(2)
(3)
209
Yes
10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment 18. Statement, if the circumstances warrant it, that the Applicant has discharged his duties with
of the Colony.
"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.
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.
Прео
12. Whether holding any other Public Appointment, or receiving or claiming to receive any Public
Money by Compensation, Half-Pay or otherwise.
ho
13. If any kind of Pension or other Allowance has been commuted under the Imperial Pensions Com- inutation Acts, 1869 and 1871, and annual amount of Pension or Allowance so commuted and
the date of Commutation should be inserted.
ho
14. Absence, beyond ordinary Vacation leave, in each of the last 10 years : --
This Offer has always discharged his duties with diligener and fidelity and to the Jake faction of the Jovernments
19. Computation, by the Colonial Treasurer, of the Pension, &c.
Best Barker
Acting Jovering
Year.
Period of Absence.
Number of Days.
Cause of Absence.
18 62.
1883
From
To
I certify that the
which
27 augh
according to the Rules of the Colonial Service, amounts to
18824
1885
1866
188
1888
"12 Augh,
» 5 hov
433
Ill health.
and I base my Certificate on the following calenlation :----
1889
1890
1891
28 Act
78
Illness & death of fat
"
""
20 July
AN
30 hov.
124
By pervicacion
15. Date of Cessation of Duty,
31 Cctober 1891.
16. Date of Cessation of Salary,
do
17. Date from which, inclusively, Pension will commence,... Kovember
1891.
may be paid to the Applicant
Instructions.
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