reply please quote

Fax: 021-4-560219 No. ZPNI/SEC/ 3/4B

REPUBLIC OF ZAMBIA
ZAMBIA POLICE SERVICE
ISOKA POLICE STAION
P.O BOX 450010
MPIKA

Date: 2ND February, 2011.

The Officer Commanding,

Chinsali District Headquarters,
CHINSALI.

RE: PROMOTION QUALIFICATION REPORT ( Z.P FORM 1 ) NO. 31936 SERGEANT PHIRI A,
NO. 38145 SERGEANT MAKONDO P AND NO. 37892 CONSTABLE MUKUKA C.

May I refer to the above captioned matter and forward herewith attached Z.P Form 1
in respect of the Officers from this station who have been recommended to various positions
to fill the vacancies according to station establishment.

GENERAL DUTIES.

SHIFT OFFICER-PSS 10

1. NO. 31936 sergeant Phiri was attested on 1/10/97 and he was confirmed in the
service on 14/03/00. He is a had working officer who exihibits good
leadership qualities. He has proved himself as leader in his present rank. The
officer is recommended to the rank of INSPECTOR to fill the existing
vacancy.
SECTOR SUPERVISOR-PSS 11
2. NO. 37982 constable Mukuka was attested on 02/01/06. He was confirmed in
service on 26/12/08. He is a very intelligent, well disciplined and hard
 working officer. His bearing and turnout is very good. The officer is
recommended to the rank of sergeant to fill up the vacancy previously
occupied by sergeant Phiri.

PROSECUTIONS-PSS 10

NO. 38145 sergeant Makondo was attested on 02/01/06. The officer is very hard
working and is well disciplined. Since the time he was attached to prosecutions he has
proved himself very well were even as a court orderly he is able to present some cases. He is
currently undertaking a prosecutions course at NIPA. The officer is recommended to the
rank of INSPECTOR to fill up the vacancy of public prosecutor.

Langeni K
OFFICER-IN-CHARGE

Cc 31936
Cc 37982
Cc 38145
Cc: File.
 ZP FORM 102
Stocked by Q.M stores

ZAMBIA POLICE
ROUTE INSTRUCTIONS
Station: ........................................
…………………………………
ROUTE
…………………………………………………….TO……………………………………………………….
…………………………………………………………………………………………………………………
NUMBER……….….….RANK……………………………NAME…………………………….…………..
of…..………………………………………………………………………………..……….travelling from
……………………………….………………………..to………….............................................……………

Place…………………………..
Departure
Date…………………………….
…………………………………………………
Officer in charge/Divisional Commander
Place……………………………
Arrival
Date…………………………….

…………………………………………………
Officer in Charge/Divisional Commander

Instructions: Original Route

 ZP FORM 102
Stocked by Q.M stores

ZAMBIA POLICE
ROUTE INSTRUCTIONS
Station…………………………..
……………………20………
RETURN ROUTE
…………………………………………………………………………………………………………………
………………………………………………………………………………………
NUMBER…………….RANK…………………………NAME………………………………..
of………………………………………………………………………………….travelling from
……………………………………………..to…………………………………………………

Place…………………………….
Departure
Date…………………………….

…………………………………………………
Officer in charge/Divisional Commander

Place……………………………………
Arrival
Date…………………………………….
………………………………………………
Officer in Charge/Divisional Commander

Instructions: Return Route

Original to: Ministry of Finance
Duplicate to Head of Department
Triplicate (when used as arrival advice only) to Accts Form No 81
Personnel Division Stocked by Govt Printers

REPUBLIC OF ZAMBIA
ARRIVAL ADVICE AND PAYMENT OF SALARY
Establishment file No …………………………………… Finance File No…………………

To be completed by each officer immediately on his return from vacation leave arrival on first appointment, or whenever it is desired to amend the
method of paying salary.

THE SENIOR FINANCE OFFICER (SALARIES)

MINISTRY OF FINANCE
P.O BOX 50062
LUSAKA

1. SURNAME (IN CAPITAL LETTERS)………………………………………..………………………………....…………

FULL CHRISTIAN NAMES (IN CAPITAL LETTERS) ………………………………………………………………….
NATIONAL REGISTRATION NUMBER …………………………………………………………………………..…
WORK PERMIT NUMBER where applicable …………...………………………………………………………..……
DEPARTMENT …………………...…………. POST HELD ………………………………………………………..
CONDITIONS OF SERVICE – (Contract/Probation/Permanent/ Temporary)
2. I have to inform you that I have returned from vacation leave or
Arrived on first appointment……………………………………... and have been posted to …………………………
3. I returned by …………………....….. Vessel/flight which is ………………………………………………….………
On ………………………….……..in Cubin …….………Grade……………and I disembarked at …………………
……………………………………………on …………………….. 20 ………………………………………….
4. I was accompanied by my wife and family.
5. I was not accompanied by my wife and family, whom I expect to arrive in the Republic about
………………………………………………… and of whose arrival I will advise you immediately upon their return.
6. I reported for duty on …………………………………………………….. 20…………
7. until further notice I wish my salary to be paid:
(i) To ………………………………………… Bank at ……………..…………………………………. Branch
(ii) By open cheque at my own risk ……………………………………………………………………………..
(*See conditions on reverse)
N. B. Delete words or paragraphs not applicable.
……………………………….……………….20…….... ………………………………………………….
Officer’s signature
………………………………………….20……….. ………………………..………………………………
Permanent secretary
Head of Department

OFFICERS ARE REMINDED OF THE NECESSITY TO COMPLETE APPROPRIATE RENTAL FORMS

…………………………………………………………………………………………………...
 ZP Form 41
Stocked by QM store
Stores Voucher
No.

REQUISITION ORDER

QUATTERMASTER’S STORES CONSIGN No………………………………….

ZAMBIA POLICE ………………………………….
P.O BOX 1448 ………………………………….
LUSAKA …………………………………..

Quantity Item Size Issued Rat K N

e

Certified required for my own personal use Pack

Zambia Police/ZP Reserve/Station Upkeep No. Packer
No…………………………………
Rank…………………..Name…………………………… Wt Checker

Sent Cr
per
Date …………………………….. Signature…………………………………………………

Accounts form No. 55

Stocked by Finance

REPUBLIC OF ZAMBIA.

APPLICATION FOR HOUSE HOLD LOAN.

(To be submitted to the Ministry of Finance)

Name in full………………………………………………………………………………
Establishment Number:………………………….Finance Man No……………………..
Ministry\Department:…………………………………………………………………….
Station:…………………………………………………….
Basic Salary: K…………………………………….……..
Appointment\Rank………………………………….…..…
Service Conditions: Permanent Establishment. Contract Gratuity
Amount of loan required: K……………………………..……..
New or second hand goods…………………………………….

(If second hand, the proforma invoice must be endorsed by a senior officer to the effect that the goods are
apparently in good condition and should outlast the period of the loan)

PART II
(Head of Department)
I recommend\do not recommend that this officer be granted an advance to purchase furniture.
Delete whichever is not applicable.

PART III

THE PERMANENT SECRETARY

MINISTRY OF FINANCE
LUSAKA

I attach a completed form of agreement for an advance to purchase furniture supported by a pro forma
invoice. The application I recommended\Not recommended

………………………………………………………………….
PERMANENT SECRETARY/MINISTRY: DEPARTMENT
 ZCS Form 10
DISTRIBUTION: original to Officer Stocked by Govt. Printers.
Copies to : Permanent Secretary to Officer’s Ministry.
Provincial Permanent Secretary/Head of Department.

REPUBLIC OF ZAMBIA
CIVIL SERVICE (LOCAL CONDITIONS)
APPLICATION FOR SICK LEAVE
(To be submitted in TRIPLICATE to Provincial Permanent Secretary/Head of Department)
(G.O.624(c))

PART I
(To be completed by applicant)

Name of applicant………………………………………….…………………..…………….…………………………………..
Appointment…………………………………….………… Station………………………..…………………………….
Ministry……………………………………………………
Period of sick leave requested:………………..……...………… days from:…………………………….…………..20………
to…………………………………………………….……….20…………… (inclusive).

………………………………………………… …………………………………………….
Date Signature of applicant.
(A medical certificate on LCS Form 8 is required to support this application).

PART II
(To be completed by Provincial Permanent Secretary/Head of Department)

The above application is forwarded and recommended.

………………………………………………………. ……………………………………………………………
Date Provincial Permanent Secretary/Head of Department.

PART III
(To be completed at Ministry Headquarters if applicant is in Division Ior II or by Provincial Permanent
Secretary/Head of Department if applicant is in Division III)

The applicant is eligible for leave under G.O 622(a)/G.O 622(b)*

During the year ended…………………………………………..20……………… he has been granted total of

…………………days sick leave with pay and …………………..……………………days sick leave with half pay (including all periods granted
under G.O 623).
The sick leave asked for is available/not* available on full pay for………………………..…………………………. days
and /or half pay for……………………..…days; (if not savailable give details) (G.O 624).
…………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………

Signature………………………………………………..
Date……………………………………………………. Designation……………………………………………..
NB: Sick leave beyond the period laid down in G.O 624(a) may only be granted on the recommendation of a Medical Board.

PART IV
(To be completed by Permanent Secretary to Ministry)
Sick leave approved:
………………days from………………….20………. to…………..………………20…… on full pay.
………….…..days from………………….20……… to……………. …..…… …20……… on half pay.
………………days from……………….…20……… to…………………………..20……… without pay.

…………………………………………………… …………………………………………………………
Date Permanent Secretary.
 Ministry of……………………….……………………
*Delete whichever is not applicable. 25m R738 8/72 P/F4

Form 189
Stocked by QM Stores

REPORT OF SICKNESS
P154/ /………………….

…………………………………………

……………………………..20……….

Inspector General of Police (Staff)

Police Service Headquarters
LUSAKA

I have to inform you that No…….……..Rank……..…………..Name………....……………….

was off duty as a result of………………………………………………………………………..
………….……………………………..…………………………………………………………..
from……………………………………………………to………………………………………
inclusive.

The above absence from duty through sickness has been entered appropriately in his/her history sheet and
copy of this report has been filed in the officer’s staff file.

…………………………………………………….
Officer-in-Charge/Commanding Officer.

For Force Headquarters use only:

Noted:………………………………………………….. Statistics
 …………………………………………………….. Staff Records.

ZAMBIA POLICE…………………..…………………
P.O.Box…………………………….…………….
DATE ………………………………………
SECRETARY.
Z.P.T.C. SOC. LTD.
P.O.Box 30011
LUSAKA.

WITHDRAWAL FORM
I HEREBY GIVE NOTICE IN TERMS OF BY-LAW No 5 OF THE SOCIETYS’ BY-LAWS OF WITHDRAWAL OF THE
SUM OF K…………………………..………………… FOR THE PURPOSE of ………………….…
……………………………………………..……………………………………………….…….
…………………………………………………………………………………………………………………………………………
…………………………………....

FORCE No…………………… RANK……………..……………… FULL NAME……………………………….…..………

NRC/PIC No………………………….……………… SIGN………………………………….…………

FOR OFFICIAL USE ONLY

BALANCES: SAVINGS K…………….…….………………… LOANS K………………..………………….……………..

(AMOUNT PAYABLE) K……………….………..…………… (AMOUNT IN WORDS) :…………………………………..
…………………………………………………………………….……………………………………...…………………………
PAID BY…………………………………..………………….. DATE.…………….……………………………………
AUTHORISED BY …………………………………….……. DATE…………….……….……………………………

ZAMBIA POLICE………………………….…….…
P.O.Box………………………….……………………
DATE…………….……………..……………………
THE SECRETARY
Z.P.T.C.SOC. LTD.
P.O.Box 30011
LUSAKA.

WITHDRAWAL FORM
I HEREBY GIVE NOTICE IN TERMS OF BY-LAW No 5 OF THE SOCIETYS’ BY-LAW OF WITHDRAWAL OF THE
SUM OF K…………………………………………………..FOR THE PURPOSE OF ……………………………………..…….
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….

FORCE No…………………..….… RANK……….……………….. FULL NAME…………….………….…………………….

