}
THE HONGKONG GOVERNMENT GAZETTE, 5TH FEBRUARY, 1898. 123
SCHEDULE.
FORM A.
Date
Memorandum of Agreement made this day between A.B. of
of the first part, and C., a native of
per ship
of the second part, whose description is endorsed hereon. The conditions are that the said C. engages to serve the said A.B. as a
and otherwise to make himself generally useful to the said A.B. within the Colony of Western Australia for the term of and also to obey all the lawful and reasonable commands of the said A.B, or of the said A.B.'s overscer or authorised agent during the said period, in consideration of which services the said A.B. doth hereby agree to pay to the said C. wages at the rate of £ per annum, to be paid in money at the and to provide him with daily rations which shall be substantial, sufficient, and suitable for him, and with fit and proper lodging during the said term, and to defray the expense of the conveyance of the said C. to the place at which he is to be employed, and to provide the said C. with a free passage to
at the expiration of the said term of
Medical attendance shall be provided by the employer at his expense, when necessary and practicable, unless the illness of the labourer shall have been caused by his own improper act or fault.
end of
In witness whereof they have affixed their signatures (or marks) to this document. The above agreement was explained to the said C. in my presence, and was signed before me by the within-mentioned A.B. and C., with their names (or marks) at
the
day of
Name
Indorsement.
Apparent age
Place of birth
Place and date of shipment
Calling or occupation
Height, barefooted
Complexion
Marks
(Signed)
18
Section 12.
FORM B.
LIST of persons on board the Vessel [name of ship] whereof is Master [name of master] having on board Section 14. at [name of place], in Westeru Australis, the following persons, apparently natives of India, China, Africa, or of the Islands in the Indian or Pacific Oceans, or of the Malayan Archipelago, and imported into the Colony as labourers or servants.
Name.
Apparent age.
Place of
Birth.
Place where Shipped, and date of ship- ment.
Calling
or
Occupa- tion.
Height, bare. footed.
Com- plexion.
Marks.
Name, resi- dence, and description of employer.
FORM C.
Medical Certificate.
I hereby certify that I have this day examined [name of the labourer examined] being of the apparent age of years, and that I find that he is free from disease and of a sound constitution.*
(Signed) [name and medical qualification or title of
examining officer.]
Place of examination
Date
*Add and has been vaccinated," if such is the fact.
FORM D.
Employer's Undertaking to return Labourers. The Imported Labour Registry Act, 1897.
In consideration of [name of labourer] being allowed to land in Western Australia, I, the under- signed, A.B., being the employer at whose request he has been brought to the Colony, do for myself and my personal representatives undertake with Her Majesty that I or they will, as and when required by the law in that behalf, bear the expense of the return of the said [name of labourer] to the place where he was shipped.
And, for the consideration aforesaid, we, the undersigned, C.D. and E.F., and each of us, give the like undertaking, but as sureties only for the said A.B.
day of
Dated this
18
[Signatures]
FORM E.
Magistrate's Receipt for Employer's Undertaking.
The Imported Labour Registry Act, 1897.
day of
"
18 the undertaking of [labourer] to [Signature]
Received this [employer] for the return of
Section 15.
Section 16.
Section 16.