530

(2)

(3)

10 Whether cach of the Appointments held by the Applicant has been on the Fixed Establishment 18.statement, if the circumstances warrant it, that the Applicant "has discharged his duties with

of the Colony,

11. Whether the duties of the several offices or situations held since the Applicant entered the C

Service have been such as to require that the holder should give his whole time to the Public

Service,

Yrs

12. Whether holding any other Public Appointment, or receiving or claiming to receive any Public

Money by Compensation, Ialf-pay or otherwise.

No

13. If any kind of Pension or other Allowance has been commuted under the Imperial Pensions

Commutation Acts, 1800 and 1871, and annual amount of Pension or Allowance so commuted

and the date of Commutatiou should be inserted,

14. Absence, beyond ordinary Vacation leave :--

"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, &c., with full particulars of any injuries received on duty, or other claims or matters for consideration.

Wander D. Doyle

with deligence and

has performed his duties

fidility.

19. Computation, by the Colonial Treasurer, of the Pension, &c.

Pension

Madsais

which may be paid to the Applicant

according to the Rules of the Colonial Service, amounts to #378

and I base my Certificate on the following calculation :---

I certify that the

Period of Absence

Number of Days.

Cause of Absence.

To 3/4 Dec

269 96

Year

1909. From of Apal

or January

1. 6th April

1910

*1

1

I

1

1.

]

1

1

1

*

35

32

وو

17

1

Lougth of Service Loss 12 of 1/2 pay.

18

your

defe

2

leave

3

25-

3

18

and

Pension 10 of $126.0

00

#378° 0° @ 3/8 = £69.6.0.

The applicant is entitled to draw his pension at the rate of

3/8 to the Illaw

Chu Gluxen

Colonial Treasurer,

15. Date of Cessation of Duty, k

16. Date of Cessation of Salary,

6th April 1910.

Abril 1910

17. Date from which, inclusively, Pension will commence,

17th April 1910

[Instructions

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