NRC/ PIC No………………………………………… SIGN……………………..….…….………………………

FOR OFFICIAL USE ONLY

BALANCES : SAVINGS K……………..……………….…… LOANS K……………………….……….…………………
(AMOUNT PAYABLE) K……………………………………. (AMOUNT IN WORDS) …………...…………………….
…………………………………………………………………………………………..……………………..……………….
PAID BY ……………………………………………………. DATE…………………………….……………..…
AUTHORISED BY……………………………………….… DATE……………..………………………………

ZAMBIA POLICE THRIFT CREDIT AND CO-OPERATIVE SOCIETY LIMITED

LOAN APPLICATION FORM
Full Names:………………………………………….. Man No……………………… N.R.C.No……………………/…../…..
Bank Name & Branch…………………………………………….... Account No…………………………………………………
Contacts; OfficePhone/CellNo:………………………..……………. Personal Phone/Cell No……………………………………

I hereby apply for a loan of K…….…………………… for a period of ………………….. month to be repaid in monthly
installments of K……………………………… plus interest. I agree that deductions shall be made from my salary for the
purpose of paying installments on principal and interest due until the loan is repaid in full. I want this loan for the following
purpose (explain fully) ……………………………………………………..………
………………………………………………………………………………………...……………………………….
Security offered …………………………………………………………………………………………….…………
I hereby certify that all statements made in this application including those on the reserve side of this form are true and complete
and are submitted for the purpose of obtaining a loan.

Date ……………….….…..…… Sign …..……………..……… Address:………………………………………

……….…………………………
…………………………………..

DECISION OF THE CREDIT COMMITTEE

At a meeting held on …………………….. 20 …… we approved a loan in the amount K…………………………. and on the
conditions listed (changes in amount, terms or conditions):……………………….…………………….. The credit committees
action is recorded in the minutes of ……………….……………..…………..….. 20 …..….
All committee members present must sign.

SAVINGS BALANCE K……………………………………..

LOAN BALANCE K……………………………………..
CONTRIBUTION K……………………………………..

APPLICANT’S STATEMENT

I owe money for the following (list all creditors and debts including taxes unpaid accounts, unpaid loans installment, etc attach
additional sheet if necessary)
CREDIT ADDRESS AMOUNT OWING
……………………………… …………………………..……… ………………………………………
……………………………… ………………………………….. ……………………………………

Employer ……………………………………….. Address ……………………………………..…………………..

Date when employed ………………….. 19 …… Rank …………………………………………….……………...
Monthly salary K………….………… Other income, describe source …………………..……….…………………
……………………………………………………………………………………………………….………………
Wife/husband’s name ………………………………………..………….. Number of dependants ………….…..
Is wife/husband employed? Yes/No, monthly salary K…………………….....
Other income K…………………………Immoveable property if any owned by applicant (describe) ……………..
Reasonable market value of property K………………………...............................................................................
Reference …………………………………….……………………………………………………………………

GUARANTOR’S STATEMENT

Name of guarantor …………………………………………… Address …………………………..…………………….

Employer …………………………………………………….. Address …………………….………………………….
Position …………………………………………...………….. Monthly salary K……………….………………...……
Other income, if any (describe source) …………………………………………………………….……………………..
Wife/husband’s name …………………………………..…………….. Number of dependants ………………………..
Immovable property, if any by guarantor (describe) …………….…………..………………..…………………………...
………………………………………………………….………………….……………………………………………….

……..…………..…………….…………. ………………….….……………………………………
NAME OF APPLICANT ADDRESS

PROMISSORY NOTE

FORCE NO. …………………………………...

NAME …………………………………………
DATE ………………………………………….

K ……………………………………………….
For value received I/we jointly and severely, promise to pay the sum of K…………………. with interest
at unpaid balance at the rate of 2.5% per month payable in ……………….... installments of K...………….……… The first to be
on …………… and a like amount thereafter the amount being in full.

SECURITY ………………………………………………………………………………………………………….
In case of any default in payment as agreed herein, the entire balance of this note shall become immediately due and payable to
the holder.
It is further agreed by each party to this note, whether as borrower, endorsed by guarantee, that in the case payment if not made at
maturity he shall pay the cost of collection, but such charge shall in no event be less than K……………………………

Signature of Witness Signature of Borrower Address

……………………… ………………………………………. ……………….……………………………

…………………….………………………
………….…………………………………

PLEDGE OF DEPOSIT AS SECURITY

I, the undersigned hereby pledge all paid up deposits and payments which I/we now have or hereafter may have in this
society for the loan evidenced by a promissory note dated ……………………………………… Payable to the Z P T
C C SOC. Limited. This pledge is given to secure the payment of the loan described above and interest, cost or
expenses that may occur thereon and I/we hereby authorize this society to apply any or all such paid up deposits on to
the payment of the loan and interests, costs and expenses.
Signed ……………………………….

Date …………………............ 20……

ZP Form 198

REPUBLIC OF ZAMBIA

ZAMBIA POLICE

TRANSFER CERTIFICATE
……………………………………………………..………………

……………………………………………………………………..

……………………………………………………..………………

I,(Full Name) Mr Banda.A. Officer-in-Charge of MPIKA Police Station hereby certify that Police have no objection to

the burial or cremation of the deceased body of (Full Names …………………………….……………….………………………….

That such deceased person’s age stated to be …………………………………...………………………..………………….………..

That he/she died on the …………….…….. day of ………..………………………………….…………………….. 20……..…….

at (Place of death) .…………………..………………………..…………………………………………………...……………….…

……………………………………………………………………………….……………………………….………..…………..…..

The bereaved families are taking the body of the deceased to ………………………..………………………………………………

…………………………………………………………………………………………..……...………….…………………………..

………………………………………………………………………
(FULL NAMES OF INFORMANT)
…………………………………………………..…………

…………………………………………………………….

…………………………………………………………….

…………………………………………………………… OFFICER’S SIGNATURE

(ADDRESS OF INFORMANT)

…………………………………….……
SIGNATURE
 Accounts Form No. 17A
Ref. No.:………………………
Date:…………………………..

APPLICATION FOR SPECIAL IMPREST

(To be completed by Officers proceeding on duty outside their station, in triplicate)

Part I

Application

I, …………………………………….………….. (Name) ………………….….……….……. (Designation)

Man No.:………………………………………………of the …………………….…………………………
………………………………….……………….………………….… *(Ministry/Department stationed at)
………………………………….…… (Place) hereby apply for a special Imprest of *S/K……..…………..
……………………………………..…….…………………………….……………………………….…….
(Amount in words) to enable me to travel to ………………………………….………..…… (State place to
which proceeding) on official duty ……..……………………………………………………………………
(State nature of duty).I am expected to be away for a period of …………………………………………….
Nights and I am eligible to receive subsistence allowance at the rate or *S/K…………….……………… per
night. The amount of imprest*does/does not take into account transport charges/cost of fuel for the journey,
amounting to *S/K……………………….…….. which is being provided separately.
2. I have *no balance outstanding on previous special imprest/the following balances outstanding from
previous imprest issued to me.

No. Date P V No. Amount of Already Balance Notes on

issued Imprest Accounted for Outstanding Recoveries
*S/K *S/K *S/K being made
 PTO

Part II

Decision of Permanent Secretary or Head of Department

*Approved/Not approved

Cabinet Authority ………….………………………………..

(For journeys outside Zambia only) *Permanent Secretary/Head of Department

Date of Official Seal

Part II

(To be completed by Accounting Officer and returned to Applicant)

Payment approved. Cheque No. ……………………………. for K …………………………..

*is forwarded to enable you collect your Travelers’ Cheques. Code No. ………………………
This imprest must be retired within 24 hours of your return to your duty station vide Financial Order No.
186

Date:………………………. ……………………………
 In reply please quote

REPUBLIC OF ZAMBIA
ZAMBIA POLICE SERVICE
MPIKA POLICE STATION
P. O. Box 450010
MPIKA.

…………........................…..20…….

To ……..…………………………………………
………………………………………………..
……….………………………………………..
…………………………………………………

RE: POLICE REPORT FOR ………………………………………………..…………………………....

This serves to inform you that Mr./Mrs./Ms.……………………………………………………………..….

Reported to this office about the loss/theft/damage of…………………….…………………………….…

………………………………………………Valued at / Account Number:……………………………….
National Registration Number ………………………….………………….…………/….…../….………..
The above subject has been treated as lost/stolen/damaged property. Therefore, this office has raised no
objection for any help that may be rendered to the reporter as long as it is in accordance with your standing
orders.

Our Occurrence Book/lost number …………………..……………………………. Refers.

……………………………………………
/OFFICER IN CHARGE

NB: 1. The Police does not in any way verify the corrections of this report a burden which was solely with
the reporter.
 2. The Police cannot in anyway be held responsible for loss/damage of this report

wstocked by QM Stores
t6trhZP Form 32

MEDICAL REPORT
THE MEDICAL OFFICER

THE GOVERNMENT/MINE HOSPITAL

…………………………………………………………..

The bearer …………………………………………………………………………………………………. complains of (give

details of injury) ……………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………….…….. under the
following circumstances: ……………………………………………………………………………….……………………………..
………………………………………………………………………………………………………………….……………………...

Will you please report on the extent of injuries and whether they are consistent with the alleged circumstances.

Date: ………………………….......... ………..……….....………………………....

Police Officer

Place: ……………………………….. ……………………………………………… .

Name and Rank in BLOCK LETTERS

I have examined the above named and find: ………………………………………………………………………….........................

................................................................................................................................................................................................................
................................................................................................................................................................................................................
................................................................................................................................................................................................................
............................................................................................................................
*My findings are consistent with the circumstances alleged/ are not consistent with the circumstances alleged for the

following reasons: ………………………………………………………………………………………………...........

…………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………...

……………………………………………….
Medical Officer

*Delete where not applicable

ZP FORM 198
IN REPLY PLEASE QUOTE

REPUBLIC OF ZAMBIA

ZAMBIA POLICE SERVICE

MPIKA POLICE STATION
P.O. Box 450010
MPIKA

BROUGHT IN DEAD CERTIFICATE

…………………………………………………………
…………………………………………………………
…………………………………………………………

1. I, LANGENI KENNEDY (MR).Officer in charge of Mpika Police Station, hereby certify that
Police have no objection to the burial or cremation of the deceased body of
2. (Full Names) ……………………………………………………..........................……………………
……………………………........................................................................ in which case please lodge
the body in the Mortuary and a disposal certificate be issued to the bearer
3. That such deceased persons age stated to be ……………………………………..…............................
4. That he/she died on the ……………… day of ………………………………………..… 20…………
At (Place of Death) …..……………………………….……………………………………………….
…………………………………………………………………………………………………………..
5. Police believe the deceased to have died from (brief cause of Death)
……………………………………………………………………………………………….……….
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………
…..
…………………………………………………….
(FULL NAMES OF INFORMANT)

……………………………………………………..

……………………………………………………..

……………………………………………………..
(ADDRESS OF INFORMANT) SIGNED: ……………………………………
FOR/OFFICER-IN-CHARGE

*Delete where not applicable

ZP FORM 87
REPUBLIC OF ZAMBIA Stocked by QM Stores
100m S718 7/86 4A S
NOTICE TO EMPLOYER
………………………………………Police Station

(Date) …………………………..…………20 ……
Sir/Madam
I have to inform you that …………………………….……………………. said to be in your employment, is required to
attend…………..…………………….………
Police Station for the purpose of…………………………………………………………………………………….
…………………………………………………………………………………………………………………………
He will not be detained longer than is absolutely necessary.
I am, Sir/Madam
Your obedient servant

…………………………..
for/OFFICER IN CHARGE

ZP FORM 87
REPUBLIC OF ZAMBIA Stocked by QM Stores
100m S718 7/86 4A S
NOTICE TO EMPLOYER
………………….………………Police Station

(Date) …………..…………..…………20 ……
Sir/Madam
I have to inform you that …………………………………………..……………………..……. said to be in your
employment, is required to attend at …………………………. hours……………………….at………………………………….....
Police Station for the purpose of…………………………………………………………………………………….
…………………………………………………………………………………………………………………………
He will not be detained longer than is absolutely necessary.
I am, Sir/madam,

Your obedient servant

…………………………..
for/OFFICER IN CHARGE

IN THE SUBORDINATE COURT OF THE FIRST CLASS

HOLDEN AT MPIKA

THE MEDICAL OFFICER

………………………………………………..Government Hospital
MPIKA

ORDER FOR MEDICAL EXAMINATION

WHEREAS a preliminary inquiry is being held in respect of a Female Juvenile person by the name
of……………………………………………………………………………………………
…………………………………………………………………………………….………………

The court has therefore ordered that, the said Juvenile person is medically examined for the purpose of
ascertaining her\his age which in the opinion of the court is material to the proceedings before the court.

