(2)
(3)
92
10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment 18. Ctatement, if the circumstances warrant it, that the Applicant "has discharged his duties with “diligence and fidelity, to the satisfaction of the Head Officer or Officers of his Department,'' of the Colony.
to be signed by any two of such Head Officers, if there shall be more than one, or by such Head Officer, if there shall be but one, together with "such a statement as will exhibit the “merit, and value, and labour of the services of the Person recommended, embracing as long a "period of his public service as can be authentically stated," and observations as to Special Services, Suspension, Reprimand, &c., with full particulars of any injuries received on duty,
11. Whether the duties of the several offices or situations held since the Applicant entered the Civil Service have been such as to require that the holder should give his whole time to the Public Service.
Yes-
12. Whether holding any other Public Appointment, or receiving or claiming to receive any Public
Money by Compensation, Half-Pay or otherwise.
No.
13. If any kind of Pension or other Allowance has been conninted under the Imperial Pensions Con- mutation Acts, 1869 and 1871, and annual amount of Pension or Allowance so commuted and the date of Commutation should be inserted.
No
14. Absence, beyond ordinary Vacation leave, în cach of the last 10 years:
Year.
Period of Absence.
Number of Days.
Canse of Absence.
or other claims or matters for consideration.
Mys. Simmons has always
ferivnons
borne.
gord character and has done her duties under most difficult circumstances to my satisfaction.
Colonial Furgeon.
19. Computation, by the Colonial Treasurer, of the Pension, &c.
18
X
RI
18
18
From
་
Το
*
32
18
་་
18
17
"
18
18
**
15. Date of Cessation of Duty,
16. Date of Cessation of Salary,
None
C
I certify that the Special pension
according to the Rules of the Colonial Service, amounts to
and I base my Certificate on the following calculation :-----
which may be paid to the Applicant
Mys. Simmons joined the Lervice on the 1st of January 1845 at a salary of $360 per annum. and free quarters and rations
Agnatchelf Ime.
Treasurer.
17. Date from which, inclusively, Pension will cominence,...
Instructions.