CO885-(16-18) — Page 433

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APPENDIX 4.

Regulation 121.

and

AGREEMENT made this.. day of

One thousand nine hundred between.

uf_

in the County of _of the one part, and the undersigned, ONE OF THE CROWN AGENTS FOR THE COLONIES, of Whitehall Gardens, London, in the County of Middlesex, for and on behalf of His Majesty of the other part,

(hereinafter called the person selected) hath been duly selected and will be provided with a passage to that

day of

190-

WHEREAS

for appointment as Colony in the Steamer leaving.

in

on the

Now the person selected, in consideration of the premises, doth hereby agree that, should he fail to proceed to.

, or, within the period of three years from the date of his arrival in the Colony, either quit the Colony without leave, or leave the service of the Government of the Colony, or be dismissed or removed from his appointment in consequence of misconduct, he will refund and repay to the Government of the Colony, or to the Crown Agents for the Colonies in London, the amount paid for his passage to the Colony, and for the passage of any member or members of his family.

Provided always, that nothing herein contained shall bind or oblige the person selected to repay the aforesaid passage money, if, at the time he shall leave the service of the Government of the Colony, or quit the Colony, as aforesaid, the Colonial Secretary of the Government of the Colony, or person acting as such, shall certify that the person selected is unable, from bodily or mental infirmity, to continue in the performance of his duty.

WITNESS our Hands the Day and Year above written.

Signed by the said...

in the presence of

Of the

Witness.

Signature,

Address,

Occupation,

Signed by

(One of the Crown Agents for the Colonies, as aforesaid), in the presence of Signature,

or

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