……………………………
MAGISTRATE

THE MAGISTRATE

This is to certify that having carried out the medical examination my findings are:
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
………………………………………..…………………………………………………
…………………………………
MEDICAL OFFICER

AFFIDAVIT IN SUPPORT OF APPLICATION FOR

A WARRANT TO INSPECT BOOKS SECTION (8) (1)
EVIDENCE (BANKER’S BOOKS) ORDINANCE 1994

I, (Name of Police Officer) ……………….……………………...……………………………

Of ………………………………………………………..……….. (Station) make oath and say
as follows: - I have reason to believe and in fact do believe that
(Name of person and address) ………………………………………………………………….
……………………………………………………………………………………………………
is guilty of the (offence and section of law) ………………………………………………….....
…………………………………………………………………………………………………….
……………………………………………………………………………………………….……
I further believe that it I both necessary and desirable that
The Bank Account of the said (Name of person) …………………………..……………..…….
……………………………………..…………… at ……………………………………………..
……………………………………………….. Bank situated at (Place) ……….………………..
be inspected. I therefore, now apply for a warrant to inspect the Bank Account of the said
(Name of person)
………………………………………………………………………………………….…………
……………………………………………………………………………………………….……
Under the provision of section 8 (1) of the Evidence (Banker Books) ordinance, 1994.

………………………………………
SIGNATURE OF APPLICANT
Sworn before me at …………………………………………. This ……………..………… day of
……………………………………. 20……...
 ………………………………………………
SIGNATURE OF MAGISTRATE

WARRANT TO INSPECT BANKER’S BOOKS UNDER SECTION 8 (1) OF THE EVIDENCE

(BANKER’S BOOKS) ORDINANCE, 1994

To (Name of Policeman) ……………………………………………………………………….

WHEREAS, it has been proved to me on oath, according to reasonable suspicion, the inspection of the
account relating to …………………………………………………. (Name of suspect)
situated at ………………………………………………………………. (Name of town) as both
necessary and desirable for the purpose of investigating the commission of offence by
…………………………………………………………………………………. (Name of suspect)

You are hereby authorized to investigate the account of the said ……………………………….
……………………………………………………………………………………………………
with the said …………………………………………………………………… (Name of Bank)
and to take copies of any relative entries or matter in such Bank.
Dated at …………………………………………………… this ……………………………….
Day of ………………………………………. 20……..

……………………………………
SIGNATURE OF MAGISTRATE
 AFFIDAVIT

…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………

I DO SWEAR THIS AFFIDAVIT AND BELIEVED THE CONTENTS TO BE CORRECT AND

DECLARED THAT TO THE BEST OF MY KNOWLEDGE IS CORRECT.

……………………………….
SIGNED

SWORN BEFORE ME AT:…………………………………………… ON ……………………

DAY OF …………………………………………….……………………20……………………
 ………………………………….
MAGISTRATE/COMMISSIONER

ZP FORM 134
STOCKED BY QM STORES

ZAMBIA POLICE
MESSAGE FORM
IN REISTER NO……………………………... OUT REGISTER NO…………….…………
CALL SIGN PRIORITY NO. OF GROUPS DATE AND TIME TRANSMISSION MESSAGE
OR WORDS HANDED IN INSTRUCTIONS INSTRUCTIONS

ABOVE THIS LINE FOR SIGNALS USE ONLY

TO (FOR ACTION) (TELEGRAPHIC ADDRESS)

DISPOL CHINSALI
FROM (ORIGINATOR) (TELEGRAPHIC ADDRESS) DATE-TIME OF ORIGIN

POLICE ISOKA 051150

INFO (FOR INFORMATION) (TELEGRAPHIC ADDRESS)

DIVPOL KASAMA

ORIG’S No. ZPNI 1/4 OF 05/04/2012 xx REFER TO YOUR W/M ZPND 53/15/4 SEC 03/04/2012
WITH REFERENCE TO INGEPOL SCD GENDER W/M SHQ 52/13/1 OF 30/03/2012xx THIS
FORMATION SUBMITS THE FOLLOWING:-
NO. RANK NAME POSITION LAST PROMOTED
7391 W/C/INSP. F. NAMBEYA OPS OFFICER – P.U 01.09.2010
9784 W/INSP. C. CHIBWANTA CORDINATOR – V.S.U 01.04.2010
11112 W/INSP. E. SIANKALI COUNSELOR – V.S.U 05.07.2011
38168 W/SGT. N. MUKUPA SIGNALER 05.07.2011
38023 W/CONST. E. NGOYI ADMIN. CONST.
39317 W/CONST. A. KAPITA PATROL OFFICER – TRAFFIC
39546 W/CONST. J. CHIBWE SHIFT OFFICER
39828 W/CONST. P. MWILA BEAT CONSTABLE
40935 W/CONST. C. NYAMBE BEAT CONSTABLE
40944 W/CONST. I. MUKELABAI BEAT CONSTABLE
41109 W/CONST. T. PHIRI BEAT CONSTABLE
41308 W/CONST. K. TEMBO BEAT CONSTABLE
xx//

S. SILUMESII (C/INSP)
For/ OFFICER IN CHARGE

ZAMBIA PUBLIC SERVICE (LOCAL CONDITIONS)

APPLICATION FOR LEAVE AND LEAVE CERTIFICATE
The original and four copies of this form are to be completed by the applicant and forwarded to his
Permanent Secretary, through the District Secretary or Head of Department in accordance with General
Order F44.

PART A
Surname……KATAMBI……………….Other names……………HAPPY………………….
Personnel Division File No –P154/39569……. Nat. Reg. Card NO…382204/61/1.......Ministry/Province
MUCHINGA…….Ministry File No --P154/39569…………………………………………………….
Department ZAMBIA POLICE…SERVICE……………………RANK D/W/SGT KATAMBI…………..
Division …………II..………………….….. Salary K…………….... per annum
Date of return to duty after last leave (or date of appointment if leave not previous taken)…………………
2013….……………………………………………………………………………
Date on which leave was last commuted ……………… NIL………….…………………….........................
Date on which leave travel warrant was last received…………………………NIL……………………….…
I now apply to take …90…… ….days ………MATERNITY………….. (State type of leave now applied
for (Ordinary, special, maternity, etc. - see Section F of General Orders) the first of which is to be
9TH AUGUST, 2017…………..…….….. And to commute ……..……NIL…..………….….days, making a
total of….…90……days to be deducted from my earned leave.
I also apply for a leave travel warrant for myself, my wife and……….. Children* aged……. NIL…………..
From …….NIL. To………NIL…..… and return.
Salary on leave to be paid* in the normal way/in advance up to the last day of the month proceeding my
return from leave.
My address on leave will be.
MPIKA--- ZAMBIA
Date ….21/08/2017……… .………..……….............................
SIGNATURE OF APPLICANT

PART B

(To be completed by Head of Department)

The foregoing application is forwarded and recommended. I certify that the details are correct.
The applicant is an established officer/serving on probation/serving on agreement.*

Date………………………..……20………..
Signature…………………………….
Designation………………………….

PART C

(To be completed by the Personnel Officer of the Officer’s Ministry or Province)

Qualifying Service
Odd days of qualifying service brought forward from previous Application for
Leave and Leave Certificate …………..days

Qualifying service from date of return to duty after last leave to date of proposed leave (see note (i)):

From…………..……to………….………in Division III ………………...months ……………….days

From………….…….to…….……..……..in Division II ………………….months.………….……days
From…………….….to………………….in Division I…………………….months……...………..days
_____________________
Total (see note (i))
_____________________
Equals………………. Completed months of qualifying service and…………………..days of qualifying
Service to carry forward. (See note (ii)).

Earned Leave
Earned leave brought forward from previous for Leave and Leave Certificate = ………..….days
…………………completed months in Division III @ ………..……days per month = ……..…days
…………………completed months in Division II @ ………….…..days per month = …….….days
…………………completed months in Division I @ ………….…..days per month = ……..…days
..
TOTAL LEAVE NOW DUE … …..………………….. days
Less leave now granted …… …………..……..days
Less days commuted …………….days TOTAL …… ………...…….days
Leave to be carried forward ….…………..……...days
The officer is +/is not* entitled to leave travel warrants for himself and his dependents as shown in Part A
The officer may be grated ………….. days’ traveling time in each direction.

Date …………….…………20…….. Signature ……………....……………………

Designation ………………..………………….

PART D
(To be completed by the Permanent Secretary of the officer’s Ministry or Province)

I hereby certify that Mr./Mrs./Miss ……………………......................……………………………………….

(i) is now granted ……………`……...……….days .……….................……Leave with pay
……………………………days’ …………......….……. Leave with half pay
………….....………………days’ ……......……............. Leave without pay
A total of …….……..…….days’ leave plus ……….……...…days’ additional travel leave under
General Order F47 commencing on ………….…………day……….................………..20………
(ii) is to resume duty on …………………………………….…..………………..………20………
Date ………………………………...…………….. ……………………………………………….
Permanent Secretary
Ministry ……………………….……………………………………………………………..……. Province
*Delete as applicable.
+ Applicable to Division III officers only.

NOTES:
(i) Qualifying service is the time spent on duty or when sick on full salary. Any other period of absence from
duty doe not count as qualifying service e.
(ii) Each period of thirty odd days is reckoned as one complete month and is calculated at the leave earning
rate as at the first day of the leave now applied for.

INSTRUCTIONS TO OFFICERS

1. An officer must provide his Ministry with an address to which correspondence may be directed during his
leave and will be held responsible for any inconvenience that maybe caused through communications not reaching
him promptly.
2. An officer who is taken ill so as to require medical attention either during the journey or whilst on leave, and
remains ill for seven days or more, must report the fact to his Permanent Secretary and at the same time, forward a
medical certificate from a registered medical practitioner stating the nature of the illness and, if possible, its probable
duration. Unless this instruction is complied with, as officer will not be entitled to any salary during any sick leave
which it may be necessary to grant him.
3. An officer on leave desiring either an extension of leave or a reduction in the period of leave must submit an
application to his Permanent Secretary stating the grounds on which the extension or reduction is required.
4. An officer who, having been granted leave, fails to return to duty at the proper time, is liable to summary dismissal.
5. An officer on leave may be required to undertake any course of instruction and to discharge any duty during his
leave and will not be entitled to any additional remuneration in consequence of such employment. An allowance may,
however, be granted to cover necessary out-of-pocket expenses, and an extension of leave maybe granted where
appropriate.
6. An officer on leave may now accept any paid employment without previously obtaining the sanction of the
Permanent Secretary, Personnel.
7. Existing arrangements for the payment of salary will automatically apply unless the officer elects to receive his
leave salary in advance.
8. In the case of officers serving in Division I or Division II advances of salary will be paid by the Salaries Section.
Ministry of Finance. In the case of officers serving in Division III advances of salary will be paid by the officer’s
Ministry or Province.

ZAMBIA POLICE FORCE

ZP Form 5
STOCKED BY Q.M Stores
40m F386 11/82 S&T

APPLICATION FOR PENSION OR GRATUITY.

Delete all portions of this form which are inapplicable.
SEE NOTES PRINTED OVERLEAF BEFORE COMPLETING THIS FORM
PART 1
(To be completed by Inspector General of Police)

A Particulars of Policeman
Name………………………………………………… Date of birth………..…………………………
Date of enlistment…………………………………… Force No…………….………………………..
Rank…………………………………………………. Village…………….…………………………..
Tribe…………………………………………………. District……………………..………………….
Chief………………………………..…………………………
Station at which pension and/or gratuity is to be paid……………………….………………………………….

B Cause of Retirement.

(State clearly the cause of retirement as indicated in terms of the Zambia Civil Service (Local Conditions) (Pensions)
Act, 1968. If the Policeman is being retired on medical grounds the certificate below must be completed by a Medical
Officer of the Department of Health, otherwise it must be deleted.)
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
I certify that this Policeman is no longer able to continue in his present employment by reason of infirmity of mind or
body which is likely to be permanent and which is not occasioned by his own default.(state nature of infirmity)
…………………………………………………………..…………………………………………………..
……………………………………………………………………………………………………………………………
…………………………………………………………….………………….………………………………………….
…………………………………………………………….…………………………………………………………..…
……………………………………………………………….…………………………………………………………..

……………………………………………………
Medical Officer.

C Particulars of Service.
(i) Date of commencement of service counting for pension or gratuity……………………………….………….
(See note 7)

Date of termination of service counting for pension or gratuity…………………………………..……….

(See note 8)
i.e. ………………..months………………...days of service counting for pension or gratuity. (Less periods
included under sub-paragraph (iv) of this section)

(ii) (To be completed only in the case of a policeman who has been transferred from a non-pensionable
(Junior Division) post in the Civil Service to the Zambia Police Force).

