(4)
Instructions referred to on page 1.
If this Paper of Particulars and the Certificates connected with it, be not sent in original, the copies must be duly attested.
COPY.
64 0.0.
18536 REP
16 AUG 0
Head of Puper.-In the case of an Officer serving on the West Coast of Africa, a statement is to be added whether be
a native of that Coast. (Colonial Regulations, § 430.)
Head 3.-State the description of Allowance for which the Application is recommended, viz., Superannuation, Compensatio In the case of Persons claiming an addition to their Pensis Compassionate Allowance, or Gratuity, and its amount.
in respect of Professional or other special qualifications, this should be stated, and a reference should be given to i authority under which the claim is made.
should be added before or after t number of years and months, and the causes, dates, and eircumstances of the break or breaks should be stated und heading 9.
Head 5.-If the service has been interrupted by one or more breaks, the word "broken
Head 6-If the persou retiring has been in receipt of the same Salary, or in the class from which be retires, for the months immediately before the date of his retirement, the actual annual rate of Salary or Wages at that date shouldi inserted, preceded by the word "actual." In other cases the average ananal amount of Salary or Wages for the months next precoding the date of retirement should be inserted, preceded by the word "average." but if the wh period of service is less than three years, then the average for the whole period of service should be inserted. Heud 7.-A separate statement should be inserted of the average Annual Value, for the 36 months immediately preced retirement, of each Emolument (exclusive of salary or wages) which is claimed to be included in the calculation the Pension or Gratuity.
Whenever the value of a House or House Allowance, so ascertained, exceeds ouc-sixth of the salary and oth emoluments which conut for Pension purposes, it is to be reduced to one-sixth of that amount, so that it shall exceed one-seventh of the whole.
Fees which an Officer is allowed to retain for his own use will be taken into account for Pension purposes, regular salary, at the annual average of the net receipts of the 36 months next preceding the Officer's retirema These net receipts are to be ascertained by deducting from the gross amount of Fees such Office Expenses, &c. au Officer may have had to defray from bis own resources, in performing the services for which he was remunerated Fees. No deduction, however, from the Fees should be made in respect of Office Expenses provided from Pu Funds, for the due discharge of those duties to which a Fixed Salary is annexed. Papers of "Particulars" w forwarded to the Colonial Department should be accompanied by formal Declarations from the retiring Officers, show the amount received by them for Fees, and the amount defrayed as above for Office Expenses, &c., in each of the ti years immediately preceding the retirement. It will be the duty of the Colonial Governments concerned to saf themselves of the accuracy of such statements before forwarding them to the Colonial Office. In the case of Offe receiving Fixed Salaries aud Fees, the Fees will not in ordinary circumstances be allowed to count for Pension P poses to the extent of more than one quarter of the Salaries, and Fees will not in any case be allowed to count Pension purposes during any period in which the whole time of the Officer receiving them was not given to the Fu Service,
Head 8.-In cases of infirmity, if the Applicant is below the ordinary age for retirement, a Medical Certificate is te
furuished showing that he is disqualified by infirmity of mind or body for discharging the duties of his situation, that such infirmity is likely to be permanent.
In case of ten years' service or more, this Certificate should be signed by two Officers, of whom at least one sho
if possible, be a Salaried Officer of the Government.
Head 9.--As to "broken" service, sec Head 5.
If the Applicant has had any "acting" service, the details must be fully given, with a statement whether ort during the "acting" service, he was connected with the permanent Civil Service of the Colony,
Head 11.-If, in special circumstances, a professional Civil Officer has been allowed to have “private practice " wid
forfeiting his claim to Pension, the facts are to be fully stated.
Head 14,-If the Applicant is liable to any deduction from his service under Clause 102 of the Colonial Regulations,
facts should be fully stated.
Head 19.—The length of service and other particulars of the computation are to be given. When an average of Sa
&c., is taken, the mode of calculating it (whether by months, &c.) is to be explained.
We hereby certify that having examined Warder Powell we are of opinion that he is unfit for service
Gaol.
in the
He is suffering from varicosity of the veins of
the lower extemities.
Government Civil Hospital.
4th.June,1898.
(sd.) J.M.ATKINSON,
P.C.M.O.
(Sd.) J.BELL,
Asst.Surgeon.