COLONIAL PENSIONS, &c.

2265

Rec Ded 7 396

PARTICULARS required to be furnished in reference to Persons recommended for Superan- muation, Compensation or Compassionate Allowances, or Gratuities on retirement.

1. Name of Applicant.

2. Office or Situation

3. Recommended for

4. Age

(In filling up this Paper refer to the Instructions on page 4)

George Thomas Michael River (Monial Secretary Storykong. Pension

of £

Fifty years on 5th. hod. 1094.

5. Service in Years and Months 28

6. Salary or Wages (

8 years, one months, £27 dags.

$9720.

7. Emoluments Mil, exclusion of salary

Total amount of Salary or Wages and Emoluments, on

which Superannuation, &c., is claimed

8. Cause of Retirement

Stealth.

) 5

t

508

Nr 1800 in Ceylon, i $9720 and trusting.

9. Dates of Commencement and Termination of the several Appointments held by Applicant, with their Emoluments, distinguishing Salary from other Allowances, and specifying such Allowances.

Title of Appointment

Ahoaiko

01000 11179 H & S 8441)

Date of Commence- ment

Date of Termination

Salary

Allowances, Nature of Allowances,

kc.

Ste.

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