CO885-(16-18) — Page 69

32

14. Absence, beyond ordinary vacation leave, in each of the last ten years :-

Year.

Period of Absence.

Number of Days.

Cause of Absence.

18

From

To

18

11

18

"J

11

18

13

18

1

18

יו

18

92

18

"

M

18

17

+1

18

++

15. Date of cessation of duty

16. Date of cessation of salary

17. Date from which, inclusively, pension will com-

mence.

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 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 per- son recommended, embracing as long a period of his public service as can be authentically stated," and ob- servations as to special services, suspension, reprimand, etc., with full particulars of any injuries received on duty, or other claims or matter for consideration.

19. Computation, by the Auditor-General, of the pension, etc.

I Certify that the

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 :--

Instructions referred to on preceding page.

If this paper of particulars, and the certificates con- nected with it, he not sent in original, the copies must be duly attested.

Head 1 of Paper.-In the case of an Officer serving on the West Coast of Africa, a statement is to be added whether he is a native of that coast.-(Colonial Regulations, § 430.)

ग

PUBLIC RECORD OFFICE

C.O.

Reference :-

+885

17 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

32

14. Absence, beyond ordinary vacation leave, in each

of the last ten years :-

Year.

Period of Absence.

Number of Days,

Cause of

Absence.

18

From

To

18

11

18

11

11

18

17

"

18

1

>

18

>

18

19

19

18

#1

"

IN

м

18

13

...

PUBLIC