Date of commencement of service counting for gratuity in the junior division post of:
(State post)……………………………………………………………………..………………………………
Date of transfer to the Zambia Police Force (state rank) …………………..………………………………….
i.e, …………………………………………….Months………………….………………………………. days.
(Less periods including under sub-paragraph (iv) of this section)
(iii) Breaks in service (if any) from ………………….………………….. to ……………………………………….
and …….………………………………..…………….. to ………………..……………………………………
Authority under which the break(s) was/were condoned………………………………………………………..
…………………………………………………………………………….……………………………………...
(iv) Leave without pay or service not counting for pension or gratuity. From ……………….………………………
to…………………..…………i.e. ……………..………………months ……………………………………days
D. Particulars of Salary etc. (see note 9)
Monthly salary as at date of retirement K………………….……………………….
Total pensionable emoluments K……...…………………….……………
E. Certificate
I certify that the above accords with the records in this office.
Date………………….………. 20……. ………………………………………..
Inspector General of Police
F. Option to commute pension
(Delete in the case of a Policeman who is not eligible for pension)
Inspector General of Police
I understand regulation 6 of the Subordinate Police (Pensions) Regulations, and I wish to receive:
 (a) Pension only;
(b) gratuity and reduced pension, the fraction of the basic pension I wish to commute
being…………………………………….. (here state fraction e.g. one quarter, one eighth, etc.)
NOTE: Either (a) or (b) must be crossed out by the Policeman

Date………………………….…………20……….. ……………………………………….
Signature of Policeman

NOTES
1. The form should be submitted in quadruplicate to the Permanent Secretary (Personnel). Part I only should be
completed by the Inspector General of Police. Part II will be completed and award assessed by the Pension
Officer, Ministry of Finance.
2. When the award has been approved, the forms will be distributed as follows: Original and one copy to the
District Secretary of the area concerned; one copy to the pensions officer, Ministry of Finance; one copy to
the Inspector General of Police; one copy to the auditor general and one copy to be retained by the Permanent
Secretary (Personnel).
3. In the case of an approved pension, the pension officer, Ministry of Finance, will forward an Identity
certificate to the district secretary of the area in which the pension is to be paid. No payment of Pension
should be made without the production of an Identity Certificate.
4. In the case of an approved gratuity, the pension officer, Ministry of Finance, will arrange for Payment by the
district secretary of the area in which the pension is to be paid and the original approved form plus one copy
will be forwarded to him. The original will support the payment.
5. If a gratuity or pension is to be paid outside Zambia, payment will be arranged by the Pensions Officer,
Ministry of Finance.
6. All words in the form which are inapplicable must be deleted
7. The date of commencement of service qualifying for pension or gratuity [see section C (i) ]in the case of a
Policeman appointed on or after the 1st January, 1946 may not (in accordance with regulation 3 of the
Subordinate Police (Pensions) Regulations) be earlier than the date on which he attained his twentieth
birthday.
8. A Policeman’s service does not terminate until the expiration of any leave which may have been granted and
a pension or gratuity is therefore not payable until the expiration of such leave. Any such period of leave must
be included in the policeman’s total service in section C (i) and copy of his Leave Certificate must be
forwarded with this form to the Permanent Secretary (Personnel).
9. In the case of retirement on medical grounds under regulation 11 of the Subordinate Police (Pension)
Regulations, the medical certificate in section B should be deleted and a separate suitable medical certificate
should be attached.
10. All amendments should be initialed by the officer responsible for completing this form.

PART II
A. Awards (Delete whichever is inapplicable)
(i) Amount of unreduced pension K………………………..…………………………. per annum; or
(ii) (If the policeman has elected in conformity with regulation 6(1) of the Subordinate Police (Pensions)
Regulations to receive a gratuity and reduced pension.)

Amount of reduced pension K………………….…………………………….per annum

and amount of gratuity K……………………….……………………………..; or

(iii) (If the policeman is eligible for pension) Amount of gratuity K………………....……………………..
We certify that the above award is in accordance with the regulation governing the payment of pension and gratuity to
Subordinate police and is correctly calculated on the facts recorded in this form.
………………………..……….……………… ………….……..……………………………...
For Auditor General for Pensions Officer
Finance Division.
Date…………………..………………20…….. Date……………….…………………20…….
The pension and gratuity/gratuity is approved.
………………………….……………………..
For Permanent Secretary (Personnel)
(By command)
Date……………………..…………………..20………….

B. Calculation of Pension and/ or Gratuity.

ZAMBIA POLICE SERVICE HEADQUARTERS
CASUALTY NOTIFICATION (To be completed by Chief Accountant (Salaries only)
NOTIFICATION OF CASUALT No…………………………………………………….2009

PART A – PERSONAL DETAILS

FULL NAMES………………………………………………………………………………………………..
DESIGNATION………………………………………………………………………………………………
SALARY SCALE…………………………………………………………………………………………….
STAFF FILE No………………………………………………………………………………………………
MAN No…………………………….. DEPT………………………….. P/POINT………………………
STATION……………………………………………………………………………………………………..
PROPOSED DATE OF CESSATION OF DUTY……………………………………………………………
REASONS FOR CESSATION OF DUTY……………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

PART B OTHERS SALARIES OR “F” SECTION

(i) LOANS
(a) CAR LOAN PRINCIPLE………………………………………………………………..
INTEREST……………………………………………………………………………….
(b) HOUSE HOLD PRINCIPLE…………………………………………………………….
INTEREST……………………………………………………………………………….
(c) HONDA PRINCIPLE…………………………………………………………………….
INTEREST………………………………………………………………………………
(d) OTHERS (SPECIFY)…………………………………………………………………….
(ii) ADVANCES
 (a) SALARUY ADVANCE………………………………………………………………….
(b) IMPREST…………………………………………………………………………………
(c) SALARY OVER PAYMENT……………………………………………………………
(d) OTHER (SPECIFY)………………………………………………………………………
(iii) LOSSES
(a) LOSS OF GOVERNMENT MONEY……………………………………………………..
(b) LOSS OF STORES…………………………………………………………………………
(c) DAMAGE TO G.R.Z PROPERTY…………………………………………………………
PLEASE QUOTE FINANCE FILE No…………………………………………………………..
TOTAL AMOUNT OWING………………………………………………………………………

SIGNATURE OF OFFICER CLEARING…………………………………………………………………….

FULL NAMES…………………………………………………………………………………………………..
DESIGNATION…………………………………………………………………………………………………
DATE…………………………………………………………………………………………………………….
CHECKED BY : SIGNATURE…………………………………………………………………………………
FULL NAMES………………………………………………………………………………………………….
DESIGNATION…………………………………………………………………………………………………
DATE……………………………………………………………………………………………………………

PART C TO BE COMPLETED BY HOUSE LOAN SECTION

A. HOUSE LOAN – FILE No. ………………………………………………………………………..
INTEREST…………………………………………………………………………..
POOL/COUNCIL HOUSE PRINCIPLE…………………………………………………………..
INTEREST……………………………………………………………
TOPTAL……………………………………………………………

QUOTE HOUSE LOAN FILE No……………………………………………………………………..

SIGNATURE……………………………………………………………………………………………
NAME IN FULL…………………………………………………………………………………………..
DESIGNATION…………………………………………………………………….……………………..

PART D

PLEASE RECOVER A TOTAL OF K………………………………………………….…………………

AND REMIT THIS MINISTRY
SIGNATURE……………………………..………………………………..
 NAME……………………………………………………………………
DESIGNATION……………………………………………………….

SENIOR ACCOUNTANT(RECONCILLIATIONS)

CS Form B 24
REPUBLIC OF ZAMBIA Stocked by FBE
10m H893 7/79

APPLICATION FOR PENSION OR GRATUITY

Delete all portions of this Form which are inapplicable

SEE NOTES PRINTED OVERLEAF BEFORE COMPLETINGH THIS FORM

(To be completed by the Officer’s Ministry)

A. Particulars of Employee
Name ………………………...……………………. Date of Birth…………………………………..
Appointment………………,……………................... Department/Division……………..……………
Ministry………………………..…………………….
Address at which Pension and/or Gratuity is to be paid……………………………..………………………….
B. Cause of Retirement:

State clearly the cause of retirement together with the appropriate section of the Law governing the
pension/gratuity payment. If the employee is being retired on medical grounds the certificate below must be
completed by a Government Medical Officer, otherwise it must be deleted.
……..
……………………………………………………………………………………………………………………..
………….……………………………………………………………………………………………….
Medical Officer

C. Particulars of Service

(i) Date of commencement of service counting for pension or gratuity…………………………………

Date of last day of service………………………………………….……. .…………….. (See note 6)

i.e. months ……………………………….……….days of unbroken service.

(ii) (To be completed only in the case of an employee who has been promoted from non- pensionable
post in Division IV to a pensionable post.)

Date of commencement of service counting for gratuity in the on-pensionable post of:

(State post)………………………………..……………………………..………………… ……
 Date of appointment to pensionable post …………………..…………………….………………..

i.e.,…………..………….…….…… months ………….…..…………….. days of unbroken service.

(iii) Breaks in service (if any) from……………….………………..to……………….….………………

From…………………………………..………….to………………………………..……………….

Authority under which the break(s) was/were condoned………………….…………………………

…………………………………………………………………….………………………………….

D. Particular of Salary

If the employee during the three years proceeding the date of his retirement held more than one post:

Title of Posts

Dates Commenced
Terminated

Annual rate of salary

Aggregate salary

Total aggregate pensionable emoluments for three years proceeding retirement K…………………………………

Average pensionable emoluments for three years proceeding retirement. ..K……………..………………………..

E. Certificate

I certify that the above accords with the records in this office.

Date…………………..…………….20……….. ……………………………………………
Permanent Secretary

F. Option to Commute Pension

(Delete in the case of an employee who is not eligible for pension)

Permanent Secretary (Personnel),

I wish to receive……..

(a) pension only; or

 (b) gratuity and reduced pension.

Date………………………..…… 20….……. ……………………………………………..

Signature of Employee

NOTES

1. The form should be submitted in sextuplicate to the Permanent Secretary (Personnel). Part I only
should be completed by the Ministry. Part II will be completed and the award assessed by the Pension officer,
Finance Division.

2. When the award has been approved, the forms will be distributed as follows: Original and one copy to
the District Secretary of the area concerned; one copy to the Pensions Officer, Finance Division; one copy to the
Head of Department; one copy to the Auditor-General; and one copy to be retained by the Permanent Secretary
(Personnel).

3. In the case of an approved gratuity the Pensions Officer, Finance Division, will arrange for payment
by the District Secretary of the area in which the gratuity is to be paid, and the original approved form plus one
copy will be forwarded to him. The original will support the payment.

4. If a gratuity or pension is to be paid outside Zambia, payment will be arranged by the Pensions
Officer, Finance Division.

5. All words in the form which are inapplicable must be deleted.

6. An employee’s service does not terminate until the expiration of any leave which may have been
granted and a pension or gratuity is therefore not payable until the expiration of such leave. Any such period of
leave must be included in the employee’s total service in Section C (i) and a copy of his Leave and Last Pay
Certificate (Accounts Form 31) must be forwarded with the form to the Permanent Secretary (Personnel0.

7. In the case of retirement on medical grounds, the medical certificate in Section B should be deleted
and a separate suitable medical certificate should be attached.

8. All amendment should be initialed by the officer responsible for completing this form.

PART II

A. Service partly in Zambia and partly in another Public Service (Regulation 20)

Aggregate Emoluments—

1. In Zambia ... .. .. .. .. .. .. K……………………………………..

 2. ……………………………… .. .. .. K……………………………………..

3. ……………………………… .. .. .. K……………………………………..

