(2)
(3)
63
10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment 18. Statement, if the circumstances warrant it, that the Applicant has discharge his duties with
of the Colony.
Yes.
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.
No.
12. Whether holding any other Public Appointment, or receiving or claiming to receive any Publi
Money by Compensation, Half-pay or otherwise.
13. It any kind of Pension or other Allowance has been commuted under the Imperial P. usions Com, 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, in each of the last 10 years :—
Year.
17
l'eriod of Absence.
To
18
From
18
18
18
""
25
18
18
}
18
18
18
18
SJ
15. Date of Cessation of Duty........
16. Date of Cessation of Salary,
#5
وو
وو
Nil.
17 Date from which, inclusively, Pension will commence,....
Number of Days.
Cause of Absence.
15.
1898
5th June, 10
15th
* June, 1898.
16th June, 1895.
"diligence and fidelity, to the satisfaction of the Head Officer or Officers of his Department," 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, &e., with full particulars of any injuries received on duty,
or other claims or matters for consideration.
disch
The applicant has
with diligence
duties with
Satisfaction
diligence off deligh
19. Computation, by the Colonial Treasurer, of the Pension, &c.
I certify that the
Gratuity
d his
Lity
Supt VG.
which may be paid to the Applicant
accor ling to the Rules of the Colonial Service, amounts to Two hundred and ten dollars.
and I base my Certificate on the following calculation :----
years
months
6
Length of Service Gratuity. 5/1⁄2 months salary
3/1⁄2 of $720 = $210.
Thomson
Acting Treasurer .
Instructions.