365
(3)
10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment 15. Statement, if the circumstances warrant it, that the Applicant "has discharged his duties with
of the Colony.
Yes.
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.
12. Whether holding any other Public Appointinent, 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 commuted under the Imperial l'ensions
Commutation Acts, 1869 and 1871, and annual amount' of Pension or Allowance so commuted
and the date of Commutation should be inserted.
6
"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, togther 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 this 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.
19. Computation, by the Colonial Treasurer, of the Pension, &c.
14. Absence, beyond ordinary Vacation leave:----
Year.
I certify that the
Period of Absence
Number of Days.
Canse of Absence.
To 31:12
1904.
From 2:6
15:2
213 46
» 20:10 257
1905...
15
/:/
1909...
1911...
6:2 1:3
1
"
1
1
፡፡
>>
1
"
1
15
1
8:3
25%
Half pay
leave.
which may be paid to the Applicant
according to the Rules of the Colonial Service, amounts to
and I base myCertificate on the following calculation:-
The applicant is entitled to draw his pension at the rate of
Contribution to Widows' and Orphans' Pensions at the rate of..
annum should be deducted, up to the
.per
day of
10
inclusive,
and the full amount of the pension should thereafter be paid,
Colonial Treasurer
15. Date of Cessation of Duty,....
16. Date of Cossation of Salary,.......
17. Date from which, inclusively, Pension will commence,.........
Governor, &c.
[Instructions