4. ……………………………… .. .. .. K……………………………………..
K_____________________________

Delete if not applicable

PMECP FORM OA

PMECP EMPLOYEE PERSONAL AND EMPLOYMENT DATE UPDATE FORM

Institution:………………………………………………………………………………………………………………….
Dept: ………………………………………….………………………………………………………………..
Section: …………………………………………….……………………………………………………………..
Unit: ………………………………………….……………………………………………………….……….
Post Id:………………………….. Post Name:……………………………………………………..……………
Post Grade: ………………….……. Payroll Grade: ………………………. NRC:…….………….………….
Title:…………………………….……………………… Man No:……………..………………………..
Surname: ………………………………..…………………………………………………………..………………
First Name: ……………………………………………………………………………………………………………
Other Names: ……………………………………………………………………………………………………………
Maiden Name: …………………………………………………….…………………………………………………… *
Academic Qualification: ………………………………………………………………………………………………… *
Professional Qualifications:……………………………………………………………………………………
Sex: Date of Birth:……………………………….. Marital Status:……….…………………..
Date Employed:……………………………… Employment Type:………….…………..
Date of Present Appointment:………….…………….. Disability:…………………..…………….
Contract End Date ……...../……....../………… Pension Fund ___________ or NAPSA_________
Residential: ____________________________________________
Address: ____________________________________________
Town/Village: ____________________________________________
District: ____________________________________________
Tribe: ____________________________________________
Name of Spouse: ____________________________________________
Next of Kin ____________________________________________
Children: Name Sex Date of Birth
1 ___________________________________ ________ ____/____/_______
2 ___________________________________ ________ ____/____/_______
 3 ___________________________________ ________ ____/____/_______
4 ___________________________________ ________ ____/____/_______
5 ___________________________________ ________ ____/____/_______
6 ___________________________________ ________ ____/____/_______

Report Form B96

Stocked by Govt. Printer
50m Z572 6/74 P/F
REPUBLIC OF ZAMBIA

ANNUAL CONFIDENTIAL REPORT

(For officers required to be reported on in accordance with General Order 401)

Period:………………………………………… To: ………………………………………………

PART I – TO BE FILLED IN BY THE OFFICER

1. Full name 2. Ministry and Dept/Branch

3. (a) Marital status: 4. Year of birth 5. Date of first appointment in 6. *Perm. And Pensionable.
Zambia * Temporary/Contract
(b) Number of children. *Delete items not applicable

7. Present post held. 8. Date of appointment to 9. Present salary.

Present post

10.Salary Scale 11. Date increment due. 12. Special qualifications and date obtained.

13. Details of any special courses of instructions taken during the year

14. Government examinations passed and dates.

15. Government examinations still to be passed)

16. Type of work most interested in.

17. SERVICE HISTORY. (Only changes since the last Annual Confidential Report need be given.)

Ministry or Department Post or Grade From To

Date…………………………………………….……… Signature of Officer………………………………………………

Personnel Division File No……………….…………… Station: …………………………………………………………..

PART II – TO BE COMPLETED BY REPORTING OFFICER

A. Brief statement of the work on which the officer has been engaged during period to which the Report relates.

B. Assessment Of Qualities (see Notes on page 4).

Out- Very Good Fair Poor
Standing Good
1. Personality and force of character ... .. .. .. ..
2. Intelligence ... .. .. .. .. .. .. ..
3. Judgment and commonsense ... .. .. .. .. ..
4. Reliability and accuracy.. .. .. .. .. .. ..
5. Interest in work ... .. .. .. .. .. .. ..
6. Ability to express himself clearly -
(a) In writing ... .. .. .. .. .. .. ..
(b)
Orally ... .. .. .. .. .. .. .. ..
7. Energy and drive ... .. .. .. .. .. ..
8. Adaptability ... .. .. .. .. .. .. ..
9. Ability to lead and supervise others ... .. .. .. ..
10. Organizing and managerial ability ... .. .. .. ..
(NOTE – A cross should be placed in the appropriate ox for each item. In the case of 9 and 10 the words ‘not applicable’
may be inserted.)
C. GENERAL REMARKS (which should include references to professional or technical knowledge of the officer).

Signature …….…………………………………………..
Name …………………………………………………….
Date …………………..…………20…..…… Post …………………..…………………………

PART III – TO BE COMPLETED BY PERMANENT SECRETARY OR HEAD OF

DEPARTMENT AS APPROPRIATE

(In the case of professional and technical officers this Part should be completed by an officer who is competent to comment on the
professional or technical aspects of the officer’s performance)

1. General comments.

2. Suitability for promotion.

3. Has he been informed of his week points? (If a copy of a minute notifying the officer of his faults has not already been sent to
Personnel Division it should be sent with this report.)

4. *I consider that the officer should receive the increment due to him and I have therefore taken no action to withhold it.

*I consider that the increment due to the officer should be withheld and I am taking action in accordance with the
appropriate disciplinary regulations. +

*The officer is not due to receive an increment being already held in his salary scale, on the maximum point of his salary
Scale or receiving a super scale salary.

*Delete as appropriate.
+See below.

Signature ………………………………………
Date ………………………………………20………… Post ………….. …………………………………
ACTION TO BE TAKEN WHEN INCREMENT CERTIFICATE IS NOT SIGNED
 (1) Inform the officer in writing (copy to be sent to Personnel Division) that consideration is being given to withholding the
increment due to him, set out the reasons why and tell him that if he wishes to exculpate himself he must submit an
exculpatory statement in writing within twenty-one days.
(2) On receipt of the exculpatory statement (or after twenty-one days if no statement is received) decide whether the
officer’s increment should be authorized after all or whether it should be ‘stopped’.
(3) If it is decided that the increment should be authorized, send a minute to the appropriate Salaries Section (copies to
Personnel Division, Ministry of Finance, Auditor-General and the officer) as follows –
‘Having recently declined to sign an Increment Certificate in respect of ………………………………
and having subsequently received and considered representations, I hereby authorize the payment of the increment due to
the officer as from the due date.’
(4) If it is decided that the increment should be stopped, send a minute to the officer (copies to Personnel Division, Ministry
of Finance, Auditor-General and the appropriate Salaries Section) as follows –
‘In accordance with PSC Regulations 39 and 40 I have ‘stopped’ the increment due to you on the ……………
I will consider authorizing you to resume incremental progress in ……………. (Specify time, e.g. six months). In
accordance with the same regulations, I now notify you that you may appeal against this punishment to the Public
Service Commission in accordance with the procedure set out in PSC Regulation No. 42.’.
(NOTE-In the case of an officer who is not subject to the disciplinary control of the Public Service Commission the
Foregoing should be followed mutatis mutandis.)

The following details are given to assist reporting officers in assessing fairly the qualities in paragraph B of Part II on page 2 of
this form:

1. PERSONALITY AND FORCE OF CHARACTER: These words are to be interpreted as meaning the extent to which
the officer possesses qualities such as tactfulness in his manner with colleagues and the general public; readiness to co-
operate with others; ability to maintain an opinion without heat or personal feeling and to admit mistake without any
argument; possession of the power of inspiring confidence; and, generally of making one’s presence felt in the office or
branch.

2. INTELLIGENCE is mental power; creative ability; quickness in the uptake, ability to absorb, understand and
remember both the written and spoken word.

3. JUDGEMENT AND COMMONSENSE mean capacity to think clearly, to draw sound conclusions from the facts
available and to find the best solution for a problem; power to sift statements and seize upon the relevant and important;
ability to determine what is, or is not, necessary or worth doing, and a sense of proportion and perspective when
considering things which are all in some degree necessary or worth doing.

4. RELIABILITY AND ACCURACY: It is necessary to consider to what extent the officer can be depended upon to do
a good job or work with a minimum of supervision or direction. An odd mistake should not normally be held against the
officer.

5. INTEREST IN HIS WORK: the Reporting Officer should consider the extent to which the officer takes an interest,
not only in the particular job he does but in the wider sphere of which his work forms part; whether he finds things out
for himself without waiting to be told.

6. ABILITY TO EXPRESS HIMSELF –

(a) In writing: to state a case on paper clearly and succinctly, and with objective consideration to the relevant
factors.

(b) Orally: a corresponding ability to express himself by word of mouth.

 7. ENERGY AND DRIVE: The Reporting Officer should ask himself whether the officer puts his heart into his work and
whether he can produce results quickly.

8. ADAPTABILITY: It is necessary to consider whether the officer would be equally successful on other work or on new
procedures; to what extent he is hide-bound and set in his ways.

9. ABILITY TO LEAD AND SUPERVISE OTHERS means power to obtain the confidence and trust of colleagues, and
capacity to promote a happy spirit among them so that they work together contentedly and give of their best.

10. ORGANISING AND MANAGERIAL ABILITY: The Reporting Officer should ask himself whether the officer goes
the simplest way about things; whether he saves himself and others unnecessary work; whether he keeps his command
running smoothly, and foresee and prevent bottlenecks.

CS Form B35
Stocked by Govt Printer
40m E27 5/82 2B
REPUBLIC OF ZAMBIA
INCREMENT WARRANT
S. NO……………….. ………………………………..……………
Name ………………………….. ……….....................……………
Appointment ………………………………………. ……..……….
Ministry/Department:………………………………………………
Scale of Office ………………… ……….………..……………….
Salary at present being draw……………………….………………
Amount of Increment………………………………………………
Date Increment due ………………………….…...……………….
___________________________________________________

I certify that the Officer named has discharged his duties with
Efficiency, Diligence and fidelity, and is not debarred from
receiving the increment by failure to fulfill an examination
obligation.

Date …………………. ……………..……………….

Permanent Secretary
 Head of Department
___________________________________________________

I certify that the date and rate of increment are correct and
payment may be made accordingly.

Date …………………. …………………………….

For/Permanent Secretary
Ministry of Finance

To be submitted in Duplicate by the Permanent Secretary

Or Head of Department to the Ministry of Finance.

POLICE AND PRISONS SERVICE COMMISSION

ACTION SHEET

POLICE AND PRISONS SERVICE COMMISSION TOUR OF ……………………..………………..

…………………………………………………… DATE:………………………….……20..…….…
FULL NAMES OF OFFICER:………………………………………………………………………..….……………
DATE OF BIRTH:……………….….…..…………….. SERVICE NUMBER:………………..…..….……….…..
RANK ON FIRST APPOINTMENT:………………...…………… STATION:………….……….…….…….……
DATE OF ATTESTATION:…………….……..…...….DATE OF CONFIRMATION:……………….….….……
PRESENT APPOINTMENT:………………...........................................………………………….……..……
ACADEMIC QUALIFICATIONS:……………………………………………………………………….……….…...
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EXAMINATIONS PASSED:……………………………………………………………………………………..……
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…………………………………………………………………………………………………………………….………
RECORD OF TRANSFERS:……………………………………….………………………………………….………
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COURSES ATTENDED:…………………………………………………………..…………………………………..
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EXTRA QUALIFICATIONS TO DATE:………………………………………………….………………….……….
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……….…………………………………………………………………………………………….………………..…...
PROMOTION RECORD:………………………………………………………………………….…….…………….
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OFFICER’S GRIEVANCE:………………………………………………………………………………….
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SIGNATURE OF OFFICER……………………………… DATE………………………….……………

OFFICER-IN-CHARGE’S COMMENTS ON THE OFFICER’S PERFORMANCE AND

DISCIPLINE:
…………………………………………………………………………………………………………………
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SIGNATURE:…………….…………………. DATE:……………….…………………
OFFICER COMMANDING’S REMARKS……………………………………………………….………
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SIGNATURE………………………………….……… DATE……………………………………….

COMMANDING OFFICER’S COMMENT ON THE OFFICER:………………..…….………………..

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SIGNATURE:…………………………….. DATE:………………………………

INSPECTOR-GENERAL OF POLICE’S COMMENTS:………………………………………..……………

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PERMANENT SECRETARY HOME AFFAIRS’ COMMENTS:…………………….………………...

………………………………………………………………………………….………………………...
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SIGNATURE:…………………….………. DATE:……………..…………20..……

SECRETARY, POLICE AND PRISONS SERVICE COMMISSION COMMENTS:………………...

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SIGNATURE:…………………………….. DATE:…………………………20….…

COMMENTS BY COMMISIONERS:
 1. …………………………………………………………………………………………………………
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2. …………………………………………………………………………………………………………
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3. …………………………………………………………………………………………………………
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5. …………………………………………………………………………………………………………
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CHAIRMAN’S COMMENTS/DIRECTIVE:………….................................……………..……...
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SIGNATURE:………….……………….. DATE:…………………………20…….

POLICE AND PRISONS SERVICE COMMISSION

ACTION SHEET

POLICE AND PRISONS SERVICE COMMISSION TOUR OF:.............................................................................

