(2)
10 Whether each of the Appointments held by the Applicant has been on the Fixed Establishment
of the Colony.
Fixes but minpensivett le
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 Puhe
Service.
ye
12. Whether halding any other Public Appointment, or receiving or claiming to receive any Public
Money by Compensation, Hall-pay or otherwise.
410.
13. If any kind of Pension or other Allowance has been commuted under the Imperial Pensions Commutation Acts, 1869 and 1871, and annual amount of Pension or Allowance so commuted
and the date of Commutation should be inserted.
ho.
1. Absence, beyond ordinary Vacation leave :-
Year.
Period of Absence
1
From
]
1
I
1
To
:
21
11
Number of Days.
Cause of Absence.
Postimen only fi provides
Save on
a substitute.
(8)
426
18. Statement, if the circumstances warrant it, that the Applicant "has discharged his duties with "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,
A his cutie with
He has
performent Exceptional spear and
fidelig
1.B.5. Ros
Pishinaaber Eneral
19. Computation, by the Colonial Treasurer, of the Pension, &e,
I certify that the
Pension
which may be paid to the Applicant
according to the Rules of the Colonial Service, amounts to
and I base my Certificate on the following calculation:
service = 50 efears.
Length of servi
$80:- pa.
the of $180 - $120. /% of $1.20 - $80.- f. a.
The applicant is entitled to draw his pension at the rate-of
Contribution to Widows' and Orphans Pensions at the rate of
wawum should be deducted.
per
1
1
1
Th
15, Date of Cessation of Duty... 31/ Hugh: 1913
16. Date of Cessation of Salary,
........
31./ Aug 1913
17. Date from which, inclusively, Pension will commence,
1/Sept: 1913.
Wurke
Colonial Treasurer,
[Instructions