356

(2)

10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment

of the Colony.

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.

thes.

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

Money by Compensation, Half-pay or otherwise.

Nome.

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.

(3)

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, 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.

None.

14. Absence, beyond ordinary Vacation leave:--

I certify that the

which

may be paid to the Applicant

Year.

Period of Absence

Number of Days.

Cause of Absence.

according to the Rules of the Colonial Service, amounts to and I base myCertificate on the following calculation:-

1 FSK

From 2./

To 14-2-1894

29 months

189....

JJ

16-8-

15

16.4.193. 20

1899.

1902.

13 28.10.

12.4.1900

5-16 3/

1+

Half pay lei

13

26.10.

"J

13.41903.

مجھے کی

3/

1907.. 1893..

DJ

19.

f.

J

16-10-1907. 416

16.4.

10

1903.

+

"

33

6.7.1903.

1

19

"

""

Leave without;

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, upz iko

per

....day of......

19

incius

and the full amount of the pension should thereafter be paid,

Colonial Treasurer

16

15. Date of Cessation of Duty,

to betober, 1907.

16th botolus

16. Date of Cessation of Salary,.

19.07.

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

Governor, &o.

[Instructions

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