DATE: ...………………………………………………………….......................……………………………………………
FULL NAMES OF OFFICE:……………………………………….....................……………………............................
DATE OF BIRTH:……………………………………………….......................……………………………………………
SERVICE NO:……………………………………………………......................………………………...........................
RANK ON FIRST APPOINTMENT:……………………………......................………………………………...………...
STATION:………………………………………………………......................……………………………………………..
DATE OF ATTESTATION:…………………………………….......................…………………………………………….
DATE OF CONFIRMATION…………………………………….....................………………………............................
PRESENT APPOINTMENT:…………………………………….......................…………………………………………..
ACADEMIC QUALIFICATIONS:……………………………......................…………………………............................
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PASSED:…………………..........................………………………………………………………………………………….
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RECORD OF TRANSFERS:……………………………………...............
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COURSES ATTENDED………………………………………………….........................…………….……………………
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EXTRA QUALIFICATIONS TO DATE:……………………….........................…………………………………………….
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PROMOTION RECORD:………………………….......................……………………….................................................
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OFFICERS’ GRIEVANCES:…………............................……………………………………………………………………
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SIGNATURE OF THE OFFICER:……………………………………… DATE:…………………………

OFFICER IN CHARGE’S COMMENT ON THE OFFICER’S PERFORMANCE AND DISCIPLINE:
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COMMANDING OFFICER/REGIONAL COMMANDER…….................................………………………….……………
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SIGNATURE:……………………………............………………. DATE:…...............………………………………………..
RANK:…………………………………………………............................………………………………………………………

FOR INSPECTOR GENERAL’S REMARKS:………...............................………………………………………………..

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SIGNATURE:……………………………………………. DATE:…………………………………………..
RANK:…………………………………………………………………………………………………………

COMMENTS/RECOMMENDATION BY THE PERMANENT SECRETARY, MINISTRY OF HOME AFFAIRS:

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SIGNATURE:…………………………………………………. DATE:…….......................……………………………….
RANK…………………………………………………………….......................…………………………………………….
SECRETARY, POLICE AND PRISONS SERVICE COMMISSION COMMENTS:…….........................……………
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SIGNATURE:………………………………………………….. DATE:……….......................…………………………….
RANK…………………………………………………………………………........................……………………………….

COMMENTS BY COMMISSIONERS:
1. ……………………………………………………………………………………………………………………
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SIGNATURE:…………………............…………….. DATE:………...........…………………………….

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SIGNATURE:………………...........………….. DATE:…………..............………………………….

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SIGNATURE:……...............…………………….. DATE:………...........…………………………….
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SIGNATURE:………………….............……….. DATE:…........................………………………………….

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SIGNATURE:………………………………….. DATE:………….………………………………….

VICE CHAIRPERSON’S COMMENT:

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SIGNATURE:…………………….…………………….. DATE:……………………………………………….

CHAIRMAN’S COMMENTS/DIRECTIVE:………........................……………………………………………….......
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SIGNATURE:…………………………...……………. DATE:……….....................…………………………………..

ZP FORM 3
STOCKED BY GOVT STORES

IN CONFIDENCE

ZAMBIA POLICE

ANNUAL CONFIDENTIAL REPORT

1. Full Name S No. Force No.

2. (a) Marital status MARRIED 3.Date of Birth 4.Date of first appointment 5. *Perm. And pensionable
(c) Number of children *Probation
*Agreement
*Contract/gratuity
6. Present rank 7. Date of appointment
To present rank

8. Present salary 9. Salary scale at present rank 10. Date increment due

11. Examinations passed Date of examination Service Orders ref.

Service Standing Orders .. .. .. .. .. .. .. .. .. .. .. .. .
Service Instructions ... .. .. .. .. .. .. .. .. .. .. .. ..
Police Law – Criminal Procedure and Evidence ... . .. ..
Criminal Law ... .. .. .. .. .. .. .. .. .. .. .. .. ..
Laws of Zambia ... .. .. .. .. .. .. .. .. .. .. .. ..
Common Law ... .. .. .. .. .. .. .. .. .. . .. .. ..
First Aid ... .. .. .. .. .. .. .. .. .. .. .. .. .. . .. ..
Others – specify ... .. .. .. .. ... .. .. .. .. .. .. .. ..
.. .. .. .. .. .. .. .. .. .. .. .. .. ..

12. Details of any special courses of instructions taken since last report

13. Disciplinary offences since last report

14. Commendations awarded since last report

10m T470 9/86 P/F4

IN CONFIDENCE [PTO

Part II. To be completed by officer in charge of the officer’s formation

(Reports on officers serving at posts will be completed by the officer in charge of the present station)

A. Assessment of qualities (see Notes on page 4)

INCLINED TO BE VERY GOOD SATISFACTORY FAIR POOR

OVERBEARING GOOD
1. Relationship with:

(a) Superiors ... .. .. .. .. .. .. .. .. .. .. .. ..

(b) Subordinates . .. .. .. .. .. .. .. .. .. .. ..
© Members of the public... .. .. .. .. .. .. .. ..
2. Intelligence, judgment and commonsense ... .. .. ..
3. Reliability, accuracy and knowledge of his work ... ..
4. Energy, drive and interest in his work ... .. .. .. ..
5. Ability to lead and supervise ... .. .. .. .. .. .. ..
6. Ability to express himself clearly -
(a) In writing ... .. .. .. .. .. .. .. .. .. .. .. ..
(b) Orally... .. .. .. .. .. .. .. .. .. .. .. .. ..
7. Bearing and turnout... .. .. .. .. .. .. .. .. .. ..
8. Interest in training and welfare of subordinates... .. ..
(A cross should be placed in the appropriate box for each item. As regards Item 1, where a cross is appropriately entered in the box headed ‘Inclined
to be overbearing’, a cross should also be entered in one of the other boxes against each item.)

B. Brief statement of the work on which the officer has been engaged during the period to which the report relates

General comments

Date....................................................................... 20...... Signature.............................................................................................

(Officer in Charge of Formation)

Name.......................................................................................

Rank ......................................................................................

Station ...................................................................................

Part III. To be completed by Officer Commanding (where applicable)

Remarks
 Signature:...........................................................................
Date:........................................................ 20…........
Appointment:....................................................................

Part IV To be completed by Officer Commanding Division

Remarks (including recommendations regarding increment).

Signature:..............................................................................
Date:.......................................................... 20.........
Appointment:.....................................................................

Part V. To be completed by the Inspector-General of Police

Remarks

Date:........................................................20…......... . …………........................................................................
Inspector-General of Police

Part VI For use by Home Affairs

Date of Receipt

Instructions by Permanent Secretary (Home Affairs)

Date:..........................................................20……...... .......................................................................
Permanent Secretary (Home AffairS

NOTES FOR THE GUIDANCE OF REPORTING OFFICERS

Intelligence, judgment and commonsense

Intelligence is mental power; creative ability; quickness on the uptake; ability to absorb, understand and
remember both the written and spoken word. Judgment and commonsense mean capacity to think clearly, to draw
sound concussions from the facts available, and to find the best solution for a problem; power to sift statements
and seize upon the relevant and important; ability to determine what is, or is not, necessary or worth doing, land a
sense of proportion and perspective when considering things which are all in some degree necessary or worth
doing.
Reliability, accuracy and knowledge of his work
It is necessary to consider to what extent the officer can be depended upon to do a good job of work with a
minimum of supervision or direction. A rare mistake should not normally be held against the officer. His
knowledge should cover both the practical and theoretical aspects of his work.

Ability to express himself

(1) In writing: to state a case on paper clearly and succinctly, and with objective consideration of the
relevant facts.

(2) Orally: a corresponding ability to express himself by word of mouth.

Energy, drive and interest in his work

The reporting officer should ask himself whether the officer puts his heart into his work and whether he can
produce good results without upsetting people. Also the extent to which the officer takes an interest, not only in
the particular job he does but in the wider sphere of which his work forms part; whether he finds things out for
himself without waiting to be told.

Ability to lead and supervise

Ability to lead land supervise others means the power to obtain the confidence and trust of colleagues, and
capacity to promote a happy spirit among them so that they work together contentedly and give of their best.

Personal characteristics

The aim should be to bring out the officer’s strong and weak points and to sum him up as a person. Mention
should be made of any special talents which the officer possesses, and any special job which he may have
undertaken. Also any change of duties, illness or worry, which may have brought about a noticeable effect on his
performance during the year.

Duty of Officer Commanding Division

If the Commanding Officer seriously dissents from the markings of the reporting officer, he must raise the matter
before making his comments.

AFFIDAVIT TO CONFIRM THE DATE OF BIRTH

I, ................................................................................................................ SAY AS FOLLOWS:-

MY FULL NAMES ARE:..................................................................................................................

I AM A ZAMBIAN CITIZEN BY:...................................................................................................

I WAS BORN ON:..............................................................................................................................

 MY OCCUPATION IS:.......................................................................................................................

MY RESIDENTIAL ADDRESS IS:....................................................................................................

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

MY BUSINESS ADDRESS IS:............................................................................................................

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

I AM THE................................................................... OF.....................................................................

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

WHO WAS BORN ON ..........................................................................................................................

AT ............................................................................................................................................................

TO THE BEST OF MY KNOWLEDGE THE ABOVE INFORMATION IS TRUE AND CORRECT.

.....................................................................
SIGNED

SWORN / AFFIRMED BY THE SAID ............................................................................................

AT ...................................... ON ...................... DAY OF ...................................... 20……. BEFORE ME

.........................................................
COMMISSIONER OF OATH / MAGISTRATE

ZP FORM 126
Stocked by QM Stores

ZAMBIA POLICE
TRAFFIC OFFENCE REPORT
STATION CODE; 000077

Formation:………………….……………..……..………………..… RTO …………..…………….……………………………

Date of Offence:………….……………….…….…….…………….. Time:………………………………..…………..… hours
Plate of Offence:……………………………………………………………………………………………………………………
(if at a junction give both names, e.g. Ash Road into Independence)
PARTICULARS OF OFFENCE (for disobeying traffic signal, specify)
(1) ….………………………………….………………………………………………..……………………………….
(2)…………………………………….………………………………………………….………………………………
(3)……………………………………….……………………………………………….………………………………
(4)………………………………………….………………………………………….…………………………………
(5)………………………………………………………………………………………………………………………….
NAMES AND ADDRESS OF WITNESS:
(1)………………………………………………………………………………………………………………………….
(2)……………………………………………………………………………………………………………….
OFFENDER
Surname:……………………………..…………………….. Other names:……………………………….………………………..
Residential address:………………………………….………………………………….…………………………………………..
Business address:……………………………………………………………………..……………………………………………..
Postal address:……………………………………………………………………..………………………………………………..
Identity document No.:………………………………………..………..…… Male/Female*……...............………………………
Occupation:…………………………………….……………………………..……………………. Age:……………….…………
Driver’s License No.:……………..……….……………… Issued on:………….………..…………. At:…………….…………...
Valid for class of vehicle/unlicensed*………………………….……….….…………………………….…………………………
Insurance certificate No.:………………….…………. Issued by:…………………………...…………… Valid/invalid/uninsured*
Certificate of fitness valid/invalid/not held/not required*
Test certificate valid/invalid/not required* (Test Certificate Regulation, 1963)
Offender warned to produce driver’s license/insurance/blue book* at ……………………………. By date:……………………..
PARTICULARS OF OFFENDER’S VEHICLE:
Make:………………………………………....…………….. Type (e.g. saloon or vanette)………………………………...
Registration/Frame No.* …………………………………... PSV/not PSV* ……………………………...……………….
PARTICLARS OF OWNER OF VEHICLE DIFFERENT FROM OFFENDER:
Name:…………………………………………………………………….…………………………………………………
Address:…………………………………………………………………………….………………………………………
Offender warned at time of prosecution/issued with Notice of Intended Prosecution (ZP Form 34)*

Date:……………………………………….20…….... ………………………………………………………..
SIGNATURE, RANK AND NO. OF REPORTING OFFICER
…………………………..
OFFENDER’S SIGNATURE
 WARRANT TO INSPECT TELE-COMMUNICATIONS UNDER
SECTION 18(1) (a) OF THE TELECOMMUNICATION ACT CAP 469

To……………………………………………………………….…..... (Name of Policeman)

Number………………………………Rank……………………..………………………

Whereas it has been proved to me on oath, according to reasonable suspicion the

inspection of the cellular phone, number/s………………………………………………

……………….………………………………………………………………….relating to

………………………………….……….……………………(Name of suspect) with the

Telecommunications office at ……………..…………………………….………………..

situated at…………………………………………………………………(Name of town)

as both necessary and desirable for the purpose of investigating the commission of

offence by………………………………..………………………………………………….

…………………………….…………………………………………… (name of suspect.)

You are hereby authorized to investigate the mobile numbers of the said

……………………………………………………………..……………………………..

with the said…………………………………...…………..…………….(name of suspect)

and to take copies of any relative entries or communication in such call register.

Dated this…..………..……….day of……………….……………………20……………

………………………………..
MAGISTRATE
 REPUBLIC OF ZAMBIA
AFFIDAVIT WARRANT
(Section 110 Criminal Procedure Code Cap 88)

In the subordinate court of the…………………….………………class for the

…………………………………………..…..district holden at………………..……………..

To…………………………………………………………..…………...…..(name of officer)
of……………………………………………….…..…………..………………Police Station
And she/he has reasonable cause to suspect that cell phone used in
the………………………………………………………………………………………………
…………………………………………………………………………………………………

For he/she the said name of officer…………………………….……………………………..

deposes and says(state shortly the Ground on which warrant is applied for)
…………………………………………………………………………………………………
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……………………………………………
Signature of a person applying for warrant.

Taken and sworn at………………….this……………day of………………………..20..…

………………………………
 Magistrate

GENERAL AFFIDAVIT FORM

I ……………………………………..……………........…………………………………………......……..
State that my address:………………………………………………………………………………………..

…………………..
…………………………………………………………………………………………………………………
………………………………………………………………………………………..………..
that my nationality is…………………….………………………….……………………….……..….….……
that I am employed as……………….………………………………..………………………………………..
my reason/s for swearing is that:
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I believe from my personal knowledge that the information contained in this affidavit is true and correct.

DATE:…………………….…..……..20….…. SIGNATURE:……….……………….……

Sworn before me at………………….………….………on this………………………………...…………..

day of…………………………………………………………………….…..………..20……………..………

………………………………….………………………….
 COMMISSIONER FOR OATHS.

(Complete five copies & submit to Director DMDT)

DMDT Form I
10m F687 10/89
DIRECTOR OF MANPOWER DEVELOPMENT AND
TRAINING
APPLICATION FOR STUDY LEAVE
PART I
(To be completed by applicant)
Name:…………………………………………….……………………………………………………………………
Ts/Force/s No…………………………..…………….NRC…………………..…………………………………..
Date of birth……………………………..…………….Marital status…………..………………………………
Ministry…………………………………….………………………………………………………………………….
Province/Station………………………….…………………………………………………………………………
Date of first appointment to the civil service………………….………………………………………………
State whether confirmed or not confirmed……………………….……………………………………………
(General order F26. Please attach proof of confirmation)
Post………………………………………………………………….………………………………………………….
Main duties…………………………………………………………….……………………………………………..
………………………………………………………………………..………………………………………………….
………………………………………………………………………………….………………………………………..
Field of study…………………………………………………..……………………………………………………...
Level of study (Degree, Diploma, etc.)…………………………..…………………………………………….….
Duration of course……………………….…………… Date course starts…………..…………………………
Country of study……………………………………………..……………………………………………………….
Name of Institution………………………………………...…………………………………………………………
Sponsors………………………………………………………………………………………………………………..
In what way is your chosen course relevant to your present Job?
………………………………………...………………………………………………………………………………….
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I declare that the above details are to the best of my knowledge a correct statement of
Information required.
Signature…………………………………………. Date…………………………………………20…………
PART II
(To be completed by employer)
Please complete either section A or section B. Delete section not applicable.
SECTION A – FOR CONFIRMED OFFICERS ONLY

I wish to confirm that the information given above is correct, and I recommend that paid/unpaid
study leave be granted.
SECTION B – FOR UNCONFIRMED OFFICERS ONLY
I wish to state that the officer is not confirmed in his appointment for the following reasons:
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
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I have now taken the following measures to obtain the officer’s confirmation:
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
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Explain in details the relevance of the course to the officer’s present duties:
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
I wish to confirm that the information given above is correct and I recommend that paid/unpaid
study leave be granted
The officer will be bonded in accordance with the existing regulations. While the officer is away,
his duties will be carried out among other officers and only if absolutely necessary will it be
possible for a training grade post to be done. (See Personnel Division Circular B2 of 1982).
*Please attaché one copy of the completed bonding Agreement.

Signature………………………………………… Date:…………………………………………………
Permanent Secretary or Head of Organisation.

Name in Full:……………………………......................……………………………………………….
(Please Print)

PART III
(To be completed by the Secretary to the cabinet/Permanent
Secretary, Personnel division)
Paid/unpaid study leave approved/Not approved.
(Delete as applicable)

Signature……………………......……………… Date:……………....…………………………….
Secretary to the Cabinet.
Permanent Secretary Personnel Division.
 Bonding Form No. 3
APPENDIX III A TO SECTION F Stocked by Govt. Printers
General Order F 41 20 m R420 2/86 5 & T

REPUBLIC OF ZAMBIA
This Agreement made this…………........….......………..day of………....................................20…....……
Between the Government of the Republic of Zambia(hereinafter called ‘the Government’)..........................
…………………………………………………………acting in his capacity as...........................................
…………………….............……………..of the one part and…………........................…………………….
(Hereinafter called ‘the Candidate’) of the other part and………..........................…………………………..
Over/being of the age of…………….......….. years, by his parent/guardian…….......................…………….
WHEREAS the candidate has been selected to attend a course of instruction (hereinafter called ‘the course’)
at the expense of the Government:

NOW THEREFORE it is agreed by the parties hereto that:-

In consideration of the admission of the candidate to the course selected by the Government and the
payment by the Government of the expenses of and incidental to the course, the amount of which shall be at
the absolute discretion of the Government, the candidate/by the parent/guardian undertakes to the
Government:-
i. To follow the prescribed course of study to completion to the best of his ability and in so far
as he is capable of learning and in accordance with the directions contained in the rules for
candidates attending in service courses set out in the schedule hereto and deemed hereby to
be incorporated herein and in accordance with such other directions as may from time to time
be given to him in writing by the Government acting by an officer dully authorised in that
behalf;
ii. At the conclusion of the course to return to fulfil the duties of his substantive rank or to such
other post as the Government may direct;
iii. To repay to the government all expenditure incurred by the Government in connection with
his course including (but not limited to) any sums paid to him and on his behalf by way of
salary, allowances, fees and expenses and the cost of transport and travelling if the candidate
contravenes or fails to comply with the conditions of clauses (i) and (ii) hereof;
iv. In the event of the candidate failing to serve the Government continuously on his return to
duty at the end of the course for the period equal to the full period of the training up to the
maximum of four years either because of his resignation or because he is dismissed on the
ground of misconduct or inefficiency, to repay the Government all expenditure incurred by
the government in connection with his course or such proportion thereof as the Government
may direct.
The parties hereto are hereby deemed to have mutually agreed upon the said repayments as genuine pre-
estimates of the losses sustainable by the Government in the events referred to and to have stipulated for
these repayments as liquidated damages and not by way of penalty.

Nothing contained in this agreement shall be construed as imposing any liability on the Government to
continue to employ the candidate.
*To be completed on behalf of the Government by the Officer in charge of the training institute or
ministerial/department training officer.
Signed by the said (Name)………........................………………….. ………………………………
In the presence of………… .......................………………………… The Candidate (Signature)
Signed……………………........................………………………….
Address……………………........................………………………...
………………………………………………………

Occupation…………………………………………..
Signed………………………………………………. ……………………………….
For and behalf of the Government in the of For and on behalf of the
Signature……………………………………………. Government of the Republic of Zambia
Address……………………………………………..
………………………………………………………
Occupation………………………………………….

FIVE COPIES TO BE COMPLETED:

Distributed: ORIGINAL to candidate
COPIES: Permanent Secretary
Head of Department
Permanent Secretary (Personnel)
Officer in Charge Training School
SCHEDULE:

RULES FOR CANDIDATES ATTENDING IN-SERVICE COURSES

Every candidate selected to attend in service course is required to comply wit the following rules:
(a) To produce to the venue of the course as directed (both as to the time and means of travel)
(b) To begin his/her training at such time as may be appointed and to continue diligently with such
training until the completion of the course unless he/she is prevented from so doing by sickness
proved by a certificate from a registered medical practitioner or by other circumstances accepted
by Government as beyond his/her control
(c) To follow any direction which may be given to his/her by the Officer-In-Charge of the course
(d) To devote his/her full time and attention to following the course for which his/her course in
content or duration is granted in writing by the Government
(e) At all times to comply with the requirements of the course regarding conduct and discipline
(f) To satisfy the Government as to his/her attendance, conduct and progress by report from the
Officer-In-Charge for the course
(g) As and when called upon by the Government to present him/herself to be medically examined by
a registered medical practitioner , it being understood that his/her attendance at the course may
be suspended or terminated if he/she is found unfit to complete the course owing to illness or if
owing to illness , he/she is absent from the course for more than six months
(h) To sit and pass any prescribed examinations or group of examinations within the time fixed by
the government unless he /she is prevented from doing so by sickness proved by certificate from
a registered medical practitioner or by other circumstances accepted by the Government as
beyond his/her control
(i) Not too many during the duration of the course without the written permission of the
Government.
 MINISTRY OF COMMUNICATION AND TRANSPORT
MOTOR VEHICLE EXAMINATION REPORT.

REQUESTED BY:…………………………………………………………..……………………
MOTORVEHICLEINVOLVED:…………………………………………………………………
DATE, TIME AND PLACE OF ACCIDENT:…………………………………..………………
………………………………………………………………………………….…………………
NATUREOFACCIDENT:…………………………………………………….……………………
ELECTRICAL SYSTEM
HEADLAMPS:……………………………………………………………………………………
INDICATORS:……………………………………………………………………………………
BREAKLIGHTS:…………………………………………………………………………………
REFLECTORS:…………………………………………………………………………….………
SUSPENTION
…………………………………………………………………………………….………………
…………………………………………………………………………………….………………
TYRES:……………………………………………………………………………..………………
STEERING SYSTEM:…………………………………………………………………………….
………………………………………………………………………………….……………….…
………………………………………………………………………………………..……………
HANDBRAKE:……………………………………………………………………………………
FOOTBRAKE:……………………………………………………………………………………
SPEEDOMETER:…………………………………………………………………….…………..
GENERAL:…………………………………………………………………………………….…
…………………………………………………………………………………………………..…
DAMAGESCAUSED:…………………………………………………………………..…………
……………………………………………………………………………………………………
……………………………………………………………...………………………………………
OPINION (CAUSE OF ACCIDENT):
…………………………………………………………………….………………………………..
……………………………………………………………………………………………………...
……………………………………………………………………………………...………………
EXAMINED BY:…………………………….. SIGNED:……………………….………..…
 DATE EXAMINED:…………………………………

PUBLIC SERVICE PENSIONS FUND BOARD

P.O BOX, 38411, LUSAKA. Tel:232705/8

MORTGAGE SCHEME

APPLICATION FOR HOUSE LOAN

1. Personal particulars of Applicant(s)

Surname First Name Other Names
1. 1. 1.
2. 2. 2.
Date of Birth NRC No. Sex Marital Status
1. 1. 1. 1.
2. 2. 2. 2.

2. Occupation/Employment
Job Title Ministry Address Employee/Man No.
1. 1. 1. 1.
2. 2. 2. 2.
Date Employed Retirement date Telephone
1. 1. 1. W 1. M
1. 1. 1. W 1. M
E-Mail 1. 2.

3. Financial information
ASSETS (SAVINGS INVESTMENT ETC) LIABILITIES (LOANS PROPOSED/TAKEN)
Applicant Co-applicant Please indicate all loans proposed/ taken from employer, Etc
K K and installment(s) payable per m onth including interest against
each loan
Source of loan Amount Monthly Term
Savings in bank _____________ ______________ Installment
Immovable property (specify) Payable
______________________________________________ K K (months)
______________________________________________
______________________________________________ Applicant:
Other Assets (Specify) Employer ____________ ___________ __________
1. ________________ _____________ Bank ____________ ___________ __________
2. ________________ _____________ Other ____________ ___________ __________
Co-applicant: ____________ ___________ __________
Life Assurance policies. ___________ ____________
Policy Amount _______________ _____________ Employer ____________ ___________ __________
Maturity Date ________________ _____________ Bank ____________ ___________ __________
Others ____________ ___________ __________

4. Bank Account Details

Name of Account Name of bank Branch Name Current/Savings Account No. (s)
Holder Account
1.
2.
 5. Income per month

Basic Salary K K
Allowances K K
Other income (Source*) K K
Total Commitments Per Months (K ) (K )
NET INCOME K K
*Specify Source 1. 2.

6. Repayment Options

Interest only Part principal plus interest Full principal plus interest

7. Particulars of property and collateral security

Plot/farm/Lot/Stand No…………………………………………………………………………………………………………………….
Land Tenure
Leasehold Type of Property
From To G/Rent Flat Detached Semidetached

Value of collateral security

Pension Estimate as at Application date Insurance

8. Purchase price/cost of construction

Existing house House to be Constructed

Purchase/Construction Amount K K
Management Fees K K
Valuation fees K K
TOTAL K K

9. Means of Financing

Proposed Loan Own Resource Total

K K K

10. Consultants
Lawyers Architects
Name

Address
Telephone Numbers

11. Insurance cover

If the loan is made, the board will, at the expense of the borrower, insure the property for an amount not less than the purchase price or
the cost of the property. If desired, the insurance cover would be increased by the board without prior notification of the borrower.
12. Member’s Declaration
I/We herby agree to be bound by the rules of the scheme from time to time in force and further declare that:
[a] All the information given in this form is accurate
[b] The board may make such inquiries as it may deem necessary, including reference to my/our
Current and previous employers and bankers.

SIGNATURE OF APPLICANT(S)
1. ________________________________

Date:……………………………………………………………..
 ZP Form 188

PAYMENT OR WITHDRAWAL OF AN ALLOWANCE

P. 154/……………………………..
…………………………..20 ……

…………………………………………………………..

I have to recommend payment/withdrawal of …………………………………………..……………………

allowance in respect of No……………. Rank………………………… Name………………..…………….
with effect from ……………………….………………………… for the following reasons:-
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………

…………………………………………………………
Commanding Officer/Officer in charge

…………………………………………………….

The above recommendation is approved. An appropriate entry will now be made in the formation
history sheet of the officer named and this form will be filed in his/her staff file.

The above recommendation is not/approved for the following reasons:-

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

……..…………………………………………………
Commanding Officer or Commissioner of Police

Date:………………………………20……….

Cc: Commissioner of Police (Paymaster)

*Delete as necessary.

For. SERVICE HEADQUARTERS use only:

Entered………………………………………….…… Paymaster………………….……………………….
 Acct Form 44

CLAIM FOR SUBSISTENCE ALLOWANCE AND REIMBURSEMENT OF TRANSPORT CHARGES AND

OTHER INCIDENTIAL EXPENSES

PART I Particulars of Claimant:

Name:……………………………………… Voucher No.:……………………….…
Man No:………………………….………… Date:…….………………………….....
Designation:………….……..………………
Department:…ZAMBIA POLICE……….. Allocation Code……………………....
Ministry/Province:…HOME AFFAIRS/MUCHINGA
Postal Address: Box 450010 MPIKA
Checked by:………………………….
(Name and Signature)

Date Departed Date Arrival at Purpose of journey No. of Rate per night Amount *S/K
from nights *S/K
(a) Subsistence Allowance

(b) Transport charges and other incidental expenses (give details and attach receipts)

Authority

NOTE: Where claim is in respect of hotel bills, receipt accounts must be attached together with proof that
cheaper accommodation was not available.
Delete as necessary
2.
Part II

I certify that the journeys were undertaken on Government business.

Date …………….….…… ………………………………..

(Signature of claimant)

Part III

Certificate by Supervising Officer

I certify that the journeys were authorized and that the claim is correct in every detail.

Date:……………………. …………………………..………………
(Signature of Supervising Officer)

Part IV

Certificate by Permanent Secretary or Head of Department.

Payment of the claim is authorized.

Station:…………………………… ………...…………………………………….….
(Signature of Permanent Secretary Or Head of Department)
*(Ministry/Provincial/Division/Department)

Date:………………………..

NOTE: Code should include the Man No. of the officer.

*Delete as appropriate
 Accounts Form No. 17B

Ref:……………………………………
Date:…………………………………..

RETIREMENT OF SPECIAL IMPREST

(To be completed by official retiring Special Imprests, in triplicate)

PART I
I LANGENI KENNEDY (Name)…OFFICER IN CHARGE………………………………...(Designation)
Of….ISOKA POLICE STATION..stationed at ISOKA… (Place) hereby retire the Special Imprest of …
K800,000=00………………...which was issued to me on Cheque No…………….………... dated
…………..………………………..(Date) as follows:
*Subsistence/Kilometre allowance/Hotel charges/ $ K
Transport charges/Incidental expenses as per
Claim on Accounts Form No.44A/44B attached …………… .........................…

* Amount retired in Cash/Cheque …………… ……………….....

Balance outstanding ……………… ……..….………

____________ __

Date……………………..….…….. ………. ………………………

(SIGNATURE OF OFFICER)

PART II
(To be completed by the Accounting Officer and returned to the Officer retiring the imprest )
The retirement of imprest has been accounted for as follows: Amount

Ref Code $ K

Journal Voucher No…Dr …

……………………………………. Cr
…………………..

General Receipt No………. Cr ……………………………………………………………………

* The balance of $/K………………………… is outstanding and will be recovered from your salary as
follows (see Financial Regulation 186)…………………………………………………
 Date ……………………………. …………………………………………..
(SIGNATURE OF ACCOUNTING OFFICER)
*Delete as necessary

JOURNAL VOUCHER
PARTICULAR F ENTRY
Journal No. ..............................
Month: ..............................
Approved By: ..............................
TO: CONTROL 011 ...............................
COMPUTER SECTION -ZAMBIA POLICE (BTL)
Please make the adjustment below in the accounts for the month of …..AUGUST 2009................ and
(a) Forward the enclosed copy/copies of this form, duly endorsed with the particulars of the
(b) Complete as required
TO.........PACU.........................and to.. RECURRENT (RDCs).. for his/my records
Reasons for.... Being clearance of Imprest retired by No.020037 A/SUPT KANUNSHYA HONORATO
paid on cheque No. 000783 dated 13/11/2009 as per the
attached accounts form 44 and cash sale receipts………………………………
If adjusting a previous ……………………………………………………………………....................................
Allocation particulars ................................................................................................................................
Of the original entry ..
Signature:.............................................
Ministry of Home Affairs
Date:......................................................
CODE Amount
Warrant K N
Class & Holder
Function Head Dept Unit Accounting Programme
Officer Activity Account Code

03109 11 12 01 001 02 01 221 0 10 800,000 00

D E B I T

03109 11 12 01 001 02 03 322 020 021556 800,000 00

C R E D I T
 CPC 7 (Revised)
Stocked by Govt Printers
30m S741 6/86 P/F

REPUBLIC OF ZAMBIA
SEARCH WARRANT FOR STOLEN GOODS
(Criminal Procedure Code ss 118 – 119)

IN THE SUBORDINATE COURT of ………………………………………………………………………………….

……………………………………………………………………………………………………………………………..

, Police Officers, and other officers.

, of

has this day made information on oath that the following goods (here describe the goods)

were stolen and unlawfully carried away from and out of at

and that he has reasonable cause

to suspect, and does suspect that these goods, or some of them, are concealed in the dwelling
house or premises (or as the case may be)
of , situated at

You are hereby authorized and commanded in the name of the President with proper assistance, to
enter the of aforesaid
(in the daytime), and there diligently search for the said goods, and if the same or any thereof are found on
search, to bring the goods so found, and also the said
before this court to be dealt with according to law.

Issued at the day of , 20 .

 ……………………………………………
(Magistrate)

REPUBLIC OF ZAMBIA
SEARCH WARRANT
(Section 118 Criminal Procedure Code, CAP 88)

IN THE SUBORDINATE COURT OF THE ………………………..…………………… CLASS FOR THE

………………………………....…….. DISTRICT, HOLDEN AT ……………..…………………………….
TO ………………………………………………..………………………. Police Officers and other Officers,
Whereas ………………………………………………………. Has this ……………………………… day
of ………………………………………………………………20…….. Made information on oath that the
following goods/ items; ………………………………………………………………………………………...
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Are concealed in the premises/ dwelling house/ office of ……………..………………………………………
………………………………………………. Situated at ………………………….………………………….
…………………………………………………………………………….………………………………….....
You are hereby commanded and authorized in the name of the President with proper assistance to enter the
said …………………………………………………………………………………………………………….
aforesaid, during the day/anytime and diligently search for the said items/ goods and if the same or any are
found on search, bring the items/ goods so found and any person so found before this court to be dealt with
according to law.

Issued at ……………….………….this ………………day of ………….………………………..….20……...

………………………….…………………
MAGISTRATE
 PERFORMANCE ASSESSMENT REPORT

S/No…………………………. Names………………………………… Rank…………………...

Education standard………………………………………. Commencement date…………………

Performance in Branches where the officer served:-

Front desk…………………………………………………………………………………………...

………………………………………………………………………………………..……………..

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

C.I.D………………………………………………………………………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Prosecutions………………………………………………………………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Prosecutions………………………………………………………………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Traffic………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Victim support unit………………………………………………………………………………....

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Administration……………………………………………………………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………
Courses attended with dates………………………………………………………………………...

………………………………………………………………………………………………………

Relationship with other officers…………………………………………………………………….

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Relationship with Superiors…………………………………………………………………….......

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Intelligence, judgment and common sense…………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Reliability, accuracy and knowledge of his job and responsibility………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Ability to lead and supervise others………………………………………………………………...

………………………………………………………………………………………………………

Interest in training and welfare of his subordinates………………………………………………...

………………………………………………………………………………………………………

………………………………………………………………………………………………………

General remarks (character and personality)……………………………………………………….

……………………………………………………………………………………………………....

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

……………………………………………………………………………………………………....

……………………………………
Officer in charge.
All Correspondence to be addressed to In reply please quote…
the Divisional Commander ZPND/71/38/4
Telegrams: Divpol Kasama
Tel: 021-4-221196
Fax: 021-4-221892
REPUBLIC OF ZAMBIA
ZAMBIA POLICE SERVICE
NORTHERN DIVISION HEADQUARTERS
P.O. Box 410335
KASAMA.
Appendix II

Date: ……………………

The General Manager-Retail Banking Products

Standard Chartered Bank Zambia Plc.
P.O. Box 31353
Northend Building
LUSAKA.

Dear Sir,

Re: ASSIGNMENT OF END OF SERVICE BENEFITS FOR ………………….

We hereby confirm that ………………. NRC No. ………………………. is a bonafide employee of the Zambia Police Service and that he is
employed on permanent and pensionable terms and has been confirmed in his employment.

We further confirm that he has informed us of his loan obligations to yourselves and has agreed to allow Zambia Police to deduct on your
behalf, from any gratuity due to his monies still due to Standard Chartered Bank Zambia Plc. with regard to his/her loan to yourselves in the
event that he separated from Zambia Police Service. The net accrued terminal benefits due to the employee currently amounts to
K……………………………

Yours faithfully,

Divisional Staff Officer

For/ Divisional Commander
Cc: P154/2/…………

I ………………… NRC No. …………………… hereby confirm that I have authorized Zambia Police Service to deduct from my gratuity/terminal
benefits any and all monies still owing to Standard Chartered Bank Zambia Plc. in the event of my separation from the Zambia Police Service at
any time while my loan is still running.

Signed……………………………… Date…………………………………20………
All Correspondence to be addressed to In reply please quote…
the Divisional Commander ZPND/71/38/4
Telegrams: Divpol Kasama
Tel: 021-4-221196
Fax: 021-4-221892
REPUBLIC OF ZAMBIA
ZAMBIA POLICE SERVICE
NORTHERN DIVISION HEADQUARTERS
P.O. Box 410335
KASAMA.
Appendix III

Date: ……………………

The General Manager-Retail Banking Products

Standard Chartered Bank Zambia Plc.
P.O. Box 31353
Northend Building
LUSAKA.

Dear Sir,

Re: CONFIRMATION OF ADDRESS AND PERSONAL DETAILS.

This letter serves to confirm that ………name ……… Man No. …………………… and NRC No. ……………………….. is a bonafide employee of
the Government of the Republic of Zambia under the Ministry of Home Affairs/ Zambia Police Service. He is employed as a Police Officer in
ISOKA on permanent and pensionable terms and has been confirmed in his employment.

We further confirm that:

a) The applicant resides at House No………… Isoka Police Camp, ISOKA.
b) There is no disciplinary case currently or pending against him. Nor is he under notice to resign or under notice of redundancy.
c) Should their application be successful, the loan repayment will be deducted from the employee’s salary and remitted to the bank
every month until the loan is fully redeemed. This arrangement shall continue if an employee is transferred from one Government
entity to another. In the event that the employee’s salary is withheld or the loan repayment amount is not remitted for any reason, the
bank shall be notified in writing.
d) The bank will be informed of the employee’s resignation or termination of his employment. In the event of such occurrence, the lesser
of the outstanding loan balance or any final settlement to the employee will be transferred directly to the bank for the credit of the
employee’s loan account (in line with end of service benefits letter to be signed jointly by the applicant and the employer) except
pension benefits which have not been pledged as collateral.

Any assistance rendered to him will be appreciated. Should you need any clarification, please do not hesitate to contact the under signed.

Yours faithfully,
Government of the Republic of Zambia.
Divisional Staff Officer
For/ Divisional Commander