126
(2)
(3)
10 Whether cach of the Appointments held by the Applicant has been on the Fixed Establishments. Statement, if the circumstances warrant it, that the Applicant "has discharged his duties with
of the Colony.
11. Whether the duties of the several offices or situations held since the Applicant entered the (
Service have been such as to require that the holder should give his whole time to the Public
Service.
"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.
12. Whether holding any other Public Appointment, or receiving or claiming to receive any Public
Money by Compensation, Half-pay or otherwise.
h_o.
13. If any kind of Pension or other Allowance has been commuted under the Imperial Pensions
Commutation Acts, 1860 and 1871, and annual amount of Pension or Allowance so commuted.
and the date of Commutation should be inserted.
thei
I certify that Inlights chaw huis of wait has pergamed his duties with diligimar
findeling by valiquction.
19. Computation, by the Colonial Treasurer, of the Pension, &c.
Pension
Golubek
#
which may be paid to the Applicant
ho.
14. Absence, beyond ordinary Vacation leave :-----
home
Period of Absence
Number of Days.
Cause of Absence.
I certify that the
according to the Rules of the Colonial Service, amounts to
and I base my Certificate on the following calculation :--
Ex
To
service
ado
33.9
V
22
40
1
From
}
j
1
j
:>
A
A
1
31
j
1
>
}
3.
37
15. Date of Cessation of Duty,
Pension 20
$4000
→
$240
The applicant is entitled to draw his pension at the rate of. -Contribution-to-Widows-and-Orphans Pensions at the rate of....................................................
mun should be deducted.
16. Date of Cessation of Salary, .... 29 MA
17. Date from which, inclusively. Pension will commence, .....!~
Claus Sever
Officer Administering the Government.
Governor fo
Colonial Treasurer,
19.4.12.
sper
[Instructions
No comments yet.
Private notes are